☰ INDEX
Cardiology-CHF__BBB__Tachycardia__Bradycardia__and_Heart_Block
Cardiology-Diseases_of_the_Pericardium_and_Cardiomyopathies
Cardiology-ECG_and_Arrhythmias
Cardiology-Heart_Sounds_and_Murmurs
Cardiology-Hypertension
Cardiology-Ischemic_Heart_Disease
Cardiology-Takotsubo__Brugada_syndrome__RHD__and_Infective_Endocarditis
Cardiology-Valvular_Heart_Disease
Cardiovascular_Emergencies-Previous_Year_Questions
Clinical_Essentials-Previous_Year_Questions
Emergency_Medicine-Emergency_Cardiovascular_Care_Protocols__BCLS__ACLS__Mechanical_ventilation__and_Causes_of_Pulseless_Electrical_Activity
Emergency_Medicine-Massive_Transfusion_Protocol__ARDS__Snakebite__AHA_updates__Altitude_Sickness
Emergency_Medicine-Previous_Year_Questions
Endocrinology-DKA_and_Hyperosmolar_Coma__Pancreatic_Neuroendocrine_Tumors
Endocrinology-Diabetes_Mellitus-I
Endocrinology-Diabetes_Mellitus-II
Endocrinology-Diseases_of_Anterior_Pituitary
Endocrinology-Diseases_of_Thyroid
Endocrinology-Disorders_of_Adrenal_Gland_and_Cushing_Syndrome
Endocrinology-Disorders_of_Parathyroid_Gland_and_MEN_Syndromes
Endocrinology-Previous_Year_Questions
Gastrointestinal_System-Inflammatory_Bowel_Disease-I
Gastrointestinal_System-Inflammatory_Bowel_Disease-II
Gastrointestinal_System-Irritable_Bowel_Syndrome
Gastrointestinal_System-Malabsorption_Syndromes
Gastrointestinal_System-Peptic_Ulcer_and_Gastrointestinal_Bleeding
Gastrointestinal_System-Previous_Year_Questions
Gastrointestinal_System-Zollinger_Ellison_Syndrome
Hematology-Acute_Lymphocytic_Leukemia
Hematology-Acute_Myeloid_Leukemia
Hematology-Blood_components_and_Complications_of_blood_transfusion
Hematology-Chronic_Lymphocytic_Leukemia
Hematology-Chronic_Myeloid_Leukemia
Hematology-Hodgkin_s_and_Non-Hodgkin_s_Lymphoma
Hematology-Multiple_Myeloma
Hematology-Platelet_disorders_and_hematology_images
Hematology-Previous_Year_Questions
Hematology-Sickle_cell_disease__G6PD_deficiency__and_other_Hemolytic_anemias
Hematology-Thalassemia_and_Hereditary_Spherocytosis
Hepatobiliary_System-Autoimmune_Hepatitis__Primary_Biliary_Cirrhosis__Primary_Sclerosing_Cholangitis__and_Paracetamol_Toxicity
Hepatobiliary_System-Hepatorenal_and_hepatopulmonary_syndrome_and_alcoholic_hepatitits
Hepatobiliary_System-Hereditary_Hyperbilirubinemia__Budd_Chiari_syndrome
Hepatobiliary_System-Liver_Cirrhosis_and_its_Complications
Hepatobiliary_System-Previous_Year_Questions
Hepatobiliary_System-Viral_Hepatitis__NAFLD__ALI
Hepatobiliary_System-Wilson_disease_and_Hemochromatosis
Infections-Aspergillosis__AIDS__and_COVID-19
Infections-PUO__Dengue__Nipah__Zika__and_Pneumocystis_jirovecii
Infections-Previous_Year_Questions
Miscellaneous-Previous_Year_Questions
Miscellaneous_Topics-Previous_Year_Questions
Nephrology-AKI__Diabetic_Nephropathy__Renal_Stones
Nephrology-Chronic_Kidney_Disease
Nephrology-Ciliopathies__PKD__TTP
Nephrology-Disorders_of_Electrolyte_Imbalance
Nephrology-Electrolyte_Imbalance
Nephrology-Kidney_Urine_Analysis
Nephrology-Nephrotic_and_Nephritic_Syndromes
Nephrology-Previous_Year_Questions
Nephrology-Renal_Tubular_Acidosis_and_Renal_Artery_Stenosis
Neurology-Basics_of_Cranial_nerves__Mechanical_thrombectomy__Stroke
Neurology-CNS_hemorrhage__Headaches_and_Migraine
Neurology-Epilepsy_and_EEG
Neurology-Guillian_Barre_Syndrome_and_Alzheimer_s_disease
Neurology-Intracranial_Pathologies__ICP__Brain_Death__Tumors__and_Neurocysticercosis
Neurology-Meningitis_and_CNS_infections
Neurology-Multiple_sclerosis__neuromyelitis_optica_spectrum_disorder__and_ALS
Neurology-Myasthenia_Gravis
Neurology-Parkinsonism_and_Parkinson_s_disease
Neurology-Previous_Year_Questions
Neurology-Stroke__TIA_and_image_based_questions
Neurology-Syringomelia__conus_medullaris__channelopathies_and_SAH
Oncology-Previous_Year_Questions
Pulmonology-ABG_analysis
Pulmonology-Bronchial_asthma_and_COPD
Pulmonology-Bronchiectasis___Pneumonia
Pulmonology-Cystic_Fibrosis__Obstructive_sleep_apnea
Pulmonology-INTERSTITIAL_LUNG_DISEASE_AND_PULMONARY_ALVEOLAR_PROTEINOSIS
Pulmonology-Images_in_Pulmonology
Pulmonology-Pleural_effusion_and_pneumothorax
Pulmonology-Previous_Year_Questions
Pulmonology-Pulmonary_Embolism_and_Fat_Embolism
Pulmonology-Respiratory_Physiology_and_Failure
Pulmonology-Tuberculosis
Respiratory_System-Previous_Year_Questions
Rheumatology-Autoimmune_and_Inflammatory_Diseases_in_Medicine
Rheumatology-Crystal_Arthropathy
Rheumatology-Previous_Year_Questions
Rheumatology-Rheumatoid_arthritis
Rheumatology-SLE___Anti_phospholipid_syndrome
Rheumatology-Scleroderma_and_Sjogren_syndrome
Rheumatology-Vasculitis_Syndromes
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PR interval &gt; 0.50 seconds", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>First-degree <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">atrioventricular</span> (AV) block</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delayed <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> through the AV node, <strong>(Option A ruled out) </strong>resulting in a prolonged PR interval (&gt; 0.20 seconds but &lt; 0.50 seconds) <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely symptomatic; often found incidentally on ECG.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physiological (e.g., in athletes with high <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> tone) <strong>(Option C)</strong></li>\n<li>May indicate underlying heart disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ECG Findings</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolonged (&gt; 0.20 seconds but &lt; 0.50 seconds) but consistent PR interval <strong>(Option D)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"First-degree &lt;span class=\" custommeta\"=\"\" data-dictid=\"d77b211e3a1692777182121ece27fc\"/>atrioventricular (AV) block\" data-author=\"James Heilman, MD - Own work\" data-hash=\"8788\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/First-degree_atrioventricular_block#/media/File:FirstAVBlock.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/LKhGPaW6RCSJUE2H3jBQ1744304072.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment required in most cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with no history of myocardial infarction presents with syncope and is found to have a 2:1 AV block on his ECG. His QRS complex is widened. Which of the following is the most likely mechanism behind his AV block, and how would atropine administration affect his condition?", "options": [{"label": "A", "text": "The block is most likely in the AV node, and atropine will improve AV conduction.", "correct": false}, {"label": "B", "text": "The block is most likely in the His-Purkinje system, and atropine will improve AV conduction.", "correct": false}, {"label": "C", "text": "The block is most likely in the AV node, and atropine may increase the degree of AV block.", "correct": false}, {"label": "D", "text": "The block is most likely in the His-Purkinje system, and atropine may increase the degree of AV block.", "correct": true}], "correct_answer": "D. The block is most likely in the His-Purkinje system, and atropine may increase the degree of AV block.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/MRLZtA6CSGk1CR59E3jy1744305056.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following are included in the criteria for Metabolic syndrome 1) Waist circumference &amp;gt; 102 cm in men 2) Waist circumference &amp;gt; 88cm in women 3) HDL &amp;lt; 50 mg/dL in men 4) BP &amp;gt;128/88 mm hg 5) Fasting plasma glucose &amp;gt; 100 mg/dL 6) LDL &amp;gt; 200 mg/dL", "options": [{"label": "A", "text": "1,2,3,4,5", "correct": false}, {"label": "B", "text": "1,4,5,6", "correct": false}, {"label": "C", "text": "1,2,5", "correct": true}, {"label": "D", "text": "2,4,5,6", "correct": false}], "correct_answer": "C. 1,2,5", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:378px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1) Waist circumference</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt; 102 cm in Men</li>\n<li>&gt; 88 cmin Women</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2) <span class=\"customMeta\" data-dictid=\"5ceb81d29516927771884c732da32e\">HDL</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&lt; 40 mg/dL in Men</li>\n<li>&lt; 50 mg/dL in Women</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3) <span class=\"customMeta\" data-dictid=\"482f0bd5841692777200af07c2766c\">Triglyceride</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt; 150 mg/dL</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4) BP (Blood Pressure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt; 130/85 mmHg</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5) <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">Fasting</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt; 100 mg/dL</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are first-line drugs used in the treatment of chronic heart failure, except", "options": [{"label": "A", "text": "Telmisartan", "correct": false}, {"label": "B", "text": "Carvedilol", "correct": false}, {"label": "C", "text": "Spironolactone", "correct": false}, {"label": "D", "text": "Furosemide", "correct": true}], "correct_answer": "D. Furosemide", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:733px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>First-line drugs used in the treatment of Chronic <span class=\"customMeta\" data-dictid=\"d120a30dab1692777184bdcc21c20d\">CHF</span> (mortality-reducing)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ARBs/ACE-inhibitors/ARNI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Either of these can be started as<strong> initial therapy.</strong></li>\n<li>ACE-inhibitors: Captopril, Enalapril</li>\n<li>ARBs: Telmisartan, Olmesartan <strong>(Option A ruled out)</strong></li>\n<li>ARNI: <strong>ARB+Neprilysin <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> - Valsartan-Sacubitril (most preferred 1st line drug)</strong></li>\n<li>ADR of ACE-i: <strong>Cough, angioedema</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cardioselective (2nd gen): <strong>Metoprolol, Bisoprolol</strong></li>\n<li>3rd gen: <strong>Carvedilol</strong> (both α- &amp; β- <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> action) - Best <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> for <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> <strong>(Option B ruled out)</strong></li>\n<li>ADR: Bradycardia, Hypotension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SGLT-2 Inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dapagliflozin, Empagliflozin</li>\n<li>ADR: <strong>UTI, Forunier gangrene, <span class=\"customMeta\" data-dictid=\"dafe10db1216927771874c034ff821\">Euglycemic</span> DKA</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aldosterone antagonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Spironolactone </strong> <strong>(Option C ruled out)</strong></li>\n<li>ADR: <strong>Gynaecomastia</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with sudden onset breathlessness. On arrival his vitals were, PR- 130 bpm, BP- 180/90 mmHg and spO2- 82% in room air. X-ray done is as shown below. Airway was secured after which his saturation improved. What is the most appropriate next step in managing this patient?", "options": [{"label": "A", "text": "Reassure and monitor vitals of this patient", "correct": false}, {"label": "B", "text": "Administer IV Furosemide", "correct": true}, {"label": "C", "text": "Give Valsartan-Sacubitril immediately", "correct": false}, {"label": "D", "text": "Administer IV Digoxin", "correct": false}], "correct_answer": "B. Administer IV Furosemide", "question_images": ["https://image.prepladder.com/notes/Eewl05JgwN5dloupeVW41744304892.png"], "explanation_images": ["https://image.prepladder.com/notes/Eewl05JgwN5dloupeVW41744304892.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First line drugs used in chronic Heart failure: (mortality-reducing drugs)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ARBs/ACE-Inhibitors</li>\n<li>Beta blockers (2nd gen- cardioselective)</li>\n<li>SGLT-2 inhibitors (Dapagliflozin, Empagliflozin)</li>\n<li>Anti-aldosterone (Spironolactone)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute cases with <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> edema:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oxygen: Secure <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> and supplement O2</li>\n<li><strong>Loop diuretics: IV <span class=\"customMeta\" data-dictid=\"b1527c07251692777203d317fb2eb0\">Furosemide</span> 20-80 mg</strong>, reduces <span class=\"customMeta\" data-dictid=\"628ed9c26316927771964889249b3b\">preload</span> and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion</li>\n<li>IV Morphine: if patient is in severe pain/distress, can cause <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression</li>\n<li>IV <span class=\"customMeta\" data-dictid=\"7cfca041201692777193da668f40be\">Nitroglycerin</span> infusion: reduce afterload</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"da8747dcd51692777185e1ed0554cc\">decompensated</span> with <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> shock: (low BP)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasopressors: Norepinephrine, Dobutamine, Dopamine</li>\n<li>Inodilators: <span class=\"customMeta\" data-dictid=\"6ff4c068c31692777192101ca63477\">Milrinone</span> &amp; Amrinone</li>\n<li>Levosimendan: Ca2+ channel sensitizer</li>\n<li>Omecamtiv mecarbil: Direct <span class=\"customMeta\" data-dictid=\"99c8e09d6f1692777193d7716ab6eb\">myosin</span> activator</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-pharmacological treatment:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Implantable <span class=\"customMeta\" data-dictid=\"6aa1aed5811692777183058f0e3934\">cardioverter</span> defibrillators (ICD)</li>\n<li>Coronary revascularisation: in <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease patients</li>\n<li>Ventricular assist devices</li>\n<li>Cardiac transplantation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient, known case of Coronary artery disease presented with fatigue. Echocardiography done showed reduced ejection fraction. What could be the most likely electrolyte disturbance seen in this patient?", "options": [{"label": "A", "text": "Hyponatremia and Hypokalemia", "correct": true}, {"label": "B", "text": "Hypernatremia and Hyperkalemia", "correct": false}, {"label": "C", "text": "Hyponatremia and Hyperkalemia", "correct": false}, {"label": "D", "text": "Hypernatremia and Hypokalemia", "correct": false}], "correct_answer": "A. Hyponatremia and Hypokalemia", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:715px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Elevated BNP/N-terminal pro-BNP levels</strong> (BNP- Brain <span class=\"customMeta\" data-dictid=\"bd16654d3e169277719371077d7a8c\">Natriuretic</span> Peptide)</li>\n<li><strong>Hyponatremia</strong> (Water <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> - dilutional hypoNa+)</li>\n<li><strong>Hypokalemia</strong> (RAAS activation)</li>\n<li><strong>Hyperaldosteronism</strong></li>\n<li>Renal function tests: Urea, <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">Creatinine</span> (Renal failure can occur as a complication)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Earliest: </strong>Prominent upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> veins (Antral sign/ Reverse-Mustache sign)</li>\n<li>Batwing-shaped opacities - <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</li>\n<li>Costophrenic angle blunting</li>\n<li>Kerley B lines: <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">Horizontal</span> lines in <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle perpendicular to the pleural surface.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Echocardio- graphy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> fraction: seen in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (HFrEF)</li>\n<li>Normal to mildly <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> EF: seen in diastolic <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (HFpEF)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Preferred <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> and diastolic dysfunction.</li>\n<li>Used for prognosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:706px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations for <span class=\"customMeta\" data-dictid=\"b0eb48bbf6169277718568c051e6ad\">congestive heart failure</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BNP/N-terminal <strong>pro-BNP levels</strong> <strong>↑</strong></li>\n<li>Serum <strong>Na</strong>+, <strong>K</strong>+ ↓</li>\n<li><strong>Hyperaldosteronism</strong></li>\n<li>Renal function tests: <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> failure can occur as a complication</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Earliest<strong>: Antral</strong> sign/ <strong>Reverse</strong>-<strong>Mustache</strong> sign</li>\n<li><strong>Batwing</strong> shaped opacities</li>\n<li><strong>Costophrenic</strong> angle <strong>blunting</strong></li>\n<li><strong>Kerley B lines</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Echocardio- graphy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Reduced <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> fraction</strong>: seen in <strong>systolic</strong> dysfunction</li>\n<li><strong>Normal to mildly <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> EF</strong>: seen in <strong>diastolic</strong> dysfunction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Differentiate <strong>systolic</strong> and <strong>diastolic</strong> dysfunction.</li>\n<li>Used for <strong>prognosis</strong>.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50 year old male gives a history of fatigue and dyspnoea upon lying down for 1 week. On examination, his vitals were: HR-130 bpm, BP-150/90 mmHg, S3+ on auscultation. Chest X-ray is as shown in the image below. Which among the following in this patient is not part of the major criterion according to Framingham’s?", "options": [{"label": "A", "text": "Dyspnoea upon lying down", "correct": false}, {"label": "B", "text": "X-ray finding", "correct": false}, {"label": "C", "text": "HR-130 bpm", "correct": true}, {"label": "D", "text": "S3", "correct": false}], "correct_answer": "C. HR-130 bpm", "question_images": ["https://image.prepladder.com/notes/p4oHn1rIIefqmoyl05kW1744304723.png"], "explanation_images": ["https://image.prepladder.com/notes/p4oHn1rIIefqmoyl05kW1744304723.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:571px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (crepitations/rales)</li>\n<li>Cardiomegaly <strong>(Option B)</strong></li>\n<li>PND/Orthopnoea <strong>(Option A)</strong></li>\n<li>Elevated JVP, Abdominojugular reflex</li>\n<li>S3 <span class=\"customMeta\" data-dictid=\"91e41050fc1692777188741342606b\">gallop</span> rhythm + <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ankle <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (pitting <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> edema)</li>\n<li>Dyspnoea on exertion</li>\n<li>Tender hepatomegaly</li>\n<li>Nocturnal cough</li>\n<li>Pleural effusion</li>\n<li>Tachycardia (HR&gt;120 bpm) <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:582px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Only risk factors - Hypertension, DM, Atherosclerosis, Obesity, etc. present</li>\n<li>NO structural damage</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Structural heart disease is present (e.g., LVH, <span class=\"customMeta\" data-dictid=\"d9e29ece3c1692777186ce4d23d81b\">dysmotility</span> on ECHO, etc.)</li>\n<li>NO signs/symptoms seen</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common clinical stage</li>\n<li>Signs/symptoms seen pertaining to CHF</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No response to any medical therapy - known as <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">Refractory</span> heart failure</li>\n<li>Only treatment is <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> transplant</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male is presenting with sudden loss of consciousness and collapse. He had pallor during the attack. ECG is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Third-degree atrioventricular block", "correct": true}, {"label": "B", "text": "Myocardial infarction", "correct": false}, {"label": "C", "text": "Mobitz I block", "correct": false}, {"label": "D", "text": "Mobitz II block", "correct": false}], "correct_answer": "A. Third-degree atrioventricular block", "question_images": ["https://image.prepladder.com/notes/GRUoKAVoiKV5tut5DxJd1744304538.png"], "explanation_images": ["https://image.prepladder.com/notes/cTQE3zwyRQEeHl0nuNrk1744304611.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Third-degree <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">atrioventricular</span> block</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete failure of <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> between <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> and ventricles, resulting in independent beating (AV dissociation).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"3rd degree heart block\" data-author=\"Npatchett\" data-hash=\"8796\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Heart_block.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/cTQE3zwyRQEeHl0nuNrk1744304611.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular Activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintained by an <span class=\"customMeta\" data-dictid=\"eec51ab3a9169277718763577df122\">escape rhythm</span> from:</p>\n<p>- The <span class=\"customMeta\" data-dictid=\"93722e23b31692777182e48d478f12\">AV node</span> or <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> of His (narrow QRS complexes).</p>\n<p>- <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> Purkinje tissues (broad QRS complexes).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> <span class=\"customMeta\" data-dictid=\"9f04fb3f2f1692777199272e3daf84\">syncope</span> or 'Stokes–Adams' attacks- sudden loss of consciousness and collapse.</p>\n<p>- Brief anoxic seizure.</p>\n<p>- <span class=\"customMeta\" data-dictid=\"dd5d862f051692777194647422e1c9\">Pallor</span> and a death-like appearance during the attack; characteristic <span class=\"customMeta\" data-dictid=\"919f290c4f1692777203469825e662\">flush</span> upon recovery.</p>\n<p>- Rapid recovery distinguishes it from epilepsy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Depends on clinical circumstances.</p>\n<p>- <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">Transient</span> <span class=\"customMeta\" data-dictid=\"78a0565f7316927771827e4aca866c\">AV block</span> in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> myocardial infarction- no treatment if the patient remains stable.</p>\n<p>- <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">Symptomatic</span> third-degree AV block- <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"5d2bbf156c16927771902312f06293\">isoprenaline</span> to maintain <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> until temporary <span class=\"customMeta\" data-dictid=\"ceb4fc4ada1692777194e3daffa3e9\">pacing</span> is inserted.</p>\n<p>- Permanent pacemaker.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of heart block from the ECG given below.", "options": [{"label": "A", "text": "First-degree atrioventricular block", "correct": false}, {"label": "B", "text": "Mobitz type I block", "correct": true}, {"label": "C", "text": "Mobitz type II block", "correct": false}, {"label": "D", "text": "Third-degree atrioventricular block", "correct": false}], "correct_answer": "B. Mobitz type I block", "question_images": ["https://image.prepladder.com/notes/OqojHzeloZl5x0mthUCs1744304281.png"], "explanation_images": ["https://image.prepladder.com/notes/OqojHzeloZl5x0mthUCs1744304281.png", "https://image.prepladder.com/notes/W5CwCbjWckAJYJlPh3JG1744304408.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Second-degree heart block</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Dropped beats occur because some impulses from the <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> fail to be transmitted to the ventricles.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mobitz <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">Type I</span> (<strong>Wenckebach</strong>) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mobitz Type II<strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progressive lengthening of PR intervals until a <span class=\"customMeta\" data-dictid=\"6c53004b121692777186c3d7797ee0\">dropped beat</span> occurs.</li>\n<li>Cycle repeats itself.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Mobitz type I\" data-author=\"Npatchett\" data-hash=\"8792\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Second-degree_atrioventricular_block#/media/File:Second_degree_heart_block.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/OqojHzeloZl5x0mthUCs1744304281.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PR interval remains constant.</li>\n<li>Some P waves are not conducted.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Mobitz type II\" data-author=\"Npatchett\" data-hash=\"8793\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Second-degree_atrioventricular_block#/media/File:Second_degree_heart_block.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/W5CwCbjWckAJYJlPh3JG1744304408.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often physiological; can occur in young athletes.</li>\n<li>May not cause symptoms.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by His–Purkinje system disease.</li>\n<li>Higher risk of asystole.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically does not require treatment.</li>\n<li>Monitor for changes; consider underlying heart disease.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>May require treatment if symptomatic.</li>\n<li>Consider temporary pacing.</li>\n<li>Monitor closely due to the risk of progression.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old patient with a history of chronic obstructive pulmonary disease (COPD) presents with palpitations and shortness of breath. The ECG is given below and has an irregular rhythm with at least three distinct P-wave morphologies. The heart rate is 120 beats per minute. What is the most likely diagnosis based on the ECG findings?", "options": [{"label": "A", "text": "Atrial Fibrillation", "correct": false}, {"label": "B", "text": "Multifocal Atrial Tachycardia", "correct": true}, {"label": "C", "text": "Atrial Flutter", "correct": false}, {"label": "D", "text": "Sinus Tachycardia", "correct": false}], "correct_answer": "B. Multifocal Atrial Tachycardia", "question_images": ["https://image.prepladder.com/notes/7dzx1upzIF4NxENH5fFZ1744300376.png"], "explanation_images": ["https://image.prepladder.com/notes/7dzx1upzIF4NxENH5fFZ1744300376.png", "https://image.prepladder.com/notes/p5bwSQNF9j4opdY6og4v1744300524.png", "https://image.prepladder.com/notes/3Ac7ovqmXozSoww0aMri1744300620.png", "https://image.prepladder.com/notes/dnJbESwprU6Wu9yx6Pod1744300744.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:665px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Multifocal <span class=\"customMeta\" data-dictid=\"a135b2b5b01692777182c1145ad335\">atrial tachycardia</span> (MAT)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Characteristics</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>At least <strong>three distinct P-wave </strong>morphologies</li>\n</ul>\n<ul>\n<li>Atrial rates typically between<strong> 100-150 bpm</strong>.</li>\n</ul>\n<ul>\n<li>Clear <strong>isoelectric</strong> <strong>intervals</strong> between P waves (unlike atrial fibrillation)</li>\n</ul>\n<ul>\n<li>Atrial rate slower than atrial fibrillation</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"728faaed2f1692777182aa9163a46a\">automaticity</span> from multiple atrial foci, with multiple areas in the <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> spontaneously generating electrical impulses.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease</li>\n<li>Acute illness</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements on transvenous pacing is wrong?", "options": [{"label": "A", "text": "Central venous access is needed", "correct": false}, {"label": "B", "text": "Intracardiac lead placement is done", "correct": false}, {"label": "C", "text": "Permanent method of pacing", "correct": true}, {"label": "D", "text": "Not suitable for emergencies", "correct": false}], "correct_answer": "C. Permanent method of pacing", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/xsBVOKI8tl9zPPgZihhX1745563789.png", "https://image.prepladder.com/notes/mKDQW1BBQvnn4B0vkpYq1744303958.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:728px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Transcutaneous Pacing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Transvenous Pacing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Purpose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary, fast <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> bradyarrhythmias or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer-term temporary <span class=\"customMeta\" data-dictid=\"ceb4fc4ada1692777194e3daffa3e9\">pacing</span> for evaluation of permanent <span class=\"customMeta\" data-dictid=\"e70797a893169277719467eb262506\">pacemaker</span> need. <strong>(Option C) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initiation Time</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fastest method, used in emergencies (e.g., bradycardia, asystole).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires more time due to the need for central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> access. <strong>(Option A and Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Electrode Placement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior pad: <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> or lead V3 position.</p>\n<p>Posterior pad: <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> to <span class=\"customMeta\" data-dictid=\"153f2ea4be16927771981ce5d9171f\">scapula</span> or between <span class=\"customMeta\" data-dictid=\"153f2ea4be16927771981ce5d9171f\">scapula</span> and spine.</p>\n<p style=\"text-align:center\"><img alt=\"Transcutaneous Pacing\" data-author=\"\" data-hash=\"11253\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"195\" src=\"https://image.prepladder.com/notes/xsBVOKI8tl9zPPgZihhX1745563789.png\" width=\"195\"/></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intracardiac lead placement through a central <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> (e.g., femoral, subclavian). <strong>(Option B ruled out)</strong></p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><img alt=\"Transverse pacing\" data-author=\"\" data-hash=\"8786\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"195\" src=\"https://image.prepladder.com/notes/mKDQW1BBQvnn4B0vkpYq1744303958.png\" width=\"195\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old male presents with dizziness. His heart rate is 38 bpm, blood pressure 80/50 mmHg, and ECG confirms sinus bradycardia. What is the medication to be used?", "options": [{"label": "A", "text": "IV atropine 0.5 mg every 3-5 minutes", "correct": true}, {"label": "B", "text": "IV atropine 2 mg every 5-10 minutes", "correct": false}, {"label": "C", "text": "IV atropine 5 mg every 2 minutes", "correct": false}, {"label": "D", "text": "IV atropine 3 mg every 10 minutes", "correct": false}], "correct_answer": "A. IV atropine 0.5 mg every 3-5 minutes", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sinus <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sinus <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> is a <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> rhythm with normal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> but a <strong>rate &lt; 60 bpm.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ECG showing <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> rhythm at a rate lower than 60 bpm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Etiologies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normal in athletes</li>\n<li>Medications (beta-blockers, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers, digoxin)</li>\n<li>Hypothyroidism, hypothermia</li>\n<li>Sick <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> syndrome, myocardial infarction</li>\n<li>Vagal <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> (e.g., <span class=\"customMeta\" data-dictid=\"8b7ff268db16927772018672ed7531\">vasovagal</span> syncope)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asymptomatic (in many patients)</li>\n<li>Fatigue</li>\n<li><strong>Dizziness</strong> or lightheadedness</li>\n<li>Exercise intolerance</li>\n<li>Syncope or presyncope</li>\n<li>Cognitive slowing</li>\n<li>Worsening <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> or <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> symptoms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assess <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> stability</li>\n<li>ECG to confirm <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> rhythm</li>\n<li>Review medication list for <span class=\"customMeta\" data-dictid=\"23a27ffd991692777183b72a8abd5e\">bradycardic</span> agents</li>\n<li>Evaluate for comorbidities (e.g., hypothyroidism, myocardial infarction)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>If Hemodynamically Unstable:</strong>\n<ul>\n<li>IV <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> 0.5 mg every 3-5 minutes (max 3 mg) <strong>(Option A)</strong></li>\n<li>If there is no improvement, consider a temporary pacemaker</li>\n</ul>\n</li>\n<li><strong>If Stable:</strong>\n<ul>\n<li>Treat underlying causes</li>\n<li>Withdraw bradycardia-inducing medications</li>\n<li>Evaluate for permanent pacemaker</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man with a history of hypertension and coronary artery disease presents to the emergency department with worsening shortness of breath over the past 3 days. His blood pressure is 160/90 mmHg, and he has bilateral pitting edema in his lower extremities. Lung auscultation reveals crackles at the bases. His chest X-ray shows cardiomegaly and pulmonary congestion. Which of the following is the most likely underlying mechanism contributing to his symptoms?", "options": [{"label": "A", "text": "Increased cardiac output", "correct": false}, {"label": "B", "text": "Decreased preload", "correct": false}, {"label": "C", "text": "Left ventricular systolic dysfunction", "correct": true}, {"label": "D", "text": "Pulmonary embolism", "correct": false}], "correct_answer": "C. Left ventricular systolic dysfunction", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features of Left-Sided vs. Right-Sided <span class=\"customMeta\" data-dictid=\"b0eb48bbf6169277718568c051e6ad\">Congestive Heart Failure</span> (CHF)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left-Sided Heart Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right-Sided Heart Failure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong>:</p>\n<ul>\n<li>Ischemic heart disease (myocardial infarction).</li>\n<li>Hypertension</li>\n<li>Dilated cardiomyopathy.</li>\n<li>Aortic or <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong>:</p>\n<ul>\n<li>Left-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> (<strong>most common cause</strong>).</li>\n<li>Chronic lung diseases (COPD, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension).</li>\n<li>Pulmonary embolism.</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> infarction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In left-sided heart failure, the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> cannot effectively pump blood to the body, leading to a backup of blood into the lungs.</p>\n\t\t\t \n\n\t\t\t<p><strong>Clinical features:</strong></p>\n<p>This primarily results in <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> symptoms.</p>\n<ul>\n<li>Dyspnea</li>\n<li>Exertional dyspnea).</li>\n<li>Orthopnea</li>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> dyspnea</li>\n</ul>\n<p> </p>\n<p><strong>Pulmonary Congestion:</strong></p>\n<ul>\n<li>Crackles (rales) heard on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> due to fluid in the alveoli.</li>\n<li>Cough</li>\n<li>Wheezing (cardiac asthma).</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Fatigue and Weakness</li>\n<li>Decreased Exercise Tolerance</li>\n<li>Limited physical activity due to breathlessness and fatigue.</li>\n<li>S3 Gallop</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Cool Extremities: </strong>Reduced <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output may cause poor <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> circulation, leading to cold, pale skin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In right-sided heart failure, the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> fails to pump blood effectively into the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> circulation, leading to <strong>systemic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion. </strong>It is often secondary to left-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> or conditions affecting the lungs <strong>(cor pulmonale).</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>Peripheral Edema</li>\n<li>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension (JVD)</li>\n</ul>\n<ul>\n<li>Hepatomegaly</li>\n<li>B/L <span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\">pitting</span> <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> edema</li>\n<li><strong>Kussmaul sign: </strong>JVP <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> on inspiration</li>\n<li>Ascites</li>\n<li>Nocturia</li>\n<li>Weight Gain</li>\n<li>Anorexia and Nausea</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old man presents to the emergency department with complaints of palpitations and dizziness over the past week. He denies any chest pain or syncope. What is the most likely diagnosis based on the ECG findings?", "options": [{"label": "A", "text": "Brugada Syndrome", "correct": false}, {"label": "B", "text": "Ventricular Tachycardia", "correct": false}, {"label": "C", "text": "Left Bundle Branch Block (LBBB)", "correct": false}, {"label": "D", "text": "Right Bundle Branch Block (RBBB)", "correct": true}], "correct_answer": "D. Right Bundle Branch Block (RBBB)", "question_images": ["https://image.prepladder.com/notes/iZyoahGXmTwLZZGXcdZC1744303156.png"], "explanation_images": ["https://image.prepladder.com/notes/iZyoahGXmTwLZZGXcdZC1744303156.png", "https://image.prepladder.com/notes/w2y0wJqJ14t1QjfVPm4u1744303569.png", "https://image.prepladder.com/notes/P3QqIinhn55Ng6M6jQkr1744303569.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block (RBBB) is an electrocardiogram finding that occurs when the <span class=\"customMeta\" data-dictid=\"e6a317ff3c16927771956fee0e76ed\">physiologic</span> electrical <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> system of the heart, specifically in the His-Purkinje system, is altered or <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">interrupted</span> resulting in a widened QRS and electrocardiographic <span class=\"customMeta\" data-dictid=\"1f7e7543bc16927772015cdb525c2b\">vector</span> changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structural Heart Disease:</strong></p>\n<ul>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> Disease (CAD)</li>\n<li>Heart Failure</li>\n<li><strong>Valvular Heart Disease: </strong>Aortic <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> or regurgitation, <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> stenosis, or regurgitation, leading to <span class=\"customMeta\" data-dictid=\"72421e3a581692777197a98d00066c\">right heart</span> strain and RBBB.</li>\n<li><strong>Cardiomyopathies</strong>: Dilated or hypertrophic cardiomyopathy.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Pulmonary Causes:</strong></p>\n<ul>\n<li><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> (PE)</strong>: Large <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> can cause <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"72421e3a581692777197a98d00066c\">right heart</span> strain, leading to RBBB.</li>\n<li><strong>Chronic Obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Disease (COPD)</strong></li>\n<li>Pulmonary Hypertension</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Infiltrative Diseases:</strong></p>\n<ul>\n<li>Amyloidosis</li>\n<li>Sarcoidosis</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Due to the <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> of the right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch, damage typically occurs at 3 different locations.</li>\n<li>The <strong>proximal right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> </strong>nearest the <span class=\"customMeta\" data-dictid=\"3e75ada4451692777187fae136230b\">endocardium</span> is the <strong>most common location </strong>to be affected.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> is typically only injured when the <span class=\"customMeta\" data-dictid=\"58d1d9af0116927771929c2171ed44\">moderator band</span> is transected during surgery.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> is injured during <span class=\"customMeta\" data-dictid=\"746ae92f051692777201e4a67b69cc\">ventriculotomy</span> or <span class=\"customMeta\" data-dictid=\"db577159c61692777200b35a8851db\">transatrial</span> resectio</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> and found incidentally.</li>\n<li>In some cases, patients may experience palpitations, dizziness, or lightheadedness.</li>\n<li>When associated with other <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> (heart failure, ischemia), it may indicate an underlying issue.</li>\n<li>Wide split S2 heart sound heard.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The characteristic <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> findings for right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block are as follows:</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RBBB\" data-author=\"Steven Fruitsmaak - Own work\" data-hash=\"8776\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Right_bundle_branch_block#/media/File:RBBB_with_first_degree_AV_block.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/iZyoahGXmTwLZZGXcdZC1744303156.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>QRS duration is greater than or equal to 120 milliseconds.</li>\n<li>In lead V1 and V2, there is an RSR` in leads V1 and V2.</li>\n<li>In Leads 1 and V6, the S wave is of greater duration than the R wave, or the S wave is greater than 40 milliseconds.</li>\n<li>In Leads V5 and V6, there is a normal R wave peak time.</li>\n<li>In Lead V1, the R wave peak time is greater than 50 milliseconds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Brugada syndrome</strong></li>\n<li><strong>Ventricular tachycardia</strong></li>\n<li><strong>Incomplete left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"a4a589776216927771991b881f95b1\">specific treatment</span> is required for <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> isolated RBBB.</li>\n<li>Management focuses on treating underlying conditions (if present).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:727px\">\n<thead>\n<tr>\n<th colspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>ECG difference between <span class=\"customMeta\" data-dictid=\"0a89512f961692777191c1515a8adc\">LBBB</span> and RBBB</strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LBBB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBBB</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WiLLiaM - </strong>W pattern in V1 and M pattern in V6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MaRRoW - </strong>M pattern in V1 and W pattern in V6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"LBBB\" data-author=\"\" data-hash=\"8781\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/w2y0wJqJ14t1QjfVPm4u1744303569.png\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"RBBB\" data-author=\"\" data-hash=\"8782\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/P3QqIinhn55Ng6M6jQkr1744303569.png\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male with a history of chronic hypertension and known Left Bundle Branch Block (LBBB) presents to the emergency department with acute chest pain radiating to the left arm. His ECG shows a wide QRS complex due to LBBB. You are concerned about a possible myocardial infarction (MI), and consider using the Sgarbossa criteria. Which of the following findings would be consistent with a positive Sgarbossa criterion for acute myocardial infarction?", "options": [{"label": "A", "text": "Concordant ST elevation ≥ 1 mm in leads with a positive QRS complex", "correct": true}, {"label": "B", "text": "Discordant ST elevation ≥ 1 mm in leads with a negative QRS complex", "correct": false}, {"label": "C", "text": "Concordant ST elevation ≥ 1 mm in any anterior lead (V1-V3)", "correct": false}, {"label": "D", "text": "Discordant ST depression ≥ 1 mm in any lead", "correct": false}], "correct_answer": "A. Concordant ST elevation ≥ 1 mm in leads with a positive QRS complex", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/JpBz9juVKyrqq7B9URWS1744302950.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:759px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sgarbossa criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to diagnose <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (AMI) in the presence of a Left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">Bundle</span> Branch Block (LBBB) or ventricular-paced rhythm, where typical <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> changes of MI may be obscured by the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> pattern.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"cde8da74a516927771848febc986b1\">Concordant</span> ST <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> ≥ 1 mm in any lead with a positive QRS complex (QRS and <span class=\"customMeta\" data-dictid=\"6b3384701916927771998cea03ba94\">ST segment</span> in the same direction).</strong></p>\n<ul>\n<li>Score: 5 points</li>\n<li>This finding is highly specific for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> MI.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>2. <span class=\"customMeta\" data-dictid=\"cde8da74a516927771848febc986b1\">Concordant</span> ST depression ≥ 1 mm in leads V1, V2, or V3 (with a negative QRS complex).</strong></p>\n<ul>\n<li>Score: 3 points</li>\n<li>ST depression in these leads suggests <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> infarction.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>3. <span class=\"customMeta\" data-dictid=\"98d754de081692777186fc8119cb0c\">Discordant</span> ST <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> (ST <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> ≥ 5 mm) in leads with a negative QRS complex (QRS and <span class=\"customMeta\" data-dictid=\"6b3384701916927771998cea03ba94\">ST segment</span> in opposite directions).</strong></p>\n<ul>\n<li>Score: 2 points</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"sgarbossa critiera\" data-author=\"\" data-hash=\"8773\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/JpBz9juVKyrqq7B9URWS1744302950.png\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Sgarbossa Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> to the original criteria uses a ST/S ratio in <span class=\"customMeta\" data-dictid=\"98d754de081692777186fc8119cb0c\">discordant</span> leads.</li>\n<li>ST <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> must be ≥ 25% of the depth of the preceding S wave in leads with a negative QRS complex (instead of ≥ 5 mm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A total score of ≥ 3 points is considered suggestive of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> MI in the setting of LBBB.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with complaints of occasional chest discomfort and shortness of breath on exertion.His medical history includes hypertension and diabetes. What is the most likely diagnosis based on the ECG findings?", "options": [{"label": "A", "text": "Left Ventricular Hypertrophy (LVH)", "correct": false}, {"label": "B", "text": "Premature Ventricular Contractions (PVCs)", "correct": false}, {"label": "C", "text": "Right Bundle Branch Block (RBBB)", "correct": false}, {"label": "D", "text": "Left Bundle Branch Block (LBBB)", "correct": true}], "correct_answer": "D. Left Bundle Branch Block (LBBB)", "question_images": ["https://image.prepladder.com/notes/OwGkXUGL2FZqGWjZlZVe1744302587.png"], "explanation_images": ["https://image.prepladder.com/notes/OwGkXUGL2FZqGWjZlZVe1744302587.png", "https://image.prepladder.com/notes/PaciprAiwg4XuCpjpOHA1744302823.png", "https://image.prepladder.com/notes/ahI8AaIhcFoizovokTAY1744302823.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block (LBBB) is an <span class=\"customMeta\" data-dictid=\"390a9178d716927771907c0c9d72c5\">intraventricular</span> <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> usually caused by ischemic or mechanical factors affecting the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> system's left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Structural heart disease:</strong> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease (CAD), hypertension, cardiomyopathies such as dilated, left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> noncompaction, stress, and hypertrophic cardiomyopathies, and <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> diseases like <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">aortic stenosis</span> and regurgitation</li>\n<li><strong>Degenerative changes:</strong> Age-related fibrosis, Lev disease, and Lenègre disease</li>\n<li><strong>Infiltrative conditions:</strong> <span class=\"customMeta\" data-dictid=\"1bea5cbf1d16927771988b19241f4c\">sarcoidosis</span> or amyloidosis</li>\n<li><strong>Inflammatory cardiomyopathies: </strong>Infectious <span class=\"customMeta\" data-dictid=\"b37b57210716927771933ee216a834\">myocarditis</span> or <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disease</li>\n<li>Hyperkalemia</li>\n<li>Antiarrhythmic medications</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Electrical Dyssynchrony:</strong> With LBBB, the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> is activated first, followed by a right-to-left septal transmission and <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of the left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3e75ada4451692777187fae136230b\">endocardium</span> at the level of the <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> septum.</li>\n<li><strong>Mechanical Dyssynchrony: </strong>In LBBB, the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> is activated before <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> opening (isovolumetric contraction), stretching the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> walls</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>LBBB may be silent, especially in its early stages, or present with <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">nonspecific</span> symptoms, such as fatigue, dyspnea, and palpitations.</li>\n<li>Symptoms due to underlying heart disease can include chest pain, dyspnea, fatigue, palpitations, syncope, or presyncope.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG findings</strong></p>\n<ul>\n<li>QRS duration greater than or equal to 120 ms.</li>\n<li>Broad <strong>notched or slurred R wave </strong>in leads I, aVL, V5, and V6 or, occasionally, an <strong>RS pattern </strong>in leads V5 and V6.</li>\n<li>Absence of Q wave in <strong>leads I, V5, and V6 </strong>(with the possible exception of aVL).</li>\n<li>R wave peak time greater than 60 ms in leads V5 and V6.</li>\n<li>ST-T waves change opposite to the QRS direction.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"LBBB\" data-author=\"\" data-hash=\"8770\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/PaciprAiwg4XuCpjpOHA1744302823.png\"/></p>\n<ul>\n<li>Echocardiography</li>\n<li>Stress Imaging</li>\n<li>Electrophysiological studies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Incomplete Left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">Bundle</span> Branch Block</li>\n<li>Ventricular Paced Rhythm</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Hypertrophy</li>\n<li>Premature <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Contractions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Asymptomatic Patients:</strong> No <span class=\"customMeta\" data-dictid=\"a4a589776216927771991b881f95b1\">specific treatment</span> is required if <span class=\"customMeta\" data-dictid=\"0a89512f961692777191c1515a8adc\">LBBB</span> is discovered incidentally and the patient has no symptoms or associated conditions (coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease, heart failure).</li>\n</ul>\n<ul>\n<li><strong>Symptomatic Patients:</strong> If <span class=\"customMeta\" data-dictid=\"0a89512f961692777191c1515a8adc\">LBBB</span> is associated with <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease, hypertension, or heart failure, these conditions should be managed according to standard treatment guidelines.</li>\n</ul>\n<ul>\n<li><strong>Cardiac <span class=\"customMeta\" data-dictid=\"175cb514a61692777197f78c0b1edf\">Resynchronization</span> Therapy (CRT): </strong>Indicated in patients with <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> fraction (HFrEF).</li>\n<li><strong>Immediate <span class=\"customMeta\" data-dictid=\"910e53d9bf1692777197e57fd0c1b6\">reperfusion</span> therapy: </strong>Indicated in patients with <span class=\"customMeta\" data-dictid=\"8329065e421692777181cfd6ac06f5\">AMI</span> and LBBB.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the heart rate if there are 5 large boxes between R waves on an ECG?", "options": [{"label": "A", "text": "60 beats per minute", "correct": true}, {"label": "B", "text": "75 beats per minute", "correct": false}, {"label": "C", "text": "100 beats per minute", "correct": false}, {"label": "D", "text": "50 beats per minute", "correct": false}], "correct_answer": "A. 60 beats per minute", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/TR0tPKX2dVYNfpSYEUqY1744301068.png", "https://image.prepladder.com/notes/vuoLf0OBPR1tb4Fv53Aw1744301577.png", "https://image.prepladder.com/notes/fYhEgecBCMfERK5TTQDI1744301577.png", "https://image.prepladder.com/notes/6RQhsVXrxa9yVOtw4Uvv1744301578.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It represents atrial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> on the ECG. As atrial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> is initiated by the SA <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> located in the right atrium, the right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> gets depolarized first, followed by left atrial depolarization.</li>\n<li>Its duration is three small squares wide and 2.5 small squares high.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PR Interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It represents the time from the beginning of atrial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> to the start of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> and includes the delay at the AV node.</li>\n<li>The average interval is 3 to 5 small squares (120 to 200 ms).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>QRS complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It represents <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> as current passes down the AV node.</li>\n<li>A standard QRS complex has a duration of less than three small squares (under 120 ms, usually 60 to 100 ms).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Septal Q-Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Represents the <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> of the <span class=\"customMeta\" data-dictid=\"769fa5be3616927771906f8ae8b053\">interventricular</span> septum.</li>\n<li>Its <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> is not bigger than 0.1 mV,</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>R-Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is the tallest wave of the QRS complex, representing the electrical stimulus as it passes down the ventricles during depolarization.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>S-Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It represents the final <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> of the Purkinje fibers.</li>\n<li>It is any downward <span class=\"customMeta\" data-dictid=\"0d8576d139169277718594452670bd\">deflection</span> after R-wave.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T-Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It represents <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> repolarization.</li>\n<li>The suggested criteria for the typical T wave include the size of one-eighth or less than two-thirds of the size of the R wave and a height of less than 10 mm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ST-Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It depicts the end of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> and the beginning of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> repolarization.</li>\n<li>The average duration of the <span class=\"customMeta\" data-dictid=\"6b3384701916927771998cea03ba94\">ST segment</span> is less than 2 to 3 small squares (80-120 ms).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>QT-Interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It represents the start of <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> to the end of the <span class=\"customMeta\" data-dictid=\"40451a27bd1692777197d6c276d0bc\">repolarization</span> of ventricles.</li>\n<li>Generally, the normal QT interval is less than 400 to 440 milliseconds (ms), or 0.4 to 0.44 seconds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>U-Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small wave that follows the T wave.</li>\n<li>It represents the delayed <span class=\"customMeta\" data-dictid=\"40451a27bd1692777197d6c276d0bc\">repolarization</span> of the <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> muscles or Purkinje fibers.</li>\n<li>It is commonly associated with hypokalemia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents to the ER with palpitations and shortness of breath. His ECG shows an irregular rhythm with at least three distinct P-wave morphologies and a heart rate of 120 beats per minute. Which of the following is the most appropriate initial management approach for this patient?", "options": [{"label": "A", "text": "Electrical cardioversion", "correct": false}, {"label": "B", "text": "Intravenous beta-blockers", "correct": false}, {"label": "C", "text": "Correcting underlying metabolic abnormalities and treating the underlying lung disease", "correct": true}, {"label": "D", "text": "Long-term use of amiodarone", "correct": false}], "correct_answer": "C. Correcting underlying metabolic abnormalities and treating the underlying lung disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/7dzx1upzIF4NxENH5fFZ1744300376.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:665px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Multifocal atrial tachycardia</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Characteristics</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>At least three distinct P-wave morphologies</li>\n</ul>\n<ul>\n<li>Atrial rates typically between 100-150 bpm.</li>\n</ul>\n<ul>\n<li>Clear <span class=\"customMeta\" data-dictid=\"95f7d4c24d16927771904b4278640d\">isoelectric</span> intervals between P waves (unlike atrial fibrillation)</li>\n</ul>\n<ul>\n<li>Atrial rate slower than atrial fibrillation</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Atrial Tachycardia\" data-author=\"Jer5150\" data-hash=\"8720\" data-license=\"CC BY-SA 3.0 \" data-source=\"https://commons.wikimedia.org/wiki/File:Multifocal_atrial_tachycardia_-_MAT.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/7dzx1upzIF4NxENH5fFZ1744300376.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"728faaed2f1692777182aa9163a46a\">automaticity</span> from multiple atrial foci, with multiple areas in the <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> spontaneously generating electrical impulses.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease</li>\n<li>Acute illness</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Approaches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Treat underlying disease</strong>: Most important step.</li>\n<li><strong>Correct <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> abnormalities</strong>: Address <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalances.</li>\n<li><strong>Calcium channel blockers</strong>: <strong>Verapamil </strong>or <strong>diltiazem </strong>to slow atrial and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rate.</li>\n<li><strong>Amiodarone</strong>: Can be effective but <strong>avoided long-term </strong>due to potential toxicities (e.g., <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis). <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thromboembolism Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not as well-defined or high as in <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> or flutter.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 28 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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His family history is significant for a relative who experienced sudden cardiac death at a young age. In managing this patient with suspected hypertrophic obstructive cardiomyopathy (HOCM), which of the following is a first-line treatment option to relieve symptoms?", "options": [{"label": "A", "text": "Enalapril", "correct": false}, {"label": "B", "text": "Metoprolol", "correct": true}, {"label": "C", "text": "Candesartan", "correct": false}, {"label": "D", "text": "Surgical myomectomy", "correct": false}], "correct_answer": "B. Metoprolol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First-line Medications:</strong>\n<ul>\n<li><strong>β-Adrenergic <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">Blocking</span> Agents (e.g., Metaprolol):</strong> Reduce heart rate and improve diastolic filling.</li>\n<li><strong>L-type <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> Channel Blockers (e.g., Verapamil):</strong> Help decrease <span class=\"customMeta\" data-dictid=\"3d46029a83169277718580263882c3\">contractility</span> and relieve outflow obstruction.</li>\n</ul>\n</li>\n<li><strong>Additional Therapy for Persistent Symptoms:</strong>\n<ul>\n<li><strong>Disopyramide:</strong> An <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">antiarrhythmic</span> agent with negative <span class=\"customMeta\" data-dictid=\"d44f29df6116927771902150f69464\">inotropic</span> properties to control exertional <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> and chest pain.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical and Procedural Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Surgical Myectomy:</strong> Effective in relieving outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> by excising part of the septal myocardium.</li>\n<li><strong>Alcohol Septal Ablation:</strong> Suitable for patients with appropriate <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> anatomy; involves controlled <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> to relieve obstruction. Primarily for patients who prefer to avoid surgery or have comorbidities.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recommended for patients with two or more risk factors for SCD.</li>\n<li>Considered selectively for those with one risk factor.</li>\n<li>Strongly indicated for patients who have previously survived <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest due to <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> or sustained <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> tachycardia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Risk Features for Primary Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unexplained syncope</li>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> response during exercise</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> (&gt;30mm thickness)</li>\n<li>Family history of SCD</li>\n<li>Multiple episodes of non-sustained <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> (NSVT)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 y/o woman presents with acute chest pain, difficulty breathing, and signs of heart failure following sudden emotional distress. Her ECG shows ST-segment elevation without reciprocal depression, and echocardiography reveals ballooning of the left ventricular apex. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myocardial Infarction", "correct": false}, {"label": "B", "text": "Takotsubo Cardiomyopathy", "correct": true}, {"label": "C", "text": "Aortic Dissection", "correct": false}, {"label": "D", "text": "Yamaguchi Syndrome", "correct": false}], "correct_answer": "B. Takotsubo Cardiomyopathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/boAJ7aDzhmn9J5L1EubD1744301666.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Takotsubo <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">Cardiomyopathy</span> (Broken Heart syndrome)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yamaguchi Syndrome (Apical Hypertrophic Cardiomyopathy)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Definition: </strong>Takotsubo cardiomyopathy, or stress cardiomyopathy, is a <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> condition characterized by left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> often <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by emotional or physical stress, mimicking <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome without <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> obstruction.</li>\n<li><strong>Epidemiology</strong>: Predominantly affects <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> women, <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by emotional or physical stress.</li>\n<li><strong>Clinical Presentation</strong>: Chest pain, signs of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> heart failure, resembling <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome.</li>\n<li><strong>ECG</strong>: ST-segment elevation, absent <span class=\"customMeta\" data-dictid=\"5afb1c86751692777197cf9452d41b\">reciprocal</span> depression, T-wave inversion, mild QT prolongation.</li>\n<li><strong>Biochemistry</strong>: Elevated catecholamines, BNP, and modest <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">troponin</span> rise.</li>\n<li><strong>Imaging</strong>:\n\t\t\t\t<ul>\n<li><strong>Echocardiography</strong>: Classic \"takotsubo\" <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> of the left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> apex, with <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> segments hyperdynamic and <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> hypokinetic. Can show left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> regurgitation.</li>\n<li><strong>MRI</strong>: <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">Apical</span> <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> with high T2 intensity (oedema), typically sparing the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> segments. No late enhancement, differentiating it from <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> STEMI.</li>\n<li><strong>Left Ventriculography</strong>: Demonstrates <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> and <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> of <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> and <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> segments of the left ventricle.</li>\n</ul>\n</li>\n<li><strong>Prognosis</strong>: Excellent recovery with supportive treatment, typically resolves in weeks to months.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"Takotsubo Cardiomyopathy\" data-author=\"\" data-hash=\"8751\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/boAJ7aDzhmn9J5L1EubD1744301666.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Definition</strong>: A rare <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of hypertrophic <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> affecting the left ventricle's apex, occasionally the right or both.</li>\n<li><strong>Epidemiology</strong>: More common in Japanese populations (15-25% of <span class=\"customMeta\" data-dictid=\"b9210f211b1692777188dda55ca97e\">HCM</span> cases) compared to the U.S. (~3%).</li>\n<li><strong>Symptoms</strong>: Often asymptomatic; possible symptoms include chest pain, palpitations, dyspnea, and syncope.</li>\n<li><strong>ECG Findings</strong>: Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> with deep negative T waves, especially in leads V4-V5.</li>\n<li><strong>Pathology</strong>: Usually sporadic, with occasional autosomal dominant inheritance.</li>\n</ul>\n<p><strong>Imaging</strong>: \"Ace-of-spades\" or \"spade-like\" left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> <span class=\"customMeta\" data-dictid=\"1792af7b92169277718423182d599d\">configuration</span> on imaging</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Spade-like &lt;span class=\" custommeta\"=\"\" data-dictid=\"1792af7b92169277718423182d599d\"/>configuration on ventriculogram\" data-author=\"A. PayusFarisha SholehN. Mustafa\" data-hash=\"8753\" data-license=\"Open access\" data-source=\"https://www.semanticscholar.org/paper/Yamaguchi-syndrome-%E2%80%93-A-pseudoacute-coronary-of-the-Payus-Sholeh/6aff765d73025529152e4756f377ead16487bb54/figure/3\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/BknugIRWXDkiz5PAHEME1744301744.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient presents with sharp chest pain, fever, and pleuritis 3 weeks after undergoing coronary artery bypass surgery. Which of the following is the most likely underlying mechanism?", "options": [{"label": "A", "text": "Bacterial pericarditis", "correct": false}, {"label": "B", "text": "Hypersensitivity reaction to myocardial antigens", "correct": true}, {"label": "C", "text": "Direct trauma from the procedure", "correct": false}, {"label": "D", "text": "Viral infection", "correct": false}], "correct_answer": "B. Hypersensitivity reaction to myocardial antigens", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A post-mortem study reveals fibrinous deposits between the pericardial leaflets with a “bread and butter” appearance. Which of the following is most consistent with this form of pericarditis?", "options": [{"label": "A", "text": "Hemorrhagic pericarditis", "correct": false}, {"label": "B", "text": "Purulent pericarditis", "correct": false}, {"label": "C", "text": "Fibrinous pericarditis", "correct": true}, {"label": "D", "text": "Caseous pericarditis", "correct": false}], "correct_answer": "C. Fibrinous pericarditis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/vaRqTw8j1JGEgKfwAUwm1744301532.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Types of Pericarditis</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrinous pericarditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often called \"bread and butter\" <span class=\"customMeta\" data-dictid=\"607e653eef1692777195e56becea2c\">pericarditis</span> due to <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> deposits creating a rough appearance on the pericardium.</li>\n<li>Caused by conditions like myocardial infarction, infections, trauma, or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> diseases.</li>\n<li>Associated with a granular, <span class=\"customMeta\" data-dictid=\"1b8aa0db391692777194178f73c98c\">opaque</span> <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> surface from <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> and leukocytic exudate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serous pericarditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by clear fluid accumulation, often seen in <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections or <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases.</li>\n<li>Less intense <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> than fibrinous type.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purulent pericarditis</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by bacterial infections, leading to a pus-filled <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> sac.</li>\n<li>Requires urgent treatment to prevent severe complications.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Haemorrhagic pericarditis</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves blood within the pericardium, often due to trauma, malignancy, or uremia.</li>\n<li>Common in cases with malignancies like lung or breast cancer.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caseous pericarditis</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rare and typically associated with tuberculosis.</li>\n<li>Has a cheese-like appearance due to necrotic tissue in the pericardium.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50 y/o female with a history of heart failure presents with worsening fatigue, shortness of breath, and leg swelling. The Chest X-ray and Cardiac MRI of the patient are given below. Which of the following statements regarding the treatment of her condition is FALSE?", "options": [{"label": "A", "text": "Oral diuretics should be administered to maintain a euvolemic state.", "correct": false}, {"label": "B", "text": "ACE inhibitors are recommended for heart failure with reduced ejection fraction.", "correct": false}, {"label": "C", "text": "Beta-blockers should not be used in patients with symptomatic heart failure.", "correct": true}, {"label": "D", "text": "Isosorbide dinitrate plus hydralazine combination therapy may improve survival.", "correct": false}], "correct_answer": "C. Beta-blockers should not be used in patients with symptomatic heart failure.", "question_images": ["https://image.prepladder.com/notes/zuRw6Szw3PTzsCqwfsOO1744300873.png", "https://image.prepladder.com/notes/qSo3iyFqbS2y0xO6nLzx1744300739.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray: </strong>May show cardiomegaly, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> effusions, and <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion.</li>\n<li><strong>Electrocardiogram:</strong> Shows <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">nonspecific</span> <span class=\"customMeta\" data-dictid=\"6b3384701916927771998cea03ba94\">ST segment</span> and T wave abnormalities; can reveal atrial fibrillation.</li>\n<li><strong>Echocardiography:</strong> Can identify <span class=\"customMeta\" data-dictid=\"b61dc1c68d1692777193f8a6b8809b\">mural</span> <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> from other cardiomyopathies.</li>\n<li><strong>Cardiac MRI</strong>.</li>\n<li><strong>Cardiac <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">Catheterization</span> with <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> Angiography: </strong>Assesses <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and rules out ischemic disease.</li>\n<li><strong>Heart Biopsy:</strong> Rarely needed; evaluates for storage diseases or <span class=\"customMeta\" data-dictid=\"3107ad472c16927771900477b8dae0\">infiltrative</span> causes.</li>\n<li><strong>Genetic Testing:</strong> Considered in <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> cases to identify <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> factors.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes:</strong> Address any underlying and <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> conditions contributing to DCM.</li>\n<li><strong>Acute Congestive Heart Failure:</strong> Use <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"1848b160c11692777191b60caaf622\">loop diuretics</span> to manage hypervolemia. <strong>(Option A ruled out)</strong></li>\n<li><strong>Chronic Management:</strong> Administer oral diuretics to maintain a euvolemic state.</li>\n<li><strong>Medical management:</strong>\n<ul>\n<li><strong>ACE Inhibitors/ARBs</strong><strong>(Option B ruled out)</strong></li>\n<li><strong>Aldosterone <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Antagonists</strong></li>\n<li><strong>Beta-Blockers</strong></li>\n<li><strong>Combination Therapy:</strong> <span class=\"customMeta\" data-dictid=\"2805ce68a3169277719040c558e937\">Isosorbide</span> <span class=\"customMeta\" data-dictid=\"a76b0cae0e169277718616dd5c5b8b\">dinitrate</span> plus hydralazine. <strong>(Option D ruled out)</strong></li>\n</ul>\n</li>\n<li><strong>Anticoagulation:</strong> Use in patients with artificial valves, atrial fibrillation, or known <span class=\"customMeta\" data-dictid=\"b61dc1c68d1692777193f8a6b8809b\">mural</span> <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> to reduce stroke risk.</li>\n<li><strong>Advanced Therapies:</strong> Consider <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> or left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> assist devices (LVAD) for <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases.</li>\n<li><strong>ICD and CRT:</strong> Evaluate for implanted <span class=\"customMeta\" data-dictid=\"6aa1aed5811692777183058f0e3934\">cardioverter</span> defibrillators and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"175cb514a61692777197f78c0b1edf\">resynchronization</span> therapy for appropriate patients.</li>\n<li><strong>Heart Transplant:</strong> An option for severe cases, with indications including <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> shock and high <span class=\"customMeta\" data-dictid=\"059764ac1c1692777190e0dfa68335\">inotrope</span> dependency.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chest X-Ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiac MRI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Dilated &lt;span class=\" custommeta\"=\"\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\"/>cardiomyopathy chest x ray\" data-author=\"James Heilman, MD\" data-hash=\"8738\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Dilated_cardiomyopathy#/media/File:DifDilatedCardiomyoMagCXR.png\" data-tags=\"April2025\" height=\"400\" src=\"https://image.prepladder.com/notes/HsLUCSBj9iaz5gb84se91744301178.png\" width=\"355\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Dilated &lt;span class=\" custommeta\"=\"\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\"/>cardiomyopathy <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> MRI\" data-author=\"Praveen Jha\" data-hash=\"8728\" data-license=\"\" data-source=\"https://radiopaedia.org/cases/dilated-cardiomyopathy-4\" data-tags=\"April2025\" height=\"385\" src=\"https://image.prepladder.com/notes/qSo3iyFqbS2y0xO6nLzx1744300739.png\" width=\"385\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Specimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac Biopsy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Dilated &lt;span class=\" custommeta\"=\"\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\"/>cardiomyopathy gross specimen\" data-author=\"CDC/Dr. Edwin P. Ewing, Jr.\" data-hash=\"8733\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Cardiomyopathy#/media/File:Idiopathic_cardiomyopathy,_gross_pathology_20G0018_lores.jpg\" data-tags=\"April2025\" height=\"281\" src=\"https://image.prepladder.com/notes/W6Ie53TAHCUcUivnjaBc1744301001.png\" width=\"407\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Healthy &lt;span class=\" custommeta\"=\"\" data-dictid=\"e1fb96fd2416927771830dfed40e14\"/>cardiac <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> vs dilated <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> biopsy\" data-author=\"Michael Chute, Preetinder Aujla, Sayantan Jana and Zamaneh Kassiri\" data-hash=\"8737\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_interstitial_fibrosis_in_dilated_cardiomyopathy.jpg\" data-tags=\"April2025\" height=\"324\" src=\"https://image.prepladder.com/notes/YpKUkuILzaUxUwrlUKlq1744301098.png\" width=\"755\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child presents with increasing fatigue, shortness of breath during physical activity, and swelling in the legs. His mother reports that he has difficulty lying flat at night due to breathlessness. The child appears malnourished with signs of muscle wasting. On examination, there are crackles in the lung fields and elevated jugular venous pressure. An ECG reveals left ventricular enlargement. Which of the following findings is most consistent with the clinical features observed in this patient?", "options": [{"label": "A", "text": "Ejection fraction usually &amp;gt;55%", "correct": false}, {"label": "B", "text": "Left ventricular diastolic dimension ≥60 mm if chronic", "correct": true}, {"label": "C", "text": "Right ventricular dysfunction with no valvular regurgitation", "correct": false}, {"label": "D", "text": "Point of maximum impulse displaced medially", "correct": false}], "correct_answer": "B. Left ventricular diastolic dimension ≥60 mm if chronic", "question_images": ["https://image.prepladder.com/notes/J1GjfF3lOyApKhSufkki1744300412.png"], "explanation_images": ["https://image.prepladder.com/notes/V2V9okl8kbKWEjvuUieF1744300538.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 y/o male presents to the emergency department with fatigue, shortness of breath, and swollen legs. Upon examination, his heart on imaging revealed the following, and his left ventricular ejection fraction is markedly reduced. Which of the following is NOT a recognised cause of this patient’s diagnosis?", "options": [{"label": "A", "text": "Sarcoidosis", "correct": false}, {"label": "B", "text": "Chagas disease", "correct": false}, {"label": "C", "text": "Scleroderma", "correct": true}, {"label": "D", "text": "Heavy metal exposure to lead", "correct": false}], "correct_answer": "C. Scleroderma", "question_images": ["https://image.prepladder.com/notes/ovvBWkudqtm94fU9ZwMq1744300162.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of Dilated Cardiomyopathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infective</strong></p>\n<ul>\n<li>Viral (<strong>coxsackievirus</strong>, adenovirus, <strong>HIV,</strong> <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> C)</li>\n<li>Parasitic (<strong>Chagas’ disease</strong>, trypanosomiasis, toxoplasmosis) <strong>(Option B ruled out)</strong></li>\n<li>Bacterial (<strong>diphtheria</strong>)</li>\n<li>Spirochetal (<strong>Lyme disease)</strong></li>\n<li>Rickettsial (Q fever)</li>\n<li>Fungal (with <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> infection)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Noninfective</strong></p>\n<ul>\n<li>Granulomatous <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease\n\t\t\t\t<ul>\n<li><strong>Sarcoidosis</strong> <strong>(Option A ruled out)</strong></li>\n<li>Giant cell myocarditis</li>\n<li><strong>Eosinophilic myocarditis</strong></li>\n</ul>\n</li>\n<li><strong>Polymyositis, dermatomyositis</strong></li>\n<li>Collagen <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease</li>\n<li>Checkpoint <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> chemotherapy</li>\n<li>Transplant rejection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxic</strong></p>\n<ul>\n<li><strong>Alcohol</strong></li>\n<li>Catecholamines (amphetamines, cocaine)</li>\n<li>Chemotherapeutic agents (anthracyclines,<strong> trastuzumab</strong>)</li>\n<li>Interferon</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> agents (<strong>hydroxychloroquine</strong>, chloroquine)</li>\n<li>Drugs of misuse (emetine, <span class=\"customMeta\" data-dictid=\"3e0d247aa916927771812684526ac0\">anabolic</span> steroids)</li>\n<li>Heavy metals (<strong>lead, mercury</strong>) <strong>(Option D ruled out)</strong></li>\n<li>Occupational exposure (hydrocarbons, arsenicals)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic</strong></p>\n<ul>\n<li>Nutritional deficiencies (<strong>thiamine, selenium</strong>, carnitine)</li>\n<li>Electrolyte deficiencies (calcium, phosphate, magnesium)</li>\n<li>Endocrinopathy (thyroid disease, pheochromocytoma, diabetes, obesity, <strong>hemochromatosis)</strong></li>\n</ul>\n<ul>\n<li>Skeletal and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> myopathy</li>\n<li>Dystrophin-related <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">dystrophy</span> <strong>(Duchenne’s, Becker’s)</strong></li>\n<li><strong>Mitochondrial myopathies (e.g., Kearns-Sayre syndrome</strong>)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overlap with Nondilated Cardiomyopathy</strong></p>\n<ul>\n<li>Minimally dilated cardiomyopathy</li>\n<li><strong>Hemochromatosis</strong></li>\n<li><strong>Amyloidosis</strong></li>\n<li><strong>Hypertrophic <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> </strong>(“burned-out”)</li>\n<li>Idiopathic</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Miscellaneous</strong></p>\n<ul>\n<li><strong>Arrhythmogenic <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> cardiomyopathy</strong></li>\n<li><strong>Peripartum cardiomyopathy</strong></li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> noncompaction</li>\n<li>Tachycardia-related cardiomyopathy</li>\n<li>Supraventricular arrhythmias with uncontrolled rate</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male is being evaluated for restrictive cardiomyopathy (RCM). Which of the following statements regarding the investigations and treatment options for RCM is FALSE?", "options": [{"label": "A", "text": "An echocardiogram is the primary test for diagnosing RCM.", "correct": false}, {"label": "B", "text": "Low-to-normal QRS voltage on ECG can suggest amyloidosis.", "correct": false}, {"label": "C", "text": "Therapeutic phlebotomy is the primary treatment for sarcoidosis.", "correct": true}, {"label": "D", "text": "Endomyocardial biopsy is the gold standard for diagnosing cardiac amyloidosis.", "correct": false}], "correct_answer": "C. Therapeutic phlebotomy is the primary treatment for sarcoidosis.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/qohmsYwipjQAG3RaJnMR1744299753.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>ECG: </strong>Low-to-normal QRS <span class=\"customMeta\" data-dictid=\"25ad895a231692777202f568bc6bfc\">voltage</span> may suggest amyloidosis, but the absence of low <span class=\"customMeta\" data-dictid=\"25ad895a231692777202f568bc6bfc\">voltage</span> does not rule it out. <strong>(Option B ruled out)</strong></li>\n<li><strong>Echocardiogram: </strong>\n<ul>\n<li>It is the primary test for <span class=\"customMeta\" data-dictid=\"a1c428cc8e1692777197cfbf884768\">RCM</span> and helps <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> it from conditions like <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> pericarditis. <strong>(Option A ruled out)</strong></li>\n<li>Thickened walls of both ventricles without major chamber dilation.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> are markedly dilated, indicating chronically elevated <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> pressures.</li>\n<li>There is a characteristic hyperrefractile “glittering” appearance of the myocardium, typical of <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> infiltration.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Granular sparkling heart: Restrcitive cardiomyopathy\" data-author=\"Zhang, Qisi &amp; Qiao, Yingli &amp; Yan, Dongmei &amp; Deng, Yuhui &amp; Zhang, Mengyang &amp; Xu, Poshi.\" data-hash=\"8704\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Echocardiography-showing-increased-ventricular-mass-and-granular-sparkling-pattern-of_fig3_341657242\" data-tags=\"April2025\" height=\"348\" src=\"https://image.prepladder.com/notes/qohmsYwipjQAG3RaJnMR1744299753.png\" width=\"455\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Granular sparkling heart</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Cardiac Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> (CMR): </strong>Useful for diagnosing <span class=\"customMeta\" data-dictid=\"a1c428cc8e1692777197cfbf884768\">RCM</span> and suggests <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">amyloidosis</span> through <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">gadolinium</span> enhancement.</li>\n<li><strong>Endomyocardial <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> (EMB):</strong> <strong>Gold standard </strong>for diagnosing <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> amyloidosis; fat pad <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> is also beneficial. <strong>(Option D ruled out)</strong></li>\n<li><strong>Nuclear Imaging: </strong>Can show <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> for <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> and aid in diagnosis.</li>\n<li><strong>Biomarkers: </strong>Troponin T, BNP, and pro-BNP are useful for diagnosis and prognosis.</li>\n</ul>\n<p><strong>Mutation Analysis: </strong>Used to diagnose <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> hemochromatosis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treat Underlying Causes: Focus on alleviating symptoms and managing heart failure.</li>\n<li><strong>Diuretics:</strong> Mainstay for reducing volume overload; must be monitored to avoid excessive diuresis.</li>\n<li><strong>Beta-blockers/Calcium Channel Blockers:</strong> May be used to increase <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> time and manage dysrhythmias.</li>\n<li><strong>Angiotensin-Receptor Blockers: </strong>Considered if <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> develops.</li>\n<li><strong>For Sarcoidosis: </strong>Antiarrhythmics and <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> agents like corticosteroids may be used.</li>\n<li><strong>For Hemochromatosis:</strong> <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">Therapeutic</span> <span class=\"customMeta\" data-dictid=\"9ac5819d6716927771954bde596564\">phlebotomy</span> is the treatment of choice. <strong>(Option C)</strong></li>\n</ul>\n<strong>Advanced Treatments:</strong> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> transplant or left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> assist devices may be options for some patients.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o male with a history of amyloidosis presents with shortness of breath, fatigue, and leg swelling. He has jugular venous distension and ascites. An echocardiogram shows normal systolic function but diastolic dysfunction. The chest X-ray of the patient is given below. Which of the following statements is true?", "options": [{"label": "A", "text": "The atria are severely shrunken.", "correct": false}, {"label": "B", "text": "Jugular venous pressure often shows rapid Y descents.", "correct": true}, {"label": "C", "text": "Atrial fibrillation is rare in these patients.", "correct": false}, {"label": "D", "text": "A third heart sound is more common than a fourth heart sound in sinus rhythm.", "correct": false}], "correct_answer": "B. Jugular venous pressure often shows rapid Y descents.", "question_images": ["https://image.prepladder.com/notes/NPMNhPIsR4fWUBWxb14e1744298996.png"], "explanation_images": ["https://image.prepladder.com/notes/y7lwOwmj7U6MSvC3h1101744299118.png", "https://image.prepladder.com/notes/BKSIuxLs1zv0FGFXm3k61744299215.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:457px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amyloidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carpal tunnel syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sarcoidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral Hair infiltrates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemochromatosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bronze skin, cirrhosis, Arthralgias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrinopathies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diabetes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with worsening fatigue, shortness of breath, and ankle swelling. His medical history includes joint pain, elevated liver enzymes, hyperpigmentation, and diabetes. He has recently been diagnosed with a metabolic disorder. An echocardiogram reveals elevated filling pressures and bilateral atrial enlargement. Which of the following best explains the underlying pathophysiology of this patient’s condition?", "options": [{"label": "A", "text": "Increased contractility due to myocardial hypertrophy", "correct": false}, {"label": "B", "text": "Impaired diastolic filling due to stiffened ventricular walls", "correct": true}, {"label": "C", "text": "Dilated ventricular chambers leading to heart failure", "correct": false}, {"label": "D", "text": "Obstruction of blood flow through the left ventricle", "correct": false}], "correct_answer": "B. Impaired diastolic filling due to stiffened ventricular walls", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abnormal Diastolic Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The primary <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in restrictive <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> is impaired diastolic <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> due to the stiffened <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> walls.</li>\n<li>Elevated end-diastolic pressures in both ventricles without significant chamber dilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral Atrial Enlargement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The non-compliant ventricles lead to increased pressures, resulting in <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of both atria.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right-Sided Heart Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The stiff ventricles result in increased <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> pressures, particularly affecting the right side, causing <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> oedema, ascites, and <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> distention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amyloid Infiltration</strong> (in amyloidosis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amyloid fibrils (pink <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> deposits) accumulate between myocytes, leading to myocardial stiffening and restrictive physiology.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Cardiac &lt;span class=\" custommeta\"=\"\" data-dictid=\"959f3344b116927771815235718f3d\"/>amyloidosis in congo red stain\" data-author=\"Novikov, Aleksey &amp; Holzer, Horatio &amp; DeSimone, Robert &amp; Abu-Zeinah, Ghaith &amp; Pisapia, David &amp; Mark, Tomer &amp; Pastore, Raymond.\" data-hash=\"8672\" data-license=\"CC0\" data-source=\"https://www.researchgate.net/figure/Cardiac-amyloidosis-A-Congo-red-stain-of-left-ventricle-showing-focal-positive_fig1_284096165\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/dJpPe8RwpqgEgabbGhLT1744298841.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Cardiac <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">amyloidosis</span> (Congo red stain)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In conditions like radiation-induced <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> or <span class=\"customMeta\" data-dictid=\"9ec09a7cfc169277718700e4dcac4e\">endomyocardial</span> fibrosis, stiffening of the <span class=\"customMeta\" data-dictid=\"c64e23ddb8169277719344010b3fc0\">myocardium</span> occurs due to scarring, further impairing <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> filling.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female marathon runner collapses and is found unresponsive during a race. Despite attempts at resuscitation, she is pronounced dead at the scene. Her family reports a history of sudden cardiac death in her brother at a young age, and they mention that she had previously experienced episodes of dizziness and palpitations during training. Which of the following conditions is most likely to contribute to sudden cardiac death in this young athlete?", "options": [{"label": "A", "text": "Hypertrophic cardiomyopathy (HCM)", "correct": true}, {"label": "B", "text": "Commotio cordis", "correct": false}, {"label": "C", "text": "Valvular heart disease", "correct": false}, {"label": "D", "text": "Atherosclerotic coronary artery disease", "correct": false}], "correct_answer": "A. Hypertrophic cardiomyopathy (HCM)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Structural Heart Disease:</strong> The presence of structural heart issues or inherited <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> syndromes significantly increases <span class=\"customMeta\" data-dictid=\"ab1832bcef169277719850bbfb5670\">SCD</span> risk.</li>\n<li><strong>Major Risk Factors:</strong>\n<ul>\n<li>Coronary Heart Disease (CHD)</li>\n<li>Heart Failure</li>\n<li>Diabetes</li>\n<li>Hypertension</li>\n<li>Smoking</li>\n<li>Family History of SCD</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precipitating Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>SCD and Sudden <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Arrest (SCA) frequently occur at specific times (e.g., mornings, winter months) and in public places.</li>\n<li>Vigorous exertion, especially in men, can trigger SCD; however, regular exercise may reduce this risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Underlying Heart Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The most common cause of <span class=\"customMeta\" data-dictid=\"ab1832bcef169277719850bbfb5670\">SCD</span> is <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> fibrillation</li>\n<li>Many <span class=\"customMeta\" data-dictid=\"ab1832bcef169277719850bbfb5670\">SCD</span> cases are <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease (CAD), but non-ischemic cardiomyopathies and other heart conditions also contribute.</li>\n<li>Common mechanisms leading to <span class=\"customMeta\" data-dictid=\"ab1832bcef169277719850bbfb5670\">SCD</span> include:\n\t\t\t\t<ul>\n<li>Acute Myocardial Infarction</li>\n<li>Bradyarrhythmias</li>\n<li>Ventricular scars leading to arrhythmias</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following medications is not contraindicated in patients with hypertrophic cardiomyopathy?", "options": [{"label": "A", "text": "Amlodipine", "correct": false}, {"label": "B", "text": "Verapamil", "correct": true}, {"label": "C", "text": "Furosemide", "correct": false}, {"label": "D", "text": "Digoxin", "correct": false}], "correct_answer": "B. Verapamil", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o male presents with sharp, pleuritic chest pain worsened by lying down and relieved by sitting up. He had a recent viral illness. A friction rub is heard on auscultation, and ECG shows the following. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myocardial infarction", "correct": false}, {"label": "B", "text": "Pulmonary embolism", "correct": false}, {"label": "C", "text": "Acute pericarditis", "correct": true}, {"label": "D", "text": "Aortic dissection", "correct": false}], "correct_answer": "C. Acute pericarditis", "question_images": ["https://image.prepladder.com/notes/40mYYw55Ya4bVZMo975L1744281368.png"], "explanation_images": ["https://image.prepladder.com/notes/5mKJMnQpSWDFyytJjl7W1744281527.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute Pericarditis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aetiology </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infectious causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Noninfectious causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Viruses</u>: Coxsackievirus, echovirus, <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> viruses.</li>\n<li><u>Bacteria</u>: Streptococcus, Staphylococcus, tuberculosis.</li>\n<li><u>Fungal infections</u>: Histoplasmosis.</li>\n<li><u>Other infections</u>: Syphilis, protozoal, and <span class=\"customMeta\" data-dictid=\"c0433f52ad1692777194c2ffb6fc63\">parasitic</span> infections.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Renal failure</li>\n<li>Neoplasms</li>\n<li>Trauma</li>\n<li>Aortic dissection</li>\n<li>Myocardial infarction, post-irradiation, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders (myxedema, cholesterol pericarditis).</li>\n<li><strong>Drug-induced</strong>: Medications like procainamide, and hydralazine.</li>\n<li><strong>Post-cardiac</strong><strong> </strong>injury syndrome: <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">Autoimmune</span> reaction after surgery, trauma.</li>\n<li><strong>Autoimmune diseases</strong><strong>:</strong> Lupus, <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis, scleroderma.</li>\n<li>Idiopathic.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest pain</strong></li>\n</ul>\n<p><strong>Sharp, pleuritic pain, worsened by lying down, relieved by sitting up</strong>. Radiates to trapezius, may <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> myocardial ischemia.</p>\n<ul>\n<li><strong>Pericardial <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rub</strong></li>\n</ul>\n<p>Rasping and scratching sounds are heard in the majority of patients. It is best heard<strong> during end-expiration</strong> with the patient leaning forward.</p>\n<ul>\n<li><strong>Pericardial effusion</strong>:</li>\n</ul>\n<p>It can lead to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> if rapid. Faint heart sounds, and a large <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"980c8bc3ce1692777198a4c20033fd\">silhouette</span> on X-ray.</p>\n<p><strong>Ewart’s sign</strong>: <span class=\"customMeta\" data-dictid=\"e452a3bf5716927771867e7ea9b4da\">Dullness</span> and <span class=\"customMeta\" data-dictid=\"c63956cd1516927771879dd2641a28\">egophony</span> below the left <span class=\"customMeta\" data-dictid=\"153f2ea4be16927771981ce5d9171f\">scapula</span> due to <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the base of the lungs</p>\n<ul>\n<li><strong>ECG changes</strong>:</li>\n</ul>\n<p><strong>Diffuse <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> upward ST-segment elevation, PR-segment depression</strong>.</p>\n<p>Evolves through stages: ST <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> → return to <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> → T-wave <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> → normalisation.</p>\n<p>PR segment depression in MI patients is seen due to <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> atrial injury.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 y/o male presents with exertional chest pain and occasional fainting spells. His family history includes a relative who experienced sudden cardiac death. An echocardiogram reveals asymmetric septal hypertrophy. Which of the following is not a characteristic investigatory finding in this condition?", "options": [{"label": "A", "text": "Brockenbrough-Braunwald-Morrow sign", "correct": false}, {"label": "B", "text": "Deep, narrow Q waves in the lateral leads", "correct": false}, {"label": "C", "text": "Left ventricle free wall thickness &amp;gt;10 mm", "correct": true}, {"label": "D", "text": "Increased precordial voltages", "correct": false}], "correct_answer": "C. Left ventricle free wall thickness &gt;10 mm", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CqCpgwUp5nsRMXTRJRkI1745564807.png", "https://image.prepladder.com/notes/v1hWMnReXcOuJIjnWMtD1744298299.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old male presents to the ED after experiencing syncope while playing basketball. He has a palpable double impulse at the apex, and an ECG shows signs of left ventricular hypertrophy. An echocardiogram reveals asymmetric septal thickening with left ventricular outflow tract obstruction. Which of the following examination findings would NOT be expected in this patient?", "options": [{"label": "A", "text": "Palpable double impulse at the apex", "correct": false}, {"label": "B", "text": "Late-peaking ejection systolic murmur best heard at the left sternal border", "correct": false}, {"label": "C", "text": "Pulsus bisferiens on peripheral pulse examination", "correct": false}, {"label": "D", "text": "Prominent y descent in jugular venous pressure (JVP)", "correct": true}], "correct_answer": "D. Prominent y descent in jugular venous pressure (JVP)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/uMKgyga9PFGF51viFXZE1744283310.png", "https://image.prepladder.com/notes/QK5wrzjehg9Qn2Y3ZMGG1744283387.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Palpable Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Hypertrophy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An enlarged left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> can be felt during physical examination, indicating hypertrophy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Double Impulse at the Apex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> <span class=\"customMeta\" data-dictid=\"14669154fc16927772033d797d9d61\">fourth heart sound</span> suggests forceful atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> against a non-compliant ventricle. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mid-Systolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> at the Base</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Turbulent <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through the obstructed left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> produces a mid-systolic murmur.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pansystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> at the Apex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> caused by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> motion of the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Jerky Arterial Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characteristic of HOCM, contrasts with the <strong>slow-rising pulse seen in aortic stenosis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pulsus <span class=\"customMeta\" data-dictid=\"e506039a4916927771831191786c58\">bisferiens</span> </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A double pulse noticed during <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> in the <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> pulse is called <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">pulsus</span> bisferiens. It is associated with severe aortic disease accompanied by <span class=\"customMeta\" data-dictid=\"32a29a166b1692777182d46c390c42\">aortic regurgitation</span> and HOCM.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Auscultatory Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ejection <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> Murmur</strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Late-onset crescendo-decrescendo murmur.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by turbulent <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through the obstructed LVOT; best heard at the left sternal border or apex.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Dynamic Changes with Maneuvers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased Intensity:</strong> Occurs with decreased <span class=\"customMeta\" data-dictid=\"628ed9c26316927771964889249b3b\">preload</span> (e.g., Valsalva manoeuvre, <span class=\"customMeta\" data-dictid=\"5406cdc5f9169277718107b60b7619\">amyl</span> nitrite).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates worsening obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased Intensity:</strong> Occurs with increased <span class=\"customMeta\" data-dictid=\"38d395efa2169277718025e142bd0e\">afterload</span> (e.g., handgrip, inspiration).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suggests improvement in outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Non-Ejection <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> Clicks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clicks due to asymmetrical <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> affecting the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"fe7835b0b81692777184173c09d7a5\">chordae</span> tendinae.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates dynamic changes in the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> apparatus, though less common.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Abnormal <span class=\"customMeta\" data-dictid=\"ddbe945c10169277719841fa6a7fa2\">Second Heart Sound</span> (S2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May show delayed aortic <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> with patterns of reverse splitting.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Correlates with the severity of left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> outflow obstruction; reversed or partially reversed <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> indicates severe obstruction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old competitive athlete presents with recurrent syncope and exertional chest pain. He has a jerky, forceful pulse. ECG reveals left ventricular hypertrophy with deep Q waves in the inferolateral leads, and troponin T is mildly elevated. Echocardiography shows asymmetric septal hypertrophy, systolic anterior motion of the mitral valve, and a mid-systolic murmur at the heart's base. What is the most likely mechanism for his symptoms?", "options": [{"label": "A", "text": "Diastolic heart failure due to a dilated left ventricle", "correct": false}, {"label": "B", "text": "Mitral valve prolapse", "correct": false}, {"label": "C", "text": "Left ventricular outflow tract obstruction", "correct": true}, {"label": "D", "text": "Aortic stenosis", "correct": false}], "correct_answer": "C. Left ventricular outflow tract obstruction", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/eMZ5Svfm4bcZCwWpntdi1744283113.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with signs of peripheral oedema and ascites. A chest X-ray reveals the following, and echocardiography confirms a thickened pericardium. Which of the following is the least accurate regarding his likely condition?", "options": [{"label": "A", "text": "Conservative management with loop diuretics is curative", "correct": true}, {"label": "B", "text": "JVP shows a prominent “y” descent", "correct": false}, {"label": "C", "text": "Commonly caused by tuberculosis in endemic regions", "correct": false}, {"label": "D", "text": "CT scan can assist in visualizing pericardial calcification", "correct": false}], "correct_answer": "A. Conservative management with loop diuretics is curative", "question_images": ["https://image.prepladder.com/notes/QzOBSLOoKRda7kFarrSC1744282965.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose/Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> calcification, a key <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> clue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Echocardiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visualises thickened <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">pericardium</span> and assesses <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CT scanning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps in visualising <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> calcification.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complex echo-Doppler and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> catheterisation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> <span class=\"customMeta\" data-dictid=\"607e653eef1692777195e56becea2c\">pericarditis</span> from restrictive <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> when diagnosis is uncertain.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose/Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diuretics (e.g., loop diuretics, spironolactone)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps manage <span class=\"customMeta\" data-dictid=\"466b280a461692777186344883956d\">diastolic heart failure</span> by reducing fluid overload.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pericardiectomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definitive treatment through <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal of the diseased pericardium. Significant improvement is possible, but the procedure has high <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> risk and suboptimal outcomes in up to 50% of patients.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with fatigue, abdominal swelling, and peripheral oedema. On examination, he has elevated jugular venous pressure (JVP), hepatomegaly, and a loud third heart sound. There is also a rise in JVP during inspiration (see image below). Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Heart failure with preserved ejection fraction", "correct": false}, {"label": "B", "text": "Constrictive pericarditis", "correct": true}, {"label": "C", "text": "Dilated cardiomyopathy", "correct": false}, {"label": "D", "text": "Restrictive cardiomyopathy", "correct": false}], "correct_answer": "B. Constrictive pericarditis", "question_images": ["https://image.prepladder.com/notes/9FCzJZoVzatC3Cjoujij1744282798.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Elevated JVP with rapid y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reflects <strong>rapid early diastolic filling</strong> of the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> due to pressure gradient.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fatigue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by the heart’s inability to meet <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> demands.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rapid, low-volume pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restricted <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> limits stroke volume, weakening the pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pericardial knock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <strong>loud early S3 from the thickened pericardium</strong> during diastolic filling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Kussmaul’s sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paradoxical rise in JVP during inspiration.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hepatomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> due to i<strong>ncreased <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal fluid accumulation due to <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Peripheral oedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Swelling in the extremities from <strong>fluid retention.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pulsus paradoxus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A fall in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP (10mm Hg) during inspiration, potentially <span class=\"customMeta\" data-dictid=\"8ee21101ac1692777189434bcef126\">impalpable</span> pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Atrial fibrillation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common due to atrial <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> and dilation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 y/o male is brought to the emergency department after a high-speed car accident. He has a deep laceration on his thigh and is actively bleeding. His vitals are heart rate of 120 bpm, blood pressure of 80/50 mmHg, and he is pale with cold, clammy skin. Which of the following is the most appropriate initial management step?", "options": [{"label": "A", "text": "Administer intravenous antibiotics", "correct": false}, {"label": "B", "text": "Perform an urgent CT scan", "correct": false}, {"label": "C", "text": "Start intravenous fluid resuscitation", "correct": true}, {"label": "D", "text": "Apply a tourniquet to the thigh", "correct": false}], "correct_answer": "C. Start intravenous fluid resuscitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypovolemic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstructive Shock</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Critical blood loss leads to inadequate organ perfusion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obstruction of blood flow, impairing the heart's ability to pump blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Traumatic injuries (deep lacerations, internal bleeding) from crashes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injuries like tension pneumothorax, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> in crashes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dizziness, rapid heartbeat, cold skin, pale lips, nausea, confusion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid heartbeat, difficulty breathing, cold skin, anxiety.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial compensation fails, leading to low blood pressure, and multi-organ failure.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physical <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> reduces oxygen delivery to organs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Volume <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> (IV fluids, blood transfusions), control bleeding.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relieve <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (needle decompression, pericardiocentesis), and fluid resuscitation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o woman presents to the ED with severe shortness of breath and chest tightness. O/E, she is hypotensive with a blood pressure of 85/60 mmHg, has distended neck veins with a jugular venous pressure (JVP) of 12 cm H₂O, and her heart sounds are muffled. An echocardiogram shows the following: What is the most appropriate immediate and definitive treatment for this patient?", "options": [{"label": "A", "text": "Intravenous saline infusion", "correct": false}, {"label": "B", "text": "Pericardiocentesis", "correct": true}, {"label": "C", "text": "Diuretics", "correct": false}, {"label": "D", "text": "Surgical drainage (pericardiotomy)", "correct": false}], "correct_answer": "B. Pericardiocentesis", "question_images": ["https://image.prepladder.com/notes/I6lQtiaDdjSFGVCCjoaS1744282487.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiac tamponade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Echocardiography</strong>: Primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tool.\n\t\t\t\t<ul>\n<li><strong>The diastolic collapse of the right ventricle. </strong></li>\n<li>Assesses <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> (size, location).</li>\n<li><strong>Normal E/A Ratio:</strong> In healthy individuals, the E/A ratio is typically greater than 1, indicating effective <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> filling.</li>\n<li><strong>Diastolic Dysfunction:</strong> In <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, the E/A ratio can decrease to less than 1, signifying impaired diastolic <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> and relaxation.</li>\n<li>Shows <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> variations in transvalvular flow velocities.</li>\n</ul>\n</li>\n<li><strong>ECG</strong>:\n\t\t\t\t<ul>\n<li>Shows low QRS <span class=\"customMeta\" data-dictid=\"25ad895a231692777202f568bc6bfc\">voltage</span> due to fluid interference.</li>\n<li>May present electrical alternans, indicating tamponade.</li>\n</ul>\n</li>\n<li><strong>Right Heart Catheterization</strong>:\n\t\t\t\t<ul>\n<li>Provides haemodynamic data.</li>\n<li><strong>Reveals elevated and equalized pressures in all <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> chambers during diastole</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pericardiocentesis:</strong>\n<ul>\n<li><strong>Immediate procedure to drain fluid and relieve pressure on the heart. (Option B)</strong></li>\n<li>Often guided by echocardiography.</li>\n</ul>\n</li>\n<li><strong>Intravenous Saline</strong>: Given temporarily while getting ready for the procedure. <strong>(Option A ruled out)</strong></li>\n<li><strong>Catheter Placement</strong>: A small <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> may be left in place post-pericardiocentesis for ongoing <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> if fluid reaccumulates.</li>\n<li><strong>Surgical <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">Drainage</span> (Subxiphoid Pericardiotomy):</strong> Indicated for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> tamponade, loculated effusions, or ineffective pericardiocentesis. <strong>(Option D ruled out)</strong></li>\n<li><strong>Pericardial Fluid Analysis</strong>: Important for identifying the underlying cause of the <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> (e.g., cytology, cultures, <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> for infections).</li>\n<li><strong>Addressing Underlying Causes</strong>: Essential for preventing <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> (e.g., antibiotics for infections, <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> for malignancies).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a classic finding in cardiac tamponade?", "options": [{"label": "A", "text": "Pulsus paradoxus", "correct": true}, {"label": "B", "text": "S3 heart sound", "correct": false}, {"label": "C", "text": "Pulsus alternans", "correct": false}, {"label": "D", "text": "High-pitched systolic murmur", "correct": false}], "correct_answer": "A. Pulsus paradoxus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiac Tamponade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A condition where the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> chambers are compressed by a <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion, limiting <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> inflow. Fluid accumulation of as little as 200 ml to upwards of 2L may lead to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beck's triad</strong></p>\n<ul>\n<li><strong>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension</strong>: Due to increased central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure. Prominent x <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> and an absent y descent.</li>\n<li><strong>Hypotension</strong>: Resulting from impaired <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n<li><strong>Muffled Heart Sounds</strong>: Caused by fluid accumulation in the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> space, dampening heart sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Paradoxus</strong>: A drop in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP during inspiration, greater than 10 mm Hg.</p>\n<p>Causes of <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">Pulsus</span> paradoxus:</p>\n<ul>\n<li><strong>Lung Conditions:</strong> <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> asthma, COPD, tension pneumothorax, pleural effusion, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism.</li>\n<li><strong>Heart Conditions:</strong> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> tamponade, <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> pericarditis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low-Pressure <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Tamponade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This occurs when lower <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> pressure leads to tamponade, often in cases of <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> fluid <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> (e.g., hypovolemia).</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension: Often absent</p>\n<p>Pulsus Paradoxus: Rare</p>\n<p>Requires a high degree of suspicion due to the absence of typical signs like <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> distension and <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">pulsus</span> paradoxus.</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presents to the emergency department with complaints of shortness of breath, fatigue, and mild chest discomfort. On examination, his blood pressure is low, and his heart sounds are faint on auscultation. The physician orders an echocardiogram, which shows the following Based on these findings, which of the following ECG patterns would you most likely expect to see?", "options": [{"label": "A", "text": "High-voltage QRS complexes", "correct": false}, {"label": "B", "text": "ST-segment elevation in all leads", "correct": false}, {"label": "C", "text": "Prolonged PR interval", "correct": false}, {"label": "D", "text": "Electrical alternans", "correct": true}], "correct_answer": "D. Electrical alternans", "question_images": ["https://image.prepladder.com/notes/LMCYUWuFcsDmj5tieWS61744281748.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o male with acute pericarditis who has not responded to NSAIDs and colchicine is now experiencing frequent recurrences. He does not tolerate glucocorticoids well. What additional treatment can be considered?", "options": [{"label": "A", "text": "Increase the dose of NSAIDs", "correct": false}, {"label": "B", "text": "Start azathioprine", "correct": true}, {"label": "C", "text": "Begin a higher dose of colchicine", "correct": false}, {"label": "D", "text": "Stop all medications and monitor", "correct": false}], "correct_answer": "B. Start azathioprine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute Pericarditis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Echocardiography</strong>:\n\t\t\t\t<ul>\n<li>The <strong>primary tool</strong> for diagnosing <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> fluid.</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> can be identified if fluid exceeds 1 cm.</li>\n</ul>\n</li>\n<li><strong>CT &amp; MRI</strong>:\n\t\t\t\t<ul>\n<li>Detect loculated effusions, masses, or <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (MRI)</li>\n<li>Used to confirm <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> or thickening.</li>\n<li>MRI also assesses <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> pericarditis.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative Management:</strong></p>\n<p>Rest and anti-inflammatory drugs for <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> pericarditis.</p>\n<ul>\n<li><strong>Aspirin/NSAIDs</strong>:\n\n\t\t\t\t<ul>\n<li>Doses: <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">Aspirin</span> (2-4 g/day) or ibuprofen/indomethacin with <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> protection.</li>\n<li>Continue for 1-2 weeks, and taper over time.</li>\n</ul>\n</li>\n<li><strong>Colchicine</strong>:\n\t\t\t\t<ul>\n<li>Dose: 0.5 mg daily (&lt;70 kg) or twice daily (&gt;70 kg) for 3 months.</li>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk but may cause diarrhoea.</li>\n</ul>\n</li>\n<li><strong>Glucocorticoids</strong>:\n\t\t\t\t<ul>\n<li>Only for NSAID/colchicine-resistant cases, short-term use (2-4 days), then tapered.</li>\n<li>Prolonged use raises the <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n</ul>\n</li>\n<li><strong>Immunosuppressants</strong>: <strong>Azathioprine or <span class=\"customMeta\" data-dictid=\"ada6fe6d1c169277718181d592ece7\">anakinra</span> in cases of frequent <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> is unresponsive to other treatments.</strong></li>\n<li><strong>Avoid Anticoagulants</strong>: Risk of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> into the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> cavity, leading to tamponade.</li>\n</ul>\n<p><strong>Surgical:</strong> <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">Pericardial</span> <span class=\"customMeta\" data-dictid=\"85cb03377b1692777199d46846ce58\">stripping</span> for rare, severe cases with <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> effusion.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 33 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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On examination, his pulse is irregularly irregular with a rate of 140 beats per minute. An ECG of the patient is given below. CHA2DS2-VASc score calculation shows a score of 3. Which of the following statements about his condition is FALSE?", "options": [{"label": "A", "text": "The irregular pulse is due to abnormal atrial firing and re-entry circuits", "correct": false}, {"label": "B", "text": "The atrial rate is likely 300 beats per minute with a 2:1 AV block.", "correct": true}, {"label": "C", "text": "Anticoagulation is recommended to reduce stroke risk.", "correct": false}, {"label": "D", "text": "Beta-blockers and digoxin are the first-line rhythm and rate control agents respectively.", "correct": false}], "correct_answer": "B. The atrial rate is likely 300 beats per minute with a 2:1 AV block.", "question_images": ["https://image.prepladder.com/notes/nmZNocy8DVjTTC5UrbDx1744292629.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrial Fibrillation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> automatic <span class=\"customMeta\" data-dictid=\"0c2d898b0b1692777202c5d43d5e78\">firing</span> and multiple re-entry circuits. <strong>(Option A ruled out)</strong></li>\n<li>Atria beat rapidly and ineffectively; ventricles activated irregularly</li>\n</ul>\n<ul>\n<li>Produces an <strong>\"irregularly irregular\" pulse</strong></li>\n<li>Palpitations, syncope, and breathlessness can be present</li>\n<li>Asymptomatic AF: Can present as <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> and stroke</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>QRS Complexes: <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">Irregular</span> but normal</li>\n<li>P Waves: Absent; <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> may show<strong> <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> waves</strong></li>\n<li>Ventricular Rate:\n\t\t\t\t<ul>\n<li>Fast at onset (120-160 beats/min)</li>\n<li>Slower in chronic AF due to medication effects and AV nodal fatigue</li>\n</ul>\n</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Atrial &lt;span class=\" custommeta\"=\"\" data-dictid=\"6ae0ac06031692777202699c4c75a0\"/>Fibrillation <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> features\" data-author=\"PeaBrainC\" data-hash=\"8584\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Atrial_Fibrillation_in_two_leads.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/rhfXbf9ysZoOaagwaGY41744292691.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paroxysmal Atrial Fibrillation</strong></p>\n<ul>\n<li><strong>First-line Therapy: Beta-blockers</strong> are effective in patients with CAD, hypertension, and heart failure. <strong>(Option D ruled out)</strong></li>\n<li>Class <span class=\"customMeta\" data-dictid=\"e02c7dfea516927771894c64e8013a\">Ic</span> Drugs: <strong>Propafenone or flecainide</strong> to prevent episodes (not for patients with <span class=\"customMeta\" data-dictid=\"4c453b57b51692777183ad486096a9\">CAD</span> or LV dysfunction).</li>\n<li>Class III Drugs:\n\t\t\t\t<ul>\n<li><strong>Amiodarone</strong>: Most effective but with significant side effects; used when other treatments fail.</li>\n<li><strong>Dronedarone</strong>: Alternative to amiodarone; contraindicated in heart failure.</li>\n</ul>\n</li>\n<li><strong>Rate Control: <span class=\"customMeta\" data-dictid=\"508c1bf22216927771860525d4ef6f\">Digoxin</span> and verapamil </strong>for <span class=\"customMeta\" data-dictid=\"93722e23b31692777182e48d478f12\">AV node</span> <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> slowing, but not for AF prevention. <strong>(Option D ruled out)</strong></li>\n<li>Catheter Ablation: Considered for patients with <span class=\"customMeta\" data-dictid=\"d4c88fcae71692777186aa1c32423a\">drug-resistant</span> AF; prevents AF in ~75% of cases but may have complications.</li>\n</ul>\n<p><strong>Persistent Atrial Fibrillation</strong></p>\n<ul>\n<li><strong>Rhythm Control</strong>:\n\n\t\t\t\t<ul>\n<li><strong>Cardioversion</strong>: Electrical or pharmacological (e.g., <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> flecainide or amiodarone).</li>\n<li>Timing: Immediate if AF &lt;48 hours; <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> required if AF ≥48 hours.</li>\n<li>Prophylactic <strong>Amiodarone</strong>: To reduce <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n</ul>\n</li>\n<li><strong>Rate Control</strong>:\n\t\t\t\t<ul>\n<li>Medications: <strong>Digoxin, β-blockers, or rate-limiting <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> antagonists (verapamil, diltiazem)</strong>.</li>\n<li>Combination Therapy: <strong>Digoxin with β-blockers</strong>; avoid combining <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> antagonists with β-blockers.</li>\n<li>Pace and Ablate: Permanent <span class=\"customMeta\" data-dictid=\"e70797a893169277719467eb262506\">pacemaker</span> with AV nodal block for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> AF.</li>\n</ul>\n</li>\n</ul>\n<p><strong>Thromboprophylaxis</strong></p>\n<ul>\n<li>Anticoagulation: Required for stroke prevention due to blood <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> in the left atrium.\n\t\t\t\t<ul>\n<li><strong>Warfarin</strong>: INR target of 2.0–3.0; start 4 weeks prior to cardioversion.</li>\n<li><strong>DOACs: Rivaroxaban, apixaban, edoxaban, and dabigatran </strong>as alternatives to warfarin; no monitoring needed.</li>\n</ul>\n</li>\n<li>Risk Assessment:\n\t\t\t\t<ul>\n<li><strong>CHA2DS2-VASc Score</strong>: For stroke risk; anticoagulate if <strong>score ≥2</strong>. <strong>(Option C ruled out)</strong></li>\n<li>HAS-BLED Score: For <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk; monitor patients with score ≥3.</li>\n</ul>\n</li>\n<li>Aspirin: Not recommended due to low <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> in preventing <span class=\"customMeta\" data-dictid=\"acd7af7f74169277718736b038fb02\">embolic</span> stroke.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CHA2DS2-VASc stroke risk scoring system for AF</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Points</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Congestive heart failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>H</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hypertension history</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Age (≥75 years)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Diabetes mellitus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>S2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Previous stroke or <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> ischemic attack (TIA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Vascular disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Age (65-74 years)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sex category (female)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Maximum total score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>9 points</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male patient with a history of hypertension presents to the emergency department in acute distress. He is diaphoretic, tachycardic, and complains of severe chest pain. His ECG is given below. Given the patient's condition, what is the most appropriate immediate management for this patient?", "options": [{"label": "A", "text": "Amiodarone", "correct": false}, {"label": "B", "text": "Radiofrequency catheter ablation", "correct": false}, {"label": "C", "text": "Digoxin", "correct": false}, {"label": "D", "text": "Synchronized cardioversion", "correct": true}], "correct_answer": "D. Synchronized cardioversion", "question_images": ["https://image.prepladder.com/notes/8Os3hBoZQthtdGoZy4vD1744287285.png"], "explanation_images": ["https://image.prepladder.com/notes/8Os3hBoZQthtdGoZy4vD1744287285.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:683px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrial Flutter</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> is characterized by a large re-entry circuit, usually within the right atrium, encircling the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"2889a63cdd1692777181f9102ed608\">annulus</span> originating from the cavotricuspid isthmus.</li>\n</ul>\n<ul>\n<li>The atrial rate is approximately <strong>300 beats per minute</strong>.</li>\n<li>It is typically associated with 2:1, 3:1, or 4:1 AV block, resulting in <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rates of 150, 100, or 75 beats per minute.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> shows<strong> saw-tooth <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves</strong>, often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as <strong>\"F-waves.\"</strong></li>\n<li>With a 2:1 AV block, <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves may be buried in QRS complexes and T waves, making them difficult to identify.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Atrial Flutter\" data-author=\"Ewingdo\" data-hash=\"8516\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ECG_Atrial_Flutter_294_bpm.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/8Os3hBoZQthtdGoZy4vD1744287285.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> should be suspected in narrow-complex <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> at a rate of 150 beats per minute.</li>\n<li>Carotid <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> pressure or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"d3f6a49b7416927771802124ccddf0\">adenosine</span> may help reveal <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves by temporarily increasing the degree of AV block.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Rhythm Control:</strong></p>\n<ul>\n<li><strong>Acute Management:</strong>\n<ul>\n<li>Hemodynamically <strong>Unstable</strong> Patients: Synchronized <span class=\"customMeta\" data-dictid=\"f6c133a4ba1692777183c42bc77b81\">cardioversion</span> <strong>(Option D).</strong></li>\n<li><strong>Stable </strong>Patients:\n\t\t\t\t\t<ul>\n<li>Electrical <span class=\"customMeta\" data-dictid=\"f6c133a4ba1692777183c42bc77b81\">cardioversion</span> (if no <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> thrombus).</li>\n<li>Pharmacological cardioversion:\n\t\t\t\t\t\t<ul>\n<li>Antiarrhythmic drugs:\n\t\t\t\t\t\t\t<ul>\n<li>Amiodarone <strong>(Option A ruled out)</strong></li>\n<li>Class IA: Procainamide, Quinidine, Disopyramide</li>\n<li>Class IC: Flecainide, Propafenone</li>\n</ul>\n</li>\n<li>Calcium Channel Blockers: Verapamil, Diltiazem</li>\n<li>Beta-Blockers: Metoprolol, Carvedilol, Esmolol</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</li>\n<li><strong>Long-Term Management:</strong>\n<ul>\n<li>Radiofrequency <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> of the cavotricuspid isthmus. <strong>(Option B ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n<p><strong>2. Rate Control:</strong></p>\n<ul>\n<li>First-Line Agents:\n\t\t\t\t<ul>\n<li>Calcium Channel Blockers (e.g., Verapamil, Diltiazem)</li>\n<li>Beta-Blockers (e.g., Metoprolol, Carvedilol, Esmolol)</li>\n<li>Digoxin (use cautiously due to toxicity). <strong>(Option C ruled out)</strong></li>\n</ul>\n</li>\n<li>Goal: Heart rate &lt; 110 beats per minute.</li>\n</ul>\n<p><strong>3. Anticoagulation:</strong></p>\n<ul>\n<li>Assess stroke risk using the CHADS2-VASC score:</li>\n<li>Anticoagulation Recommendations:\n\t\t\t\t<ul>\n<li>2 or more points: Strong recommendation for anticoagulation.</li>\n<li>1 point: Consider either <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> or full anticoagulation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman presents to the emergency department with fatigue, confusion, and muscle weakness. The ECG is attached below. Which of the following would be the most likely diagnosis in this patient?", "options": [{"label": "A", "text": "Hypokalemia", "correct": false}, {"label": "B", "text": "Hypercalcemia", "correct": true}, {"label": "C", "text": "Hypothyroidism", "correct": false}, {"label": "D", "text": "Hypomagnesemia", "correct": false}], "correct_answer": "B. Hypercalcemia", "question_images": ["https://image.prepladder.com/notes/GizsFmQDFJC8ML8Gs3pF1744288048.png"], "explanation_images": ["https://image.prepladder.com/notes/GizsFmQDFJC8ML8Gs3pF1744288048.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Abnormality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>ECG Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Prolonged QT Interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Congenital Long QT Syndrome</li>\n<li>Acquired causes:</li>\n</ul>\n<p>- <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">Electrolyte</span> disturbances (hypokalemia, hypocalcemia, hypomagnesemia) <strong>(Option A and Option D ruled out)</strong></p>\n<p>- Medications (antiarrhythmics, antipsychotics, antibiotics)</p>\n<p>- Bradycardia</p>\n<p>- <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">Hypothyroidism</span> <strong>(Option C ruled out)</strong></p>\n<p>- Hypothermia</p>\n<p>- Myocardial ischemia</p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>QTc &gt; 440 ms in males or &gt; 460 ms in females</li>\n<li>T wave abnormalities (broad, notched, or low amplitude)</li>\n<li>Increased risk of Torsades <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> Pointes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Shortened QT Interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Congenital Short QT Syndrome</li>\n<li>Acquired causes:</li>\n</ul>\n<p>- <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">Hypercalcemia</span> <strong>(Option B)</strong></p>\n<p>- Hyperkalemia</p>\n<p>- Hyperthermia</p>\n<p>- Acidosis</p>\n<p>- <span class=\"customMeta\" data-dictid=\"508c1bf22216927771860525d4ef6f\">Digoxin</span> effect (not toxicity)</p>\n<p>- Increased <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> tone</p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>QTc &lt; 330 ms</li>\n<li>Tall, peaked T waves</li>\n<li>Absent or very short ST segment</li>\n<li>Increased risk of atrial and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> arrhythmias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>QT Dispersion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> or infarction</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy</li>\n<li>Electrolyte imbalances</li>\n<li>Autonomic dysfunction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Difference between the longest and shortest QT interval &gt; 50 ms across all 12 leads</li>\n<li>Associated with increased risk of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> arrhythmias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>T Wave Alternans</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Severe heart disease</li>\n<li>Electrolyte imbalances</li>\n<li>Long QT syndrome</li>\n<li>Acute myocardial ischemia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Beat-to-beat <span class=\"customMeta\" data-dictid=\"8fbf8fc4a41692777181e55767aeab\">alternation</span> in T wave amplitude, morphology, or polarity</li>\n<li>May be visible or <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> (requiring special <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> processing)</li>\n<li>Associated with increased risk of sudden <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> death</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man is brought to the emergency department with confusion and muscle weakness. His laboratory results show a serum potassium level of 7.2 mEq/L. Which of the following T-wave morphologies is most likely to be seen on this patient's ECG?", "options": [{"label": "A", "text": "No options available", "correct": false}], "correct_answer": "Unknown", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/oaRXrbgA2zGNkkHwvGf81744288381.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>T-wave Abnormality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Associated Conditions and Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Peaked T-waves</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Hyperkalemia: Narrow, pointed, and tall T-waves</li>\n<li>Hyperacute phase of myocardial infarction: Broad-based, asymmetric T-waves</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy: Tall T-waves in precordial leads</li>\n<li>Prinzmetal angina: Tall, pointed T-waves during chest pain</li>\n<li>Normal variant: Especially in V2-V4 in young patients and athletes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Inverted T-waves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Myocardial ischemia: Symmetrically inverted T-waves</li>\n<li>Wellens syndrome: Deeply inverted or <span class=\"customMeta\" data-dictid=\"d2d6148c9e16927771833a65ad15d2\">biphasic</span> T-waves in V2-V4</li>\n<li>Cerebrovascular injury: Deep, symmetrically inverted T-waves (cerebral T-waves)</li>\n<li>Hypertrophic cardiomyopathy: Deep T-wave inversions in <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> precordial leads</li>\n<li>Pulmonary embolism: T-wave <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> in III, aVF (as part of S1Q3T3 pattern)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Flattened T-waves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Hypokalemia: Flattened T-waves, sometimes with prominent U waves</li>\n<li>Hypothyroidism: Low amplitude, flattened T-waves</li>\n<li>Digoxin effect: Flattened or inverted T-waves with 'scooped' ST segments</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Other T-wave changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block: T-wave <span class=\"customMeta\" data-dictid=\"98d754de081692777186fc8119cb0c\">discordant</span> to QRS complex</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block: T-wave <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> in right precordial leads</li>\n<li>Acute pericarditis: T-wave <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> following ST-segment elevation</li>\n<li>Hypomagnesemia: Widened T-waves with flattened tops</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents to the emergency department with chest pain. His ECG is given below. Which of the following is NOT a common cause of changes seen in the ECG above?", "options": [{"label": "A", "text": "Acute myocardial infarction", "correct": false}, {"label": "B", "text": "Pericarditis", "correct": false}, {"label": "C", "text": "Left ventricular hypertrophy", "correct": false}, {"label": "D", "text": "Hypokalemia", "correct": true}], "correct_answer": "D. Hypokalemia", "question_images": ["https://image.prepladder.com/notes/qBmh4xM6aZVfPLbK4Q171744289148.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>ST elevation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>ST depression</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute myocardial infarction<strong> (Option A ruled out)</strong></li>\n<li>Early <span class=\"customMeta\" data-dictid=\"40451a27bd1692777197d6c276d0bc\">repolarization</span> (normal variant) </li>\n<li>Pericarditis<strong> (Option B ruled out)</strong></li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> in V1–V3 leads <strong>(Option C ruled out)</strong></li>\n<li>Left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block in V1–V3 leads.</li>\n<li>Ventricular aneurysm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myocardial ischemia</li>\n<li>Hypokalemia </li>\n<li>Digitalis effect </li>\n<li>Reciprocal changes in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> MI</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> in V5, V6, I, aVL leads. </li>\n<li>Left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block in I, aVL, V5–V6 leads.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old man presents to the emergency department with palpitations and lightheadedness. His ECG shows a rapid, regular rhythm with a rate of 150 beats per minute as shown below Which of the following conditions is most likely to be associated with this ECG finding?", "options": [{"label": "A", "text": "Ventricular tachycardia", "correct": false}, {"label": "B", "text": "AV nodal re-entrant tachycardia", "correct": true}, {"label": "C", "text": "Wolf-Parkinson-White syndrome", "correct": false}, {"label": "D", "text": "Hypothermia", "correct": false}], "correct_answer": "B. AV nodal re-entrant tachycardia", "question_images": ["https://image.prepladder.com/notes/owrR9pwloLEn3Kg6bdva1744289358.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of QRS Complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Narrow QRS complex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AV nodal re-entrant tachycardia, AV <span class=\"customMeta\" data-dictid=\"76dc70e5b41692777197c065e8ab62\">reentrant tachycardia</span> (Orthodromic)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Broad QRS complex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ventricular tachycardia, Torsades <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> Pointes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delta Wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wolf-Parkinson-White syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>J wave/Osbourne wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypothermia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epsilon wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arrhythmogenic right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> dysplasia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following tachyarrhythmias with their most appropriate initial treatment: Tachyarrhythmia Treatment Atrial Fibrillation A. Intravenous Adenosine Stable Monomorphic Ventricular Tachycardia B. Synchronized Cardioversion Torsades de Pointes C. Intravenous Magnesium Sulfate Supraventricular Tachycardia (AVNRT) D. Intravenous Amiodarone", "options": [{"label": "A", "text": "1-B, 2-D, 3-C, 4-A", "correct": true}, {"label": "B", "text": "1-B, 2-A, 3-D, 4-C", "correct": false}, {"label": "C", "text": "1-D, 2-B, 3-A, 4-C", "correct": false}, {"label": "D", "text": "1-A, 2-C, 3-B, 4-D", "correct": false}], "correct_answer": "A. 1-B, 2-D, 3-C, 4-A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:562px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrial fibrillation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Esmolol/ Ibutilide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrial flutter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Esmolol/ Ibutilide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AV nodal <span class=\"customMeta\" data-dictid=\"76dc70e5b41692777197c065e8ab62\">reentrant tachycardia</span> (AVNRT)/PSVT </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention: Verapamil</li>\n<li>Unstable: Adenosine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wolff Parkinson White (WPW) syndrome </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention: Flecainide</li>\n<li>Drug of choice: Procainamide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Post MI: Lignocaine</li>\n<li>Stable: Amiodarone</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular bigeminy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lignocaine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Torsades <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> Pointes (TDP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Magnesium sulphate</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman presents to the emergency department with palpitations and lightheadedness. She has a history of hypertension and is on multiple medications. Her ECG is given below: Which of the following is the most appropriate immediate management for this patient?", "options": [{"label": "A", "text": "Administer intravenous amiodarone", "correct": false}, {"label": "B", "text": "Perform immediate electrical cardioversion", "correct": false}, {"label": "C", "text": "Administer intravenous magnesium sulfate", "correct": true}, {"label": "D", "text": "Start oral beta-blocker therapy", "correct": false}], "correct_answer": "C. Administer intravenous magnesium sulfate", "question_images": ["https://image.prepladder.com/notes/brHfnJOVBoKTKGYsP9qv1744289551.png"], "explanation_images": ["https://image.prepladder.com/notes/zskszaHKCBB0BxEGy0Tf1744289653.png", "https://image.prepladder.com/notes/gH2hBNlFPyLrhfUw5RiU1744290272.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with a history of prior myocardial infarction presents to the emergency department with severe palpitations, dizziness, and chest pain. His blood pressure is 80/50 mmHg, and he appears diaphoretic and confused. An ECG shows wide QRS complexes, a regular rhythm, and a ventricular rate of 160 bpm. What is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Intravenous Adenosine", "correct": false}, {"label": "B", "text": "Intravenous Magnesium Sulfate", "correct": false}, {"label": "C", "text": "Synchronized Cardioversion", "correct": true}, {"label": "D", "text": "Intravenous Procainamide", "correct": false}], "correct_answer": "C. Synchronized Cardioversion", "question_images": ["https://image.prepladder.com/notes/ZkD9SOcxEPJ8VfvZcfvp1744290461.png"], "explanation_images": ["https://image.prepladder.com/notes/ZkD9SOcxEPJ8VfvZcfvp1744290461.png", "https://image.prepladder.com/notes/EEC1jxYueX0KQBFBQgta1744290614.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Consider the following statements regarding Wolff-Parkinson-White (WPW) syndrome: WPW syndrome is characterized by the presence of an accessory pathway between the atria and ventricles. The classic ECG findings in WPW syndrome include a prolonged PR interval, delta waves, and narrow QRS complexes. Orthodromic AVRT in WPW syndrome always presents with a wide QRS complex tachycardia. A premature ventricular complex (PVC) can initiate AVRT in patients with WPW syndrome. Which of the following options correctly identifies the true statements?", "options": [{"label": "A", "text": "1 and 4 only", "correct": true}, {"label": "B", "text": "2 and 3 only", "correct": false}, {"label": "C", "text": "4 only", "correct": false}, {"label": "D", "text": "1, 2, 3, and 4", "correct": false}], "correct_answer": "A. 1 and 4 only", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4SACi7SNGON8nT5ARMFN1744290914.png", "https://image.prepladder.com/notes/EEWdTJ2mVPB2sorL1TUJ1744291016.png", "https://image.prepladder.com/notes/3jcRKP4TGkMgjnFarJVb1744291119.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female presents with sudden onset palpitations. ECG is taken and given below. It shows a narrow complex tachycardia at 180 bpm. The postgraduate successfully terminates the arrhythmia using the Valsalva maneuver. Which of the following best describes the primary mechanism by which this maneuver terminates the arrhythmia?", "options": [{"label": "A", "text": "Direct stimulation of the sinoatrial node", "correct": false}, {"label": "B", "text": "Increased sympathetic tone to the heart", "correct": false}, {"label": "C", "text": "Transient block in AV node conduction", "correct": true}, {"label": "D", "text": "Mechanical disruption of accessory pathways", "correct": false}], "correct_answer": "C. Transient block in AV node conduction", "question_images": ["https://image.prepladder.com/notes/jpArG0cgEQTT8NQvui7g1744291357.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute termination:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Vagal maneuvers (e.g., Valsalva, <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> massage)</strong></li>\n<li>If <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> maneuvers fail, <strong>IV adenosine</strong> is the first-line pharmacological treatment: 6 mg - 12mg fast iv push.</li>\n<li>Alternative drugs: verapamil, diltiazem, or beta-blockers</li>\n<li>Synchronized <span class=\"customMeta\" data-dictid=\"f6c133a4ba1692777183c42bc77b81\">cardioversion</span> for hemodynamically unstable patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long-term management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Catheter ablation: Often curative, especially for AVNRT and AVRT</li>\n<li>Pharmacological therapy:\n\t\t\t\t<ul>\n<li>Beta-blockers or <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers for prevention</li>\n<li>Class <span class=\"customMeta\" data-dictid=\"e02c7dfea516927771894c64e8013a\">IC</span> or III <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">antiarrhythmic</span> drugs in selected cases</li>\n</ul>\n</li>\n<li>Patient education on performing <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> maneuvers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle modifications:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Avoid triggers (e.g., caffeine, alcohol, stress)</li>\n<li>Regular exercise</li>\n<li>Adequate sleep</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man comes to your clinic for a routine check-up. He has no significant past history, exercises regularly, and reports no chest pain, palpitations, or shortness of breath. On physical examination, his blood pressure is 130/80 mmHg, and his pulse rate is 75 beats per minute and regular. You perform an ECG as part of the screening, shown below. What is the most likely finding based on this ECG?", "options": [{"label": "A", "text": "Left ventricular hypertrophy", "correct": false}, {"label": "B", "text": "Normal sinus rhythm", "correct": true}, {"label": "C", "text": "First-degree AV block", "correct": false}, {"label": "D", "text": "Right bundle branch block", "correct": false}], "correct_answer": "B. Normal sinus rhythm", "question_images": ["https://image.prepladder.com/notes/SnTZQN7Q2CW4eYSWlZHF1744273136.png"], "explanation_images": ["https://image.prepladder.com/notes/po29uJYsibgNKtgUoYe11744273641.png", "https://image.prepladder.com/notes/qhOBKA8LHKuu9LVy07V61744273668.png", "https://image.prepladder.com/notes/v519kNbCZ0oXLDXeBYhR1744273701.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Duration and Size </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atrial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> is initiated by the SA node.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>0.08–0.11 seconds</li>\n<li>2–2.75 small boxes</li>\n<li>&lt;2.5 mm (0.25 mV) in amplitude/ height</li>\n<li>&lt;0.12 sec (120 <span class=\"customMeta\" data-dictid=\"324240732616927771930d34d9e907\">msec</span> or 3 small boxes) in width</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PR interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Time from onset of atrial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> (P wave) to onset of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> (electrical impulse passing through AV node)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>0.12–0.20 seconds</li>\n<li>3–5 small boxes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Q wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> of the <span class=\"customMeta\" data-dictid=\"769fa5be3616927771906f8ae8b053\">interventricular</span> septum, directed from left to right.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&lt;0.04 seconds</li>\n<li>&lt;1 small box</li>\n<li>Depth: &lt;1/4 of R wave or ~1–2 mm (&lt;0.5 small boxes)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>QRS complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ventricular <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> - the time taken for the electrical impulse to spread through the ventricles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&lt;0.10 seconds</li>\n<li>&lt;2.5 small boxes in width</li>\n<li>Height: 5–30 mm (1–6 big boxes)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>QT interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Time from the start of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> to the end of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> repolarization.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duration depends on HR.</li>\n<li>HR inversely proportional QT length. Rate-corrected (QTc) 330–350 msec</li>\n<li>~11 small boxes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ST segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Represents the early part of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> repolarization. It is <span class=\"customMeta\" data-dictid=\"95f7d4c24d16927771904b4278640d\">isoelectric</span> (flat).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>0.08–0.12 seconds</li>\n<li>2–3 small boxes</li>\n<li>Normally <span class=\"customMeta\" data-dictid=\"95f7d4c24d16927771904b4278640d\">isoelectric</span> (flat), deviations &gt;1 small box indicate pathology</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Represents the later stage of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> repolarization.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&lt;0.04 seconds</li>\n<li>2.5–6.25 small boxes</li>\n<li>Height: Varies. Normally &lt;5 mm (1 big box) in limb leads, &lt;10 mm (2 big boxes) in precordial leads</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>U wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unknown origin; possibly related to <span class=\"customMeta\" data-dictid=\"40451a27bd1692777197d6c276d0bc\">repolarization</span> of Purkinje fibers or <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> walls.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Not always measurable</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old patient is diagnosed with severe bradycardia and is scheduled for a pacemaker implantation. The electrophysiologist is evaluating different types of artificial pacemakers. Where are the leads of the single-lead and dual-lead pacemakers placed in the heart?", "options": [{"label": "A", "text": "Single-lead: Right ventricle; Dual-lead: Right atrium and right ventricle", "correct": true}, {"label": "B", "text": "Single-lead: Right atrium; Dual-lead: Right ventricle and left ventricle", "correct": false}, {"label": "C", "text": "Single-lead: Left ventricle; Dual-lead: Right atrium and left ventricle", "correct": false}, {"label": "D", "text": "Single-lead: Right ventricle; Dual-lead: Left ventricle and right ventricle", "correct": false}], "correct_answer": "A. Single-lead: Right ventricle; Dual-lead: Right atrium and right ventricle", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/LM5qRD8KlgG0dekfCCUL1744292826.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 74-year-old patient comes to the emergency department with complaints of intermittent dizziness and lightheadedness. An electrocardiogram (ECG) is performed, as shown below. Based on the ECG findings and the clinical scenario, what type of atrioventricular block is most likely present in this patient?", "options": [{"label": "A", "text": "2:1 AV block (Type I - Wenckebach)", "correct": false}, {"label": "B", "text": "2:1 AV block (Type II - Infranodal)", "correct": true}, {"label": "C", "text": "First-degree AV block", "correct": false}, {"label": "D", "text": "Third-degree AV block", "correct": false}], "correct_answer": "B. 2:1 AV block (Type II - Infranodal)", "question_images": ["https://image.prepladder.com/notes/PWN58QuqSXjrnJOyy0zb1744292977.png"], "explanation_images": ["https://image.prepladder.com/notes/EI0vFL7GhILimAmeEvCW1744293101.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2:1 <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">Atrioventricular</span> Block</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>2:1 <span class=\"customMeta\" data-dictid=\"78a0565f7316927771827e4aca866c\">AV block</span> occurs when every other P wave is not conducted to the ventricles, resulting in missed QRS complexes.</li>\n<li>It can arise from either the <span class=\"customMeta\" data-dictid=\"93722e23b31692777182e48d478f12\">AV node</span> (nodal) or the <span class=\"customMeta\" data-dictid=\"84383ec8c3169277718963211ba7ce\">His-Purkinje system</span> (infranodal).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nodal (Type I - Wenckebach):</strong> Results from impaired <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> in the AV node, which can be influenced by <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> and <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> tone. Characterized by progressively prolonged PR intervals before a dropped beat; usually benign.</li>\n<li><strong>Infranodal Block (Type II):</strong> Indicates a <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the His-Purkinje system, where interventions affecting the <span class=\"customMeta\" data-dictid=\"93722e23b31692777182e48d478f12\">AV node</span> will not alter the block. It is less affected by <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> interventions. PR interval remains normal with a dropped beat; often requires a permanent pacemaker.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Every other P wave is not followed by a QRS complex.</li>\n<li>In Type I, the PR interval is progressively prolonged, and the QRS complex is narrow.</li>\n<li>In Type II, the PR interval is normal, and the QRS complex is prolonged.</li>\n<li>A narrow QRS with <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">Type I</span> suggests AV nodal block, while a wide QRS indicates <span class=\"customMeta\" data-dictid=\"c84d27695c1692777190b79260039a\">infranodal</span> involvement.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Second degree AV block\" data-author=\"Npatchett\" data-hash=\"8589\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Heart_block.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/EI0vFL7GhILimAmeEvCW1744293101.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Maneuvers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Carotid <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> Massage/Adenosine:</strong> Slows the <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> rate, potentially unmasking PR interval changes indicative of Type I.</li>\n<li><strong>Atropine Administration:</strong> Enhances AV conduction; can resolve <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">Type I</span> block.</li>\n<li><strong>Exercise Testing: </strong>Also enhances AV conduction, potentially eliminating <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">Type I</span> block.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Type II block typically requires <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> of a permanent pacemaker.</li>\n<li>In cases of His-Purkinje disease, <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> may worsen the degree of block.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old man presents to the emergency department with severe fatigue, dizziness, and episodes of syncope. His medical history includes hypertension and a prior myocardial infarction. ECG of the patient is given below. What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Oral beta-blockers", "correct": false}, {"label": "B", "text": "Intravenous atropine", "correct": true}, {"label": "C", "text": "Permanent pacemaker placement", "correct": false}, {"label": "D", "text": "Observation only", "correct": false}], "correct_answer": "B. Intravenous atropine", "question_images": ["https://image.prepladder.com/notes/3YwcIDfjGiSo4jHpGOPT1744293499.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Third-Degree <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">Atrioventricular</span> Block</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete loss of communication between the <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> and ventricles.</li>\n<li>SA <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> activity continues independently, but impulses do not reach the ventricles.</li>\n<li>Atrial and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> activities are completely dissociated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common causes include <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> fibrosis, structural heart disease, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> ischemia, medication toxicity, and post-surgical effects.</li>\n<li>Associated conditions: Lyme disease, <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disorders, and myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (especially <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> wall MI).</li>\n<li>Risk factors include diabetes, hypertension, and prior <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> diseases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms may include fatigue, chest pain, shortness of breath, and syncope.</li>\n<li>Patients often exhibit <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> and may show signs of <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> instability.</li>\n<li>Physical exam may reveal cannon A-waves due to simultaneous atrial and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> contractions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by complete <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">atrioventricular</span> dissociation.</li>\n<li>The atrial rate is faster than the <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rate.</li>\n<li>ECG shows independent P waves and QRS complexes with no relationship between them.</li>\n<li>P-P interval and R-R interval is constant but there is no <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777199b2d38b34f3\">synchrony</span> between P-R.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Third-Degree &lt;span class=\" custommeta\"=\"\" data-dictid=\"d77b211e3a1692777182121ece27fc\"/>Atrioventricular Block <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> features\" data-author=\"James Heilman, MD\" data-hash=\"8599\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Third-degree_atrioventricular_block\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/D6nk8lt9Rq1xAHWpLGoA1744293577.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial management may include <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <strong>atropine</strong>.</li>\n<li>Patients typically require <strong>pacing, either temporary (transcutaneous or transvenous) or permanent <span class=\"customMeta\" data-dictid=\"e70797a893169277719467eb262506\">pacemaker</span> placement.</strong></li>\n<li>Urgent <span class=\"customMeta\" data-dictid=\"61d68435aa1692777185d5e4ccda1d\">consultation</span> with <span class=\"customMeta\" data-dictid=\"498d1d322616927771831c4a35e399\">cardiology</span> and <span class=\"customMeta\" data-dictid=\"b542627d2d1692777187ab167fa576\">electrophysiology</span> is advised for further management.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male patient presents to the emergency department with complaints of fatigue and occasional lightheadedness. He has a history of hypertension and coronary artery disease. During the examination, he describes episodes of near-syncope. The physician performs an ECG to evaluate his symptoms. What is the most likely diagnosis based on the ECG findings?", "options": [{"label": "A", "text": "First-degree heart block", "correct": false}, {"label": "B", "text": "Mobitz Type I", "correct": false}, {"label": "C", "text": "Mobitz Type II", "correct": true}, {"label": "D", "text": "Complete heart block", "correct": false}], "correct_answer": "C. Mobitz Type II", "question_images": ["https://image.prepladder.com/notes/Ml5euCB0AqLafRegWEzn1744293716.png"], "explanation_images": ["https://image.prepladder.com/notes/nDQa8ZoRy45tVyznx5mH1744293771.png", "https://image.prepladder.com/notes/nHmsBZFQIwPACHjGe2ff1744293844.png", "https://image.prepladder.com/notes/2g4GWM9F8U23vilNYHXJ1744293945.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mobitz <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">Type I</span> (Wenckebach)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mobitz Type II</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Progressive prolongation of PR interval until dropped beat.</li>\n<li>PR interval longest before dropped beat.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Constant PR interval until a P wave is not followed by a QRS complex.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Normal variant; high <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> tone; <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> ischemia; medication toxicity; post-surgery.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Associated with structural heart disease; myocardial ischemia; fibrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Often asymptomatic;</p>\n<p>May cause <span class=\"customMeta\" data-dictid=\"9f04fb3f2f1692777199272e3daf84\">syncope</span> or lightheadedness.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Symptoms include fatigue, dyspnea, chest pain;</p>\n<p>Can progress to complete heart block.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PR interval progressively lengthens</strong> before a <strong>dropped beat</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Mobitz type I\" data-author=\"Npatchett\" data-hash=\"8606\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Heart_block.png\" data-tags=\"April2025\" height=\"120\" src=\"https://image.prepladder.com/notes/nHmsBZFQIwPACHjGe2ff1744293844.png\" width=\"258\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Constant PR </strong>interval;</p>\n<p>May have <strong>widened QRS </strong>complex.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Mobitz type II\" data-author=\"Npatchett\" data-hash=\"8608\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Heart_block.png\" data-tags=\"April2025\" height=\"110\" src=\"https://image.prepladder.com/notes/2g4GWM9F8U23vilNYHXJ1744293945.png\" width=\"175\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Usually no treatment needed; may use <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> if symptomatic.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Requires immediate pacing; often necessitates a permanent pacemaker.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old woman comes to the clinic for a routine follow-up. She has a history of mild hypertension, which is well-controlled with medication. She reports no symptoms such as palpitations, dizziness, or chest pain. An ECG of the patient is given below. What is the most likely diagnosis based on the ECG findings?", "options": [{"label": "A", "text": "Second-Degree AV Block", "correct": false}, {"label": "B", "text": "First-Degree AV Block", "correct": true}, {"label": "C", "text": "Third-Degree AV Block", "correct": false}, {"label": "D", "text": "Bundle Branch Block", "correct": false}], "correct_answer": "B. First-Degree AV Block", "question_images": ["https://image.prepladder.com/notes/v5JKs8dFkEM8WNBkphl31744281856.png"], "explanation_images": ["https://image.prepladder.com/notes/eEWnMSGw9qyGAYMXgVyt1744281928.png", "https://image.prepladder.com/notes/CjotVXQ5I91lFEU6VZ6d1744281972.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First Degree AV Block</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First-degree <span class=\"customMeta\" data-dictid=\"78a0565f7316927771827e4aca866c\">AV block</span> is characterized by a prolonged PR interval (&gt;0.20 seconds) without <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> from <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> to ventricles.</li>\n<li>The delay typically occurs in the AV node, but may also involve the atria, His bundle, or Purkinje fibers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly attributed to increased <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> tone in younger patients.</li>\n<li>In older patients, often due to fibrotic changes in the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> system.</li>\n<li>Other causes include <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> heart disease, myocardial infarction, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> abnormalities, inflammation, infections, certain drugs, <span class=\"customMeta\" data-dictid=\"3107ad472c16927771900477b8dae0\">infiltrative</span> diseases, <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases, and <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> degenerative diseases.</li>\n<li>Lymes disease, Chagas disease, Diphtheria, <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis, Scleroderma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually asymptomatic; patients are often unaware of the condition until discovered on an ECG.</li>\n<li>In cases where the PR interval exceeds 0.30 seconds, symptoms may resemble \"pacemaker syndrome,\" including dyspnea, malaise, lightheadedness, and chest pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is confirmed by a PR interval greater than 0.20 seconds on an ECG.</li>\n<li>PR interval can be marked (&gt;0.30 seconds) in some cases, and P waves may appear within preceding T waves.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"First-Degree AV Block\" data-author=\"Npatchett\" data-hash=\"8459\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Heart_block.png\" data-tags=\"April2025\" height=\"167\" src=\"https://image.prepladder.com/notes/eEWnMSGw9qyGAYMXgVyt1744281928.png\" width=\"353\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generally, no treatment is required; routine observation is sufficient.</li>\n<li>Pacemaker placement may be considered for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients with PR interval &gt;0.30 seconds or those with coexisting heart disease.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">antiarrhythmic</span> medications are indicated, and surveillance with routine ECGs is recommended to monitor for worsening.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presents with recurrent palpitations and dizziness. An ECG of the patient is given below. Which of the following statements is true regarding this patient's diagnosis?", "options": [{"label": "A", "text": "He is at risk for pre-excited atrial fibrillation leading to dangerously fast ventricular rates", "correct": true}, {"label": "B", "text": "The accessory pathway is the Bundle of James, facilitating rapid conduction.", "correct": false}, {"label": "C", "text": "The ECG shows a short PR interval, normal QRS, and no delta wave", "correct": false}, {"label": "D", "text": "Adenosine is contraindicated in this condition", "correct": false}], "correct_answer": "A. He is at risk for pre-excited atrial fibrillation leading to dangerously fast ventricular rates", "question_images": ["https://image.prepladder.com/notes/RjnMFXkGXsJtetXUTP1Y1744281432.jpg"], "explanation_images": ["https://image.prepladder.com/notes/ovgZc6Vl7y17kjCbdCc11744281593.jpg", "https://image.prepladder.com/notes/RHJ36fVyOZ1rnfj00dqc1744281653.png", "https://image.prepladder.com/notes/gyhiyIsKh93yX0qhPQXX1744281703.png", "https://image.prepladder.com/notes/plwXICbxUP8HU3X65HGO1744281751.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:779px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wolff-Parkinson-White (WPW) Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lown-Ganong-Levine (LGL) Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accessory pathways (APs) known as the <strong>Bundle of Kent </strong>are the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> tissue bands connecting the <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> and ventricles. <strong>(Option B ruled out)</strong></li>\n<li>They allow <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> outside the AV node, either <span class=\"customMeta\" data-dictid=\"c6a42ea838169277718174ef9e8817\">antegrade</span> or <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> (in concealed APs), bypassing the normal <span class=\"customMeta\" data-dictid=\"0aded9f3231692777182ec1d089af8\">AV conduction</span> system.</li>\n<li>Present from birth, they result from incomplete <span class=\"customMeta\" data-dictid=\"cb8fd56be41692777194c32e1c1dd7\">partitioning</span> of the <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> and <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> by the <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> AV rings.</li>\n<li>Associated with Ebstein’s anomaly, hypertrophic cardiomyopathy, PRKAG2 mutations, Danon’s disease, and Fabry’s disease.</li>\n<li><strong>Accessory <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> connects to <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> myocardium.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>LGL is a type of <span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\">paroxysmal</span> <span class=\"customMeta\" data-dictid=\"619efd9f7b169277719928c9441919\">supraventricular</span> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> (SVT) characterized by a short PR interval and a normal QRS duration.</li>\n<li>It involves an <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> called the <strong>Bundle of James </strong>that allows rapid <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> between the <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> and ventricles, often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to the <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">atrioventricular</span> (AV) node.</li>\n<li><strong>Accessory <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> bypasses the normal <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> and connects to BOH.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common arrhythmias include narrow-complex <span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\">paroxysmal</span> <span class=\"customMeta\" data-dictid=\"619efd9f7b169277719928c9441919\">supraventricular</span> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> (PSVT), wide-complex tachycardias, and rarely, sudden death.</li>\n<li>Tachycardia may develop due to re-entry circuits, causing <span class=\"customMeta\" data-dictid=\"f6a1e09a851692777194bfd6641ed3\">orthodromic</span> or <span class=\"customMeta\" data-dictid=\"d51c7017151692777181946bfeea9f\">antidromic</span> AV re-entry tachycardias (AVRT).</li>\n<li>Pre-excited <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> (AF) can occur, leading to a dangerously fast <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rate, syncope, or collapse, requiring urgent treatment.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients may experience episodes of palpitations, dizziness, or syncope.</li>\n<li>Symptoms can vary in frequency and intensity; some may have mild symptoms while others experience significant distress.</li>\n<li>Episodes may be <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by stress, caffeine, or exertion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Short PR interval (&lt;0.12 s), wide QRS complex, and <span class=\"customMeta\" data-dictid=\"f7d3133242169277718518c059ad55\">delta</span> wave </strong>(slurred upstroke of the QRS). <strong>(Option C ruled out)</strong></li>\n<li>QRS and <span class=\"customMeta\" data-dictid=\"f7d3133242169277718518c059ad55\">delta</span> wave <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> depend on the <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> location:\n\t\t\t\t<ul>\n<li>Right-sided AP: <span class=\"customMeta\" data-dictid=\"0a89512f961692777191c1515a8adc\">LBBB</span> pattern (lead V1).</li>\n<li>Left-sided AP: <span class=\"customMeta\" data-dictid=\"8407059e5116927771971afbd677de\">RBBB</span> pattern (lead V1), negative <span class=\"customMeta\" data-dictid=\"f7d3133242169277718518c059ad55\">delta</span> wave in aVL (can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall infarction).</li>\n<li>Posteroseptal AP: Negative <span class=\"customMeta\" data-dictid=\"f7d3133242169277718518c059ad55\">delta</span> wave in leads III and aVF (mimicking <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> wall infarction).</li>\n</ul>\n</li>\n<li>Preexcitation may disappear during exercise.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Short PR interval</strong> (typically less than 120 ms).</li>\n<li><strong>Normal QRS </strong>complexes (narrow QRS).</li>\n<li>The <strong>absence of a <span class=\"customMeta\" data-dictid=\"f7d3133242169277718518c059ad55\">delta</span> wave </strong>(unlike in Wolff-Parkinson-White syndrome).</li>\n<li>May show <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> during episodes of SVT, often with a regular rhythm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Wolff-Parkinson-White (WPW) Syndrome\" data-author=\"James Heilman, MD - Own work\" data-hash=\"8450\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Wolff%E2%80%93Parkinson%E2%80%93White_syndrome\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ovgZc6Vl7y17kjCbdCc11744281593.jpg\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Lown-Ganong-Levine (LGL) Syndrome\" data-author=\"Juanita Hunter, Emmanouil Tsounias, John Cogan, and Ming-Lon Young - Hunter et al\" data-hash=\"8451\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Lown%E2%80%93Ganong%E2%80%93Levine_syndrome\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/RHJ36fVyOZ1rnfj00dqc1744281653.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute management: <strong>Carotid <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> pressure or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> adenosine</strong> can terminate the tachycardia. <strong>(Option D ruled out)</strong></li>\n<li>For pre-excited AF, <strong>urgent DC cardioversion</strong> is recommended due to the risk of collapse or death.</li>\n<li>Definitive treatment: <strong>Catheter <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> </strong>is first-line and <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> in most cases.</li>\n<li>Medications: <strong>Flecainide or propafenone </strong>can be used as alternatives but are less preferred.</li>\n<li>Avoid digoxin, verapamil, and amiodarone due to adverse effects on <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> conduction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute Management:\n\t\t\t\t<ul>\n<li><strong>Vagal maneuvers </strong>(e.g., Valsalva maneuver) can terminate <span class=\"customMeta\" data-dictid=\"f55348336516927771992c64305eca\">SVT</span> episodes.</li>\n<li><strong>Adenosine </strong>may be used for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of tachycardia.</li>\n</ul>\n</li>\n<li>Chronic Management:\n\t\t\t\t<ul>\n<li><strong>Beta-blockers or <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers</strong> may be prescribed for prevention.</li>\n<li><strong>Catheter ablation</strong> can be considered in cases of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> or <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> episodes.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Wolff-Parkinson-White (WPW) Syndrome\" data-author=\"Tom Lück\" data-hash=\"8452\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Wolff%E2%80%93Parkinson%E2%80%93White_syndrome\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/gyhiyIsKh93yX0qhPQXX1744281703.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Lown-Ganong-Levine (LGL) Syndrome\" data-author=\"\" data-hash=\"8454\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"209\" src=\"https://image.prepladder.com/notes/plwXICbxUP8HU3X65HGO1744281751.png\" width=\"209\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male presents to the emergency department with palpitations and lightheadedness. He has no significant past medical history and is otherwise healthy. After a thorough examination, an ECG is obtained. Based on the patient’s presentation and the findings of the ECG, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Atrial Fibrillation", "correct": false}, {"label": "B", "text": "Wolff-Parkinson-White (WPW) Syndrome", "correct": true}, {"label": "C", "text": "First-degree AV Block", "correct": false}, {"label": "D", "text": "Myocardial Infarction", "correct": false}], "correct_answer": "B. Wolff-Parkinson-White (WPW) Syndrome", "question_images": ["https://image.prepladder.com/notes/AcbTgEA8aykCQWud35uP1744281100.jpg"], "explanation_images": ["https://image.prepladder.com/notes/AcbTgEA8aykCQWud35uP1744281100.jpg", "https://image.prepladder.com/notes/BBimmv34cLYWWvgjzsrX1745563294.png", "https://image.prepladder.com/notes/RnAfdScRMo7P16DKeEl31744281227.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman presents with progressive fatigue, palpitations, and mild dyspnea on exertion. She has a known history of a congenital heart condition diagnosed in childhood but has not had regular follow-ups. On examination, there is a prominent jugular venous pulse and a soft systolic murmur at the left lower sternal border. A 12-lead ECG was done and it is given below. What is the most likely cause of the abnormal P waves on her ECG?", "options": [{"label": "A", "text": "Ebstein’s Anomaly", "correct": true}, {"label": "B", "text": "Hyperkalemia", "correct": false}, {"label": "C", "text": "Atrial flutter", "correct": false}, {"label": "D", "text": "Mitral stenosis", "correct": false}], "correct_answer": "A. Ebstein’s Anomaly", "question_images": ["https://image.prepladder.com/notes/pznPCL1JYd6oGUxczZHf1744294979.png"], "explanation_images": ["https://image.prepladder.com/notes/anca6VZ6vnQYVPEr0OaA1744280654.png", "https://image.prepladder.com/notes/LgFgnLgs6NUCSpPzGmlS1744280693.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal P Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right <span class=\"customMeta\" data-dictid=\"425c9b69db1692777182955542b3b0\">Atrial Enlargement</span> (</strong><strong><em>P Pulmonale</em></strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"425c9b69db1692777182955542b3b0\">Atrial Enlargement</span> (</strong><strong><em>P Mitrale</em></strong><strong>)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal atrial depolarization</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary disease</li>\n<li>Congenital heart disease</li>\n<li>Tricuspid <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disorders</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amplitude</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 2.5 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 2.5 mm (in leads II, III, aVF, sometimes V1)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be increased but less prominent than in RAA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 0.12 sec (120 ms)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal (&lt; 0.12 sec)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolonged &gt; 0.12 sec (broad P wave)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth, upright</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tall, peaked, narrow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Notched/bifid (\"M\"-shaped) in lead II</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lead II Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth and positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tall, peaked P wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Notched/bifid P wave</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lead V1 Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biphasic (small negative)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deep P wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biphasic with prominent, prolonged negative terminal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman with a history of hypertension and diabetes presents with a one-month history of mild exertional dyspnea. She denies chest pain but has noticed some occasional palpitations. Physical examination reveals a blood pressure of 140/90 mmHg and regular heart sounds. You order an ECG, which is shown below. What is the most likely diagnosis based on this ECG?", "options": [{"label": "A", "text": "Normal axis", "correct": false}, {"label": "B", "text": "Right axis deviation", "correct": false}, {"label": "C", "text": "Left axis deviation", "correct": true}, {"label": "D", "text": "Extreme axis deviation", "correct": false}], "correct_answer": "C. Left axis deviation", "question_images": ["https://image.prepladder.com/notes/SWKE82NS03KItzGLBQ621744280407.png"], "explanation_images": ["https://image.prepladder.com/notes/NDW1gSA2To95UUGbgS391744280487.png", "https://image.prepladder.com/notes/ClacVAphRLGg9gcbxMy31744295174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lead</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">Axis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">Axis</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">Deviation</span> (LAD) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">Axis</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">Deviation</span> (RAD) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lead I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (R wave &gt; S wave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (R wave &gt; S wave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative (S wave &gt; R wave)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lead II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (R wave &gt; S wave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative (S wave &gt; R wave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (R wave &gt; S wave)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lead III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (R wave &gt; S wave) or isoelectric</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative (S wave &gt; R wave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (R wave &gt; S wave)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lead aVF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (R wave &gt; S wave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative (S wave &gt; R wave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (R wave &gt; S wave)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 25 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 55-year-old man presents with gradually worsening shortness of breath and fatigue. He has a history of tuberculosis treated 10 years ago. Physical examination reveals elevated jugular venous pressure (JVP) that rises paradoxically with inspiration. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Restrictive cardiomyopathy", "correct": false}, {"label": "C", "text": "Right ventricular infarction", "correct": false}, {"label": "D", "text": "Constrictive pericarditis", "correct": true}], "correct_answer": "D. Constrictive pericarditis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Wave/ Descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Refers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>a Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> (right atrium), follows the P wave on <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> and precedes S1</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prominent in RV compliance issues</li>\n<li>Early Prominent- <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">Tricuspid</span> stenosis</li>\n<li>Late Prominent- <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">Mitral</span> stenosis</li>\n<li>Absent in atrial fibrillation</li>\n<li><strong>Cannon a waves</strong> in <span class=\"customMeta\" data-dictid=\"c6b82fe2321692777182c62220930f\">AV dissociation</span> and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> tachycardia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>x Descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fall in right atrial pressure post-a wave, reflecting atrial relaxation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dominant in normal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pulses.</li>\n<li>Prominent- <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> and <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> pericarditis</li>\n<li>Absent- <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">Tricuspid</span> Regurgitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>c Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs during <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> systole, <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> bulges into the right atrium</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seen in the <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> systole</li>\n<li>Can coincide with a <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> pulse.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>v Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Passive Atrial <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> after <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> follows S2</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prominent in <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> (TR)</li>\n<li><strong>In severe TR, </strong>the C wave may<strong> </strong><strong>merge with the V wave,</strong><strong> </strong>creating a<strong> \"</strong><strong>ventricularized</strong><strong>\" </strong><strong>waveform—a</strong><strong> giant V or CV wave</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>y Descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fall in right atrial pressure after <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> opening</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Absent </strong>in <strong>pericardial tamponade</strong></li>\n<li><strong>Prominent in </strong>constrictive pericarditis<strong> or severe TR.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is correct about grades of murmurs?", "options": [{"label": "A", "text": "Grade 1 murmur is very loud and audible even without a stethoscope", "correct": false}, {"label": "B", "text": "Grade 2 murmur is faint but audible with a stethoscope.", "correct": true}, {"label": "C", "text": "Grade 4 murmur has a loud intensity without thrill.", "correct": false}, {"label": "D", "text": "Grade 6 murmur is very faint and heard with difficulty.", "correct": false}], "correct_answer": "B. Grade 2 murmur is faint but audible with a stethoscope.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very faint, heard only with difficulty.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Faint but audible with a stethoscope.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderately loud, easily audible.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loud, with a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> thrill.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very loud, with a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> thrill, heard with the edge of the stethoscope.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extremely loud, audible without a stethoscope, with a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> thrill.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the Following Murmurs to Their Characteristics or Associated Conditions Murmurs Characteristics or Associated Conditions 1. Mitral Stenosis A. High-pitched, crescendo-decrescendo murmur best heard at the right upper sternal border. 2. Aortic Stenosis B. Holosystolic murmur radiating to the axilla, often with a displaced apical impulse. 3. Patent Ductus Arteriosus (PDA) C. Early diastolic decrescendo murmur best heard along the left sternal border. 4. Hypertrophic Cardiomyopathy D. \"Machine-like\" continuous murmur heard best at the left infraclavicular area. 5. Mitral Regurgitation E. Loud S1, opening snap, and low-pitched diastolic murmur heard best at the apex. 6. Aortic Regurgitation F. Systolic ejection murmur, often with a crescendo-decrescendo pattern, best heard at the right upper sternal border, radiating to the carotids.", "options": [{"label": "A", "text": "1 - E, 2 - F, 3 - D, 4 - A, 5 - B, 6 - C", "correct": false}, {"label": "B", "text": "1 - E, 2 - F, 3 - A, 4 - D, 5 - C, 6 - B", "correct": true}, {"label": "C", "text": "1 - F, 2 - E, 3 - D, 4 - A, 5 - C, 6 - B", "correct": false}, {"label": "D", "text": "1 - F, 2 - E, 3 - A, 4 - D, 5 - B, 6 - C", "correct": false}], "correct_answer": "B. 1 - E, 2 - F, 3 - A, 4 - D, 5 - C, 6 - B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-pitched <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> with opening snap, best at the apex. Accentuated by exercise or Valsalva's maneuver. </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur, crescendo-decrescendo pattern, radiating to carotids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patent Ductus Arteriosus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A continuous, machine-like murmur, heard at the left <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> area</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertrophic Cardiomyopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Harsh <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> murmur, crescendo-decrescendo pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral Regurgitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Holosystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> radiating to the axilla</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic Regurgitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early diastolic decrescendo murmur, best heard at the left sternal border</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graham Steell Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early diastolic decrescendo <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> regurgitation, heard best at the left upper sternal border.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Austin Flint Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-pitched, rumbling <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> due to severe <span class=\"customMeta\" data-dictid=\"32a29a166b1692777182d46c390c42\">aortic regurgitation</span> causing <span class=\"customMeta\" data-dictid=\"66c04c3ac01692777201f1d43f0964\">turbulent flow</span> in the left ventricle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carvallo's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased intensity of a <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> with inspiration, heard along the left lower sternal border.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with exertional chest pain and dyspnea. On physical examination, you note a harsh mid systolic murmur that is loudest at the left sternal border and increases in intensity with the Valsalva maneuver. Which of the following is the most likely cause?", "options": [{"label": "A", "text": "Hypertrophic Cardiomyopathy", "correct": true}, {"label": "B", "text": "Aortic Stenosis", "correct": false}, {"label": "C", "text": "Pulmonary Stenosis", "correct": false}, {"label": "D", "text": "Atrial Septal Defect", "correct": false}], "correct_answer": "A. Hypertrophic Cardiomyopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:685px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Murmur Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> (AS)</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> is loudest to the right of the sternum, radiating to the neck.</li>\n</ul>\n<ul>\n<li>The intensity remains constant with maneuvers (unlike HCM).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">Prolapse</span> (MVP)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Late <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> is best heard at the apex.</li>\n</ul>\n<ul>\n<li>Typically preceded by a non-ejection click, and intensity and duration increases with maneuvers that decrease <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> volume.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonic <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> (PS)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> is best heard in the second and third <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> spaces.</li>\n</ul>\n<ul>\n<li>Intensity increases with severity but decreases with maneuvers that decrease <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> blood flow.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD)</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Midsystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> is best heard at the left sternal border, due to increased <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> blood flow.</li>\n</ul>\n<ul>\n<li>Typically has fixed <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> of the second heart sound.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with a loud, high-pitched murmur heard best at the apex of the heart, radiating to the axilla. The intensity of the murmur does not change with inspiration. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Chronic Mitral Regurgitation", "correct": true}, {"label": "B", "text": "Chronic Tricuspid Regurgitation", "correct": false}, {"label": "C", "text": "Aortic Stenosis", "correct": false}, {"label": "D", "text": "Acute Mitral Regurgitation", "correct": false}], "correct_answer": "A. Chronic Mitral Regurgitation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old child is brought to the clinic for evaluation of high blood pressure detected during a routine check-up. On physical examination, the blood pressure is higher in the arms compared to the legs. A continuous murmur is heard over the back, near the left scapula. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Takayau Arteritis", "correct": false}, {"label": "B", "text": "Coarctation of the Aorta", "correct": true}, {"label": "C", "text": "Atrial Septal Defect", "correct": false}, {"label": "D", "text": "Aortic Dissection", "correct": false}], "correct_answer": "B. Coarctation of the Aorta", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:705px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Coarctation of the Aorta </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Narrowing occurs where the <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus connects to the aorta, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the left <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> artery.</li>\n<li>Causes elevated <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> above the narrowing (upper limbs) and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> below it (legs).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can cause <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure in newborns but may be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> in older children or adults.</li>\n<li>Hypertension above narrowing may cause headaches; <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> below may lead to leg cramps or weakness.</li>\n<li>Radio-femoral delay.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"4b9829051f1692777185296e9b484a\">continuous murmur</span> is typically heard over the back near the left scapula.</li>\n<li>Additional sound (ejection click) may be heard in the aortic area if a <span class=\"customMeta\" data-dictid=\"9461b5b89b16927771839fb979168f\">bicuspid</span> <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> is present.</li>\n<li>Collateral <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> develops through periscapular, internal mammary, and <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> arteries, sometimes causing <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> bruits </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In aortic regurgitation, capillary pulsations can be seen in the nail beds. What is this sign called?", "options": [{"label": "A", "text": "Quincke’s sign", "correct": true}, {"label": "B", "text": "Duroziez’s sign", "correct": false}, {"label": "C", "text": "de Musset’s sign", "correct": false}, {"label": "D", "text": "Austin Flint sign", "correct": false}], "correct_answer": "A. Quincke’s sign", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>deMusset's sign (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A head bob occurring with each <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> cycle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mueller's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic pulsations of the uvula.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Becker's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visible pulsations of the <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> arteries and pupils.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quincke's pulses (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visible <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">Capillary</span> pulsations in the nailbeds after holding the tip of the nail.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duroziez's sign (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> and diastolic <span class=\"customMeta\" data-dictid=\"6489bd931b1692777183431530dacf\">bruit</span> heard when the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> is partially compressed.to and fro murmur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Traube's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A pistol shot <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> (systolic and diastolic sounds) heard over the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> arteries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mayne's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than a 15 mmHg decrease in DBP with arm <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> from the value obtained with the arm in the standard position.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hill's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Popliteal <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> pressure exceeding <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> pressure by more than 60 mmHg.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rosenbach's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic pulsations of the liver.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gerhard's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic pulsations of the spleen.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "From the list of ECG findings given below which will not be seen in mitral stenosis?", "options": [{"label": "A", "text": "Tall R waves in V1-V3", "correct": false}, {"label": "B", "text": "Bifid P wave", "correct": false}, {"label": "C", "text": "Atrial fibrillation", "correct": false}, {"label": "D", "text": "Tall tented T-waves", "correct": true}], "correct_answer": "D. Tall tented T-waves", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following schematic represents murmur of mitral stenosis?", "options": [{"label": "A", "text": "No options available", "correct": true}], "correct_answer": "A. No options available", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/1sVa7VZzcyijwGqmm9Xp1744298208.png", "https://image.prepladder.com/notes/0KZEZFjvr73eOSGWL8801744298209.png", "https://image.prepladder.com/notes/1D2nHYRAJvJ8Z4Sw7NKm1744298209.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Narrowing of the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve, usually due to rheumatic disease, causing <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> to <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> from the left <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> to the left ventricle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breathlessness</li>\n<li>Fatigue</li>\n<li>Oedema, ascites</li>\n<li>Palpitation</li>\n<li>Haemoptysis</li>\n<li>Cough</li>\n<li>Chest pain</li>\n<li>Thromboembolism</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systolic murmurs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diastolic murmurs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Midsystolic </strong></p>\n<ul>\n<li>Aortic stenosis</li>\n<li>Pulmonic stenosis</li>\n<li>Atrial septal defect</li>\n<li>HOCM</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early diastolic </strong></p>\n<ul>\n<li>Aortic regurgitation</li>\n<li>Pulmonic regurgitation</li>\n<li>Austin-Flint</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Holosystolic </strong></p>\n<ul>\n<li>Mitral regurgitation</li>\n<li>Tricuspid regurgitation</li>\n<li>VSD</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mid/late diastolic </strong></p>\n<ul>\n<li>Mitral stenosis</li>\n<li>Tricuspid stenosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> </strong></p>\n<ul>\n<li>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> prolapse</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other rare murmurs</strong></p>\n<ul>\n<li>Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with fatigue and a rapid, low-volume pulse. Chest X-ray is given below. What is the treatment?", "options": [{"label": "A", "text": "Diuretics", "correct": true}, {"label": "B", "text": "Pericardiocentesis", "correct": false}, {"label": "C", "text": "Beta-blockers", "correct": false}, {"label": "D", "text": "Glyceryl trinitrate", "correct": false}], "correct_answer": "A. Diuretics", "question_images": ["https://image.prepladder.com/notes/q7HEhAHtqU8SPuZyduzG1744297364.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fatigue</strong></li>\n<li><strong>Rapid, low-volume pulse</strong></li>\n<li>Elevated JVP with rapid y descent</li>\n<li>Loud early <span class=\"customMeta\" data-dictid=\"061293bca11692777200854ead9cdb\">third heart sound</span> (‘pericardial knock’)</li>\n<li><strong>Kussmaul’s sign (</strong>rise in JVP during inspiration)</li>\n<li>Hepatomegaly</li>\n<li>Ascites</li>\n<li>Peripheral edema</li>\n<li><strong>Pulsus paradoxus </strong>(rare)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray: </strong>May show<strong> <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> calcification</strong></li>\n<li>Echo and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> from restrictive cardiomyopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics: <strong>Loop diuretics</strong> <strong>(Option A)</strong> and <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> antagonists (e.g., spironolactone)</li>\n<li>Surgical resection: Diseased <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">pericardium</span> removal, though with high <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and variable outcomes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman recently diagnosed with adenocarcinoma lung presents with sudden dyspnoea, tachycardia, and hypotension. Examination reveals elevated JVP and an abnormal drop of 15mm Hg in systolic blood pressure during inspiration. An ECG was performed and is given below. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Intravenous diuretics", "correct": false}, {"label": "B", "text": "Percutaneous pericardiocentesis", "correct": true}, {"label": "C", "text": "Start vasopressors", "correct": false}, {"label": "D", "text": "Schedule elective cardiac surgery", "correct": false}], "correct_answer": "B. Percutaneous pericardiocentesis", "question_images": ["https://image.prepladder.com/notes/xSErQ6YNhZ8wrXZd7zH91744297119.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man with a history of heart failure presents with worsening edema and jugular venous distention. You observe a steep x and steep y descent in the jugular venous waveform. Which of the following conditions is most likely responsible for these findings?", "options": [{"label": "A", "text": "Constrictive pericarditis", "correct": true}, {"label": "B", "text": "Tricuspid regurgitation", "correct": false}, {"label": "C", "text": "Pericardial tamponade", "correct": false}, {"label": "D", "text": "Acute Pericarditis", "correct": false}], "correct_answer": "A. Constrictive pericarditis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Wave/ Descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>a Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Absent in atrial fibrillation</li>\n<li><strong>Cannon a waves</strong> in <span class=\"customMeta\" data-dictid=\"c6b82fe2321692777182c62220930f\">AV dissociation</span> and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> tachycardia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>x Descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Absent x <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> in <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>v Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prominent in <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> regurgitation</li>\n<li>It may <strong>merge with the c wave</strong> in <strong>severe TR, </strong>creating a \"<strong>ventricularized</strong>\" <strong>waveform</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>y Descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Blunted </strong>in <strong>pericardial tamponade (Option C ruled out)</strong></li>\n<li><strong>Steep in <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> and severe TR.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presents with palpitations and lightheadedness. His ECG shows an unequal number of P waves and R waves and his jugular venous pressure (JVP) tracing is shown below. Which of the following conditions is responsible for this finding?", "options": [{"label": "A", "text": "Atrial fibrillation", "correct": false}, {"label": "B", "text": "Complete heart block", "correct": true}, {"label": "C", "text": "Tricuspid stenosis", "correct": false}, {"label": "D", "text": "Supraventricular tachycardia", "correct": false}], "correct_answer": "B. Complete heart block", "question_images": ["https://image.prepladder.com/notes/Yx1wqnOlwwexxGTKAn9c1744296908.png"], "explanation_images": ["https://image.prepladder.com/notes/pLvkJ9sRu95wa3ak99y01744296988.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>a Wave</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs due to <strong>atrial contraction.</strong></li>\n<li>Follows P wave on ECG.</li>\n<li>Precedes S1</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance:</strong></p>\n<ul>\n<li><strong>Prominent </strong>in <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> RV compliance</li>\n<li><strong>Absent </strong>in <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> <strong>(Option A ruled out)</strong></li>\n<li><strong>Cannon a waves</strong> in<strong> <span class=\"customMeta\" data-dictid=\"c6b82fe2321692777182c62220930f\">AV dissociation</span> and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> tachycardia.</strong>\n<ul>\n<li>They occur when the right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> contracts against a closed <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve, typically seen with <strong>AV dissociation.</strong></li>\n<li>In wide complex tachycardia, cannon ‘a’ waves in the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"19d250592b1692777202f372a17f05\">waveform</span> suggest a <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> origin of the rhythm.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Loud first heart sound (S1) in mitral stenosis indicates?", "options": [{"label": "A", "text": "Reduced LV compliance", "correct": false}, {"label": "B", "text": "Increased left atrial pressure", "correct": true}, {"label": "C", "text": "Severe calcified mitral stenosis", "correct": false}, {"label": "D", "text": "Hypertrophy of the right ventricle", "correct": false}], "correct_answer": "B. Increased left atrial pressure", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/iX0mxUpE9RWsXkHzu9BW1744296422.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old woman with a history of ischemic cardiomyopathy, hypertension, and diabetes presents with worsening shortness of breath and fatigue. On physical examination, you hear both an S3 and an S4 heart sound. Which of the following best explains the presence of both heart sounds in this patient?", "options": [{"label": "A", "text": "Atrial fibrillation with mitral stenosis", "correct": false}, {"label": "B", "text": "Acute mitral regurgitation", "correct": false}, {"label": "C", "text": "Combined systolic and diastolic heart failure", "correct": true}, {"label": "D", "text": "Severe aortic stenosis", "correct": false}], "correct_answer": "C. Combined systolic and diastolic heart failure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with palpitations. On examination, hyperdynamic precordium is noted with soft S1 and pansystolic murmur. Which of the following is the most likely cause?", "options": [{"label": "A", "text": "Hyperthyroidism", "correct": false}, {"label": "B", "text": "Mitral stenosis", "correct": false}, {"label": "C", "text": "Mitral regurgitation", "correct": true}, {"label": "D", "text": "Myxedema heart", "correct": false}], "correct_answer": "C. Mitral regurgitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First heart sound (S1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Beginning of systole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mitral and <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> closure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically single or slightly split</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loud in conditions like anemia, pregnancy, thyrotoxicosis, <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> stenosis</li>\n<li>Soft in heart failure, <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> regurgitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second heart sound (S2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>End of systole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aortic and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (A2 first, P2 second)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Splits during inspiration; single on expiration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fixed wide <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> with atrial septal defect</li>\n<li>Wide variable <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> with delayed <span class=\"customMeta\" data-dictid=\"72421e3a581692777197a98d00066c\">right heart</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> (RBBB)</li>\n<li>Reversed <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> due to delayed <span class=\"customMeta\" data-dictid=\"9a065f288c1692777191f5b93fa49b\">left heart</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> (LBBB)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Third heart sound (S3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early diastole, after S2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden <span class=\"customMeta\" data-dictid=\"7be129d4bb1692777185fa5706fe88\">deceleration</span> of blood <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> into ventricles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low pitch, often heard as 'gallop'</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normal in young people and pregnancy</li>\n<li>Pathological in heart failure, <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> regurgitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fourth heart sound (S4)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Late diastole, before S1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> against a stiff ventricle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low pitch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Present in severe left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy</li>\n<li>Absent in atrial fibrillation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old man presents to the emergency department with episodes of palpitations, dizziness, and occasional chest discomfort. He mentions that the episodes are sudden in onset and can last for several minutes before resolving spontaneously. His vitals are stable, and physical examination is unremarkable. An ECG of the condition is given below. What is the most likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Atrial Fibrillation", "correct": false}, {"label": "B", "text": "Wolff-Parkinson-White (WPW) Syndrome", "correct": true}, {"label": "C", "text": "Myocardial Infarction", "correct": false}, {"label": "D", "text": "Atrioventricular Nodal Reentrant Tachycardia (AVNRT)", "correct": false}], "correct_answer": "B. Wolff-Parkinson-White (WPW) Syndrome", "question_images": ["https://image.prepladder.com/notes/g0NatI4pj8MLKVc2ZNdh1744296624.png"], "explanation_images": ["https://image.prepladder.com/notes/g0NatI4pj8MLKVc2ZNdh1744296624.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy is brought to the pediatrician by his parents due to concerns about his difficulty keeping up with peers during physical activities. Inspection shows a prominent precordium. Auscultation reveals a systolic ejection murmur. What heart sounds will be heard in this case?", "options": [{"label": "A", "text": "Narrow split S2", "correct": false}, {"label": "B", "text": "Paradoxical split S2", "correct": false}, {"label": "C", "text": "Wide split fixed S2", "correct": true}, {"label": "D", "text": "Wide split variable S2", "correct": false}], "correct_answer": "C. Wide split fixed S2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old girl presents to the clinic with a history of recurrent respiratory infections and exercise intolerance. On physical examination, a holosystolic murmur is noted at the left lower sternal border, and the child exhibits signs of left-to-right shunting. What is this condition most likely associated with?", "options": [{"label": "A", "text": "Wide Fixed split S2", "correct": false}, {"label": "B", "text": "Paradoxical split S2", "correct": false}, {"label": "C", "text": "Narrow split S2", "correct": false}, {"label": "D", "text": "Wide split variable S2", "correct": true}], "correct_answer": "D. Wide split variable S2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with progressive dyspnea and occasional dizziness. On auscultation, a harsh crescendo-decrescendo systolic murmur is noted at the left sternal border, which increases with the Valsalva maneuver. There is also evidence of a jerky carotid pulse. Which of the following will be heard on auscultation in this case?", "options": [{"label": "A", "text": "Wide split S2", "correct": false}, {"label": "B", "text": "Fixed split S2", "correct": false}, {"label": "C", "text": "Paradoxical split S2", "correct": true}, {"label": "D", "text": "Physiological split S2", "correct": false}], "correct_answer": "C. Paradoxical split S2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Narrow split S2 heart sound is heard in which of the following conditions?", "options": [{"label": "A", "text": "Mitral regurgitation", "correct": false}, {"label": "B", "text": "Aortic stenosis", "correct": true}, {"label": "C", "text": "Atrial septal defect", "correct": false}, {"label": "D", "text": "Pulmonary hypertension", "correct": false}], "correct_answer": "B. Aortic stenosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following Condition Type of S2 Splitting 1) Wide Split a) RBBB 2) Paradoxical Splitting b) Mitral regurgitation 3) Fixed Splitting c) LBBB 4) Narrow Split d) Pulmonary artery hypertension e) ASD", "options": [{"label": "A", "text": "1-b, 2-c, 3-e, 4-d", "correct": true}, {"label": "B", "text": "1-a, 2-e, 3-b, 4-c", "correct": false}, {"label": "C", "text": "1-b, 2-d, 3-b, 4-e", "correct": false}, {"label": "D", "text": "1-c, 2-a, 3-b, 4-e", "correct": false}], "correct_answer": "A. 1-b, 2-c, 3-e, 4-d", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Split</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1)Wide split</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mitral regurgitation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2)Paradoxical split</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>LBBB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3)Fixed Splitting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ASD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4)Narrowed splitting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> hypertension</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wide Splitting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs in conditions like <strong>right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block (RBBB)</strong> due to delayed <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> closure.</li>\n<li>Seen in <strong>severe <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> (MR)</strong> due to <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the aortic valve- Wide and variable split is seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Narrow <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">Splitting</span> or Singular S2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Narrow Splitting- E.g. <strong>Aortic stenosis</strong> or Singular S2</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wide Fixed Splitting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The A2-P2 interval is wide and does not change during the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> cycle. E.g.- <strong>ASD, TAPVC, RVF</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reversed or <span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\">Paradoxical</span> Splitting- P2 before A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seen in conditions such as <strong>left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block (LBBB).</strong></li>\n<li><strong>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> pacing.</strong></li>\n<li><strong>Severe <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">aortic stenosis</span> (AS).</strong></li>\n<li><strong>Hypertrophic obstructive <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> (HOCM), </strong></li>\n<li><strong>Acute myocardial ischemia.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Loud P2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Considered loud when its intensity exceeds A2 at the base or can be palpated in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> main <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> area. E.g.- <strong>Pulmonary arterial hypertension.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased Intensity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A2 intensity decreases with <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">aortic stenosis</span> (AS) and P2 intensity decreases with <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> (PS), potentially resulting in a single S2.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman comes with a history of fever, chest pain, weight loss, and night sweats. During a physical examination of a patient, the physician notes a characteristic sound that persists on breath holding. On further evaluation, she is found to have pericardial effusion on echocardiogram. What is this finding called on auscultation known as?", "options": [{"label": "A", "text": "Opening snap", "correct": false}, {"label": "B", "text": "Pericardial friction rub", "correct": true}, {"label": "C", "text": "Pericardial knock", "correct": false}, {"label": "D", "text": "Pleural rub", "correct": false}], "correct_answer": "B. Pericardial friction rub", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following features would raise suspicion for a diagnosis of Carney complex rather than sporadic cardiac myxomas?", "options": [{"label": "A", "text": "Association with tuberous sclerosis", "correct": false}, {"label": "B", "text": "Presence of skin pigmentation abnormalities", "correct": true}, {"label": "C", "text": "Restrictive cardiomyopathy", "correct": false}, {"label": "D", "text": "A-V nodal block", "correct": false}], "correct_answer": "B. Presence of skin pigmentation abnormalities", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Introduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common primary <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tumors in adults.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often found in the left atrium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sporadic.</li>\n<li>Familial: Carney Complex (Myxomas + skin lesions + Endocrinopathies).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obstructive symptoms resembling <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease (e.g., dyspnea, fatigue).</li>\n<li>Embolic events: Risk of <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> formation and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> embolization.</li>\n<li>Constitutional symptoms: Fever, weight loss, fatigue due to <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> secretion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Echocardiography, CT, MRI, Histopathology.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Considerations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Papillary Fibroelastoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Friable tumors with frond-like projections.</li>\n<li>Commonly found on <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> valves.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can cause <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> and embolization.</li>\n<li>Generally resected.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rhabdomyoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common in infants and children.</li>\n<li>Multiple in ~90% of cases.</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> <strong>(Option A ruled out)</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>May <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> valvular stenosis, CHF, or restrictive <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> <strong>(Option C ruled out)</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemangioma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generally small, often intramyocardial.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>May cause <span class=\"customMeta\" data-dictid=\"0aded9f3231692777182ec1d089af8\">AV conduction</span> <strong>(Option D ruled out)</strong><strong> </strong>disturbances.</li>\n<li>Potential for sudden death if near AV nodes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the cardiac cycle, the closing of the aortic valve takes place at the?", "options": [{"label": "A", "text": "End of isovolumetric contraction", "correct": false}, {"label": "B", "text": "End of rapid filling phase", "correct": false}, {"label": "C", "text": "Start of isovolumetric relaxation", "correct": true}, {"label": "D", "text": "Start of ejection", "correct": false}], "correct_answer": "C. Start of isovolumetric relaxation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/iX0mxUpE9RWsXkHzu9BW1744296422.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protodiastole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Marks the earliest phase of diastole.</li>\n<li>Ventricular pressures drop more rapidly in a fully contracted state of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> musculature.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isovolumetric relaxation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventricular <span class=\"customMeta\" data-dictid=\"76c542bf481692777193e617467333\">musculature</span> relaxes in an uniform pattern with both AV and <span class=\"customMeta\" data-dictid=\"7a23f5d3cd16927771982eb39c68c1\">semilunar</span> valves closed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First rapid-filling phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Marks the opening of AV valves followed by rapid <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> filling.</li>\n<li>Also known as the <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">Passive</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> phase (due to the difference in Atrial and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> pressures).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pressures in the <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">Atria</span> and ventricles equal and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> rate declines rapidly and stops eventually.</li>\n<li>This momentary period of least <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> is known as Diastasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Last rapid filling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Eject out the remaining blood left by active atrial contractions.</li>\n<li>Also known as the Active <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> phase.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table style=\"width:50%\">\n<tbody>\n<tr>\n<td><strong>Phases</strong></td>\n<td><strong>Description</strong></td>\n</tr>\n<tr>\n<td><strong>Isovolumetric Contraction</strong></td>\n<td>\n<p>Marks the <strong>onset of systole.</strong></p>\n<p>Ventricles begin to contract with <strong>all valves closed</strong>, causing a rapid <strong>rise in <span class=\"customMeta\" data-dictid=\"390a9178d716927771907c0c9d72c5\">intraventricular</span> pressure</strong> without a change in volume.</p>\n</td>\n</tr>\n<tr>\n<td><strong>Rapid <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">Ejection</span> Phase</strong></td>\n<td>Begins when <strong>ventricular pressure exceeds aortic and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> pressure</strong>, leading to <strong>opening of <span class=\"customMeta\" data-dictid=\"7a23f5d3cd16927771982eb39c68c1\">semilunar</span> valves</strong> and <strong>rapid outflow of blood</strong> from the ventricles.</td>\n</tr>\n<tr>\n<td><strong>Reduced <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">Ejection</span> Phase</strong></td>\n<td>Ventricular <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> weakens, causing <strong>ejection to slow down</strong>; although blood still flows out, the <strong>rate decreases</strong> as pressures in the ventricles and arteries begin to equalize.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 35 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 10 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 55-year-old male presented to the clinic for a routine check-up last week. He has no significant past medical history, but Automated Office Blood Pressure (AoBP) monitoring showed blood pressure readings of 142/94 mmHg, 138/86 mmHg, and 138/90 mmHg. Ambulatory blood pressure monitoring was advised; the average 24-hour blood pressure is 138/86 mmHg. According to the ACC/AHA hypertension classification, what category does his blood pressure fall into?", "options": [{"label": "A", "text": "Normal blood pressure", "correct": false}, {"label": "B", "text": "Elevated blood pressure", "correct": false}, {"label": "C", "text": "Stage 1 hypertension", "correct": true}, {"label": "D", "text": "Stage 2 hypertension", "correct": false}], "correct_answer": "C. Stage 1 hypertension", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:567px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypertension category based on the American College of <span class=\"customMeta\" data-dictid=\"498d1d322616927771831c4a35e399\">Cardiology</span> (ACC) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blood pressure category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Systolic (mm Hg)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diastolic (mm Hg)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Normal</strong><strong> </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 120</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 80</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Elevated </strong><strong> (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">120-129</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;80</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage 1 <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">130 – 139</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">80 – 89</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage 2 <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> </strong><strong> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">≥140</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">≥90</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypertensive crisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;180</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;120</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:583px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertension Diagnosis Based on ABPM (ambulatory <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> monitoring)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>24-h Average</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥130/80 mm Hg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Awake (daytime) average</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥135/85 mm Hg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asleep (night-time) average</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥120/70 mm Hg</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a BMI of 30 presents with frequent headaches and dizziness. His office blood pressure is recorded as 126/74 mmHg, but home readings range between 150/94 mmHg and 156/90 mmHg. Ambulatory blood pressure monitoring confirms these findings with higher readings outside the office. Which of the following is the most appropriate management plan for this patient?", "options": [{"label": "A", "text": "Lifestyle modifications alone is sufficient", "correct": false}, {"label": "B", "text": "Initiate antihypertensive therapy", "correct": true}, {"label": "C", "text": "Increase clinic visit frequency to monitor blood pressure", "correct": false}, {"label": "D", "text": "Diagnosis to be reconfirmed in 3 to 6 months", "correct": false}], "correct_answer": "B. Initiate antihypertensive therapy", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:610px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACC/AHA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>White coat hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Masked hypertension</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated clinic or office BP and normal out-of-office BP (on ABPM or HBPM) in individuals not receiving <span class=\"customMeta\" data-dictid=\"a9952795951692777181001d03753a\">antihypertensive</span> therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal BP on clinic or office BP readings and elevated out-of-office BP readings in individuals not receiving <span class=\"customMeta\" data-dictid=\"a9952795951692777181001d03753a\">antihypertensive</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cutoff for Office Blood Pressure: </strong>≥130/80 mmHg</p>\n<p><strong>Cutoff for Out-of-Office <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">Blood Pressure</span> (Daytime ABPM or HBPM):</strong> &lt;130/80 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cutoff for Office Blood Pressure:</strong> 120–129/&lt;80 mmHg</p>\n<p><strong>Cutoff for Out-of-Office <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">Blood Pressure</span> (Daytime ABPM or HBPM): </strong>≥130/80 mmHg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lifestyle measures</li>\n<li>Diagnosis to be reconfirmed in 3 to 6 months <strong>(Option D ruled out)</strong></li>\n<li>Yearly follow-ups with ABPM to detect <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to sustained hypertension</li>\n<li><strong>Antihypertensive treatment:</strong>\n<ul>\n<li>Estimated 10-year atherosclerotic <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease risk of ≥10%</li>\n<li>Hypertension-related <span class=\"customMeta\" data-dictid=\"c312a0035e1692777200302a9c7957\">target organ</span> damage</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lifestyle measures + <span class=\"customMeta\" data-dictid=\"a9952795951692777181001d03753a\">antihypertensive</span> drug therapy recommended<strong> </strong><strong>(Option B)</strong><strong> </strong><strong>(Option A ruled out)</strong></li>\n<li>Long-term out-of-office BP monitoring <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Target Organ Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased risk when compared to normotensive</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Significantly increased risk</li>\n<li>Cardiovascular risk is similar to that in patients with sustained hypertension</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a lecture on cardiovascular physiology, a professor explained that conditions causing unequal arm blood pressure often involve branches of the aortic arch. Which of the following conditions is not likely to cause a difference in blood pressure between the arms?", "options": [{"label": "A", "text": "Aortic dissection involving the ascending aorta", "correct": false}, {"label": "B", "text": "Coarctation of the aorta distal to the left subclavian artery", "correct": true}, {"label": "C", "text": "Takayasu arteritis affecting the aortic arch", "correct": false}, {"label": "D", "text": "Subclavian artery stenosis", "correct": false}], "correct_answer": "B. Coarctation of the aorta distal to the left subclavian artery", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conditions causing unequal left and right arm blood pressures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aortic <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Dissection occurring at the site of arterial branching from the aorta</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subclavian <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Atherosclerosis or other causes of <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> (Thoracic Outlet Syndrome) in the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> reduce <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the affected arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Takayasu <span class=\"customMeta\" data-dictid=\"08d90ca11716927771828423b87d47\">Arteritis</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Chronic <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> that affects large arteries, particularly the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> and its branches</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Coarctation of the Aorta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Congenital narrowing of the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> affecting branches of the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> and narrowing <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> to left <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (Option C)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male with a history of resistant hypertension and periodic muscle cramps is being investigated. Lab tests show hypokalemia, low plasma renin activity, and low aldosterone levels. Genetic testing reveals a mutation in the epithelial sodium channel (ENaC). What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gordan syndrome", "correct": false}, {"label": "B", "text": "Liddle syndrome", "correct": true}, {"label": "C", "text": "Congenital adrenal hyperplasia (CAH)", "correct": false}, {"label": "D", "text": "Pheochromocytoma", "correct": false}], "correct_answer": "B. Liddle syndrome", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mode of inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liddle syndrome (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperactive <span class=\"customMeta\" data-dictid=\"50a05f16a31692777187906f1c1840\">ENaC</span> reabsorbs sodium at elevated levels, resulting in volume expansion and hypertension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypokalemia</li>\n<li>Low renin</li>\n<li>Low aldosterone</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gordan syndrome</strong></p>\n<p><strong>(Pseudohypoaldosteronism type II) (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutations in regulatory proteins for the NCC (sodium <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> cotransporter) channel allow for unchecked activity, causing subsequent <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> and fluid overabsorption</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperkalemia</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> rate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polycystic kidneys</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> kidneys</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Renal failure</li>\n<li>Liver cysts</li>\n<li>Cerebral aneurysms</li>\n<li>Valvular heart disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pheochromocytoma (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neoplasia of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> generates heightened levels of <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> and epinephrine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with</p>\n<ul>\n<li>MEN-2A (Sipple syndrome)</li>\n<li>MEN-2B</li>\n<li>VHL syndrome</li>\n<li>NF-1</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">Adrenal</span> <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">Hyperplasia</span> (CAH) (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defects in <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> lead to buildup of <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> metabolites with <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">mineralocorticoid</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> activity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>17-α <span class=\"customMeta\" data-dictid=\"0b592280091692777189e27f90a885\">hydroxylase</span> deficiency: ↑ in <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> and thus HTN</li>\n<li>11-β <span class=\"customMeta\" data-dictid=\"0b592280091692777189e27f90a885\">hydroxylase</span> deficiency: ↑ in deoxycortisol which stimulates <span class=\"customMeta\" data-dictid=\"50a05f16a31692777187906f1c1840\">ENaC</span> and causes HTN</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucocorticoid-</strong><br/>\n<strong>remediable hyperaldosteronism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chimeric 11β-hydroxylase/aldosterone gene</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Absent or mild hypokalemia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with a long-standing history of hypertension presents with occasional episodes of dizziness and transient visual disturbances. Neurological examination and fundoscopy are normal. A carotid ultrasound is performed to visualize the carotid arteries. Which of the following findings is not expected to be seen in this patient?", "options": [{"label": "A", "text": "Atherosclerotic plaque formation in the carotid arteries", "correct": false}, {"label": "B", "text": "Normal intima-media thickness", "correct": true}, {"label": "C", "text": "Carotid artery stenosis", "correct": false}, {"label": "D", "text": "Turbulent blood flow in the carotid arteries", "correct": false}], "correct_answer": "B. Normal intima-media thickness", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications of HTN</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> in <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> patients</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brain disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The second most frequent cause of death</li>\n<li>Ischemic and hemorrhagic strokes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kidney disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decrease in eGFR</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease<strong> </strong><strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial disease </strong><strong>(Options A, C &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carotid arteries: Atherosclerotic plaque/stenosis (turbulent flow of blood) and intima-media thickness</li>\n<li>Aorta: <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> stiffening, aortic dissection</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease in lower extremity: <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">Claudication</span> symptom</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypertensive retinopathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old Indian-origin male with a history of hypertension not on medications has chronic kidney disease (stage 2). His laboratory tests indicate an estimated glomerular filtration rate (eGFR) of 60 mL/min and elevated protein in his urine. His present blood pressure is 142/90 mmHg. Considering his condition, which of the following antihypertensive medications is most appropriate to initiate?", "options": [{"label": "A", "text": "Amlodipine", "correct": false}, {"label": "B", "text": "Lisinopril", "correct": true}, {"label": "C", "text": "Hydrochlorothiazide", "correct": false}, {"label": "D", "text": "Metoprolol", "correct": false}], "correct_answer": "B. Lisinopril", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>ACC/AHA Guidelines for <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">Hypertension</span> Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications for Use of antihypertensives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary prevention of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> CVD events in patients with clinical CVD (defined as CHD, CHF, stroke) and BP ≥130/≥80 mmHg</p>\n<p>Primary prevention in patients with an estimated 10-year <span class=\"customMeta\" data-dictid=\"0cefa2313f1692777182f2added22a\">ASCVD</span> risk ≥10% and BP ≥130/≥80 mmHg</p>\n<p>Primary prevention of CVD and low CVD risk in patients with BP ≥140/ ≥90 mmHg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure Goal in Treating Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BP target &lt; 130/80 mmHg for adults with confirmed <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and known CVD or 10-year <span class=\"customMeta\" data-dictid=\"0cefa2313f1692777182f2added22a\">ASCVD</span> event risk ≥10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exceptions to <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">Therapeutic</span> Target of &lt;130/80 mmHg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age &gt;80 years</p>\n<p>Blood pressure &lt;140/90 mmHg in previously untreated <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> patients who experience an <span class=\"customMeta\" data-dictid=\"bef027ba821692777190cb424e9554\">ischemic stroke</span> or TIA</p>\n<p>Acute therapy for most <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> urgencies and emergencies</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:591px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Add a Second Drug If Needed to Achieve the target BP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>If a Third Drug is Needed to Achieve the target BP </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Black patients (African ancestry): All ages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CCB or <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination of CCB + <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> or ARB + <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretic</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>White and other non-black Patients: Younger than 60 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CCB or <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretic </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>White and other non-black patients: 60 years and older</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CCB or <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertension with other associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial drug of choice</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension and diabetes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension and chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease <strong>(Option B) (Options A &amp; C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n<p>Note: in black patients, good evidence for the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> protective effects of <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension and clinical <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>β-Blocker plus ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension and stroke history</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension and heart failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regardless of blood pressure, ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> + β-blocker + <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> + spironolactone. A dihydropyridine CCB can be added if needed for BP control.</p>\n<p><strong>Pneumonic: ABDS</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As a medicine resident, you are counselling a newly diagnosed hypertensive patient on lifestyle modifications to promote better health and help manage her blood pressure. Which of the following recommendations would be inappropriate or misleading for this patient?", "options": [{"label": "A", "text": "Brisk walking for 15 mins/day, 5 days a week", "correct": true}, {"label": "B", "text": "Reduce sodium intake to &amp;lt;6g NaCl/day", "correct": false}, {"label": "C", "text": "Target BMI of &amp;lt;25kg/m2", "correct": false}, {"label": "D", "text": "DASH-type dietary plan", "correct": false}], "correct_answer": "A. Brisk walking for 15 mins/day, 5 days a week", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hypertension lifestyle modifications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weight reduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BMI &lt; 25kg/m2 <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dietary salt reduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&lt;6g NaCl/day <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DASH-type dietary plan </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A diet rich in fruits, vegetables, and low-fat dairy products with <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"bd2ac838bb16927771983dd9afc74c\">saturated</span> and total fat content.</li>\n<li>Diet is also rich in potassium, calcium, and magnesium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderation of alcohol consumption</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>≤2 drinks/day in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> and ≤1 drink/day in women</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Regular <span class=\"customMeta\" data-dictid=\"789c9dd31a16927771801dd2426384\">aerobic</span> activity, e.g., brisk walking for 30 min/day for 5 days a week. <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with severe headache, nausea, and confusion. His blood pressure is recorded at 190/130 mmHg. Neurological examination reveals altered mental status, and the patient appears distressed. A fundoscopic exam shows retinal haemorrhages. What is the most appropriate classification of this patient’s condition?", "options": [{"label": "A", "text": "Hypertensive urgency", "correct": false}, {"label": "B", "text": "Hypertensive emergency", "correct": true}, {"label": "C", "text": "Malignant hypertension", "correct": false}, {"label": "D", "text": "Essential hypertension", "correct": false}], "correct_answer": "B. Hypertensive emergency", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment Approach</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertensive Urgency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systolic BP &gt; 180 mmHg and/or Diastolic BP &gt; 120 mmHg <strong>without <span class=\"customMeta\" data-dictid=\"c36bccf76e169277718712a7cc339f\">end-organ</span> damage</strong></li>\n<li>Stable patients, often noncompliant or discontinued therapy<strong> </strong><strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reinstitution or increase of oral antihypertensives</li>\n<li>No <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> required</li>\n<li>Gradual BP reduction over hours/days</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertensive Emergency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The same BP values as <span class=\"customMeta\" data-dictid=\"026c92ea6316927772013c7cfd287b\">urgency</span> but <strong>with <span class=\"customMeta\" data-dictid=\"c36bccf76e169277718712a7cc339f\">end-organ</span> damage</strong></li>\n<li>Examples:\n\t\t\t\t<ul>\n<li>Encephalopathy, stroke</li>\n<li>Retinal haemorrhages</li>\n<li>Aortic dissection</li>\n<li>MAHA</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate 25% reduction in BP using IV agents (e.g., nitroprusside, nicardipine, labetalol)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (BP &gt; 180/120) <strong>with 3 or more <span class=\"customMeta\" data-dictid=\"c312a0035e1692777200302a9c7957\">target organ</span> damage</strong><strong> </strong><strong>(Option C)</strong></li>\n<li>It is a type of <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> emergency but with 3 or &gt; 3 <span class=\"customMeta\" data-dictid=\"c312a0035e1692777200302a9c7957\">target organ</span> damage</li>\n<li>Abrupt increase in BP in previously <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> or sudden onset in normotensive</li>\n<li>Values of BP are not important but it's the rapid rise and <span class=\"customMeta\" data-dictid=\"c312a0035e1692777200302a9c7957\">target organ</span> damage which is important</li>\n<li>Pathology\n\t\t\t\t<ul>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> vasculitis, arterial thrombi, <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> deposition in arterioles</li>\n<li>Fibrinoid <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> in kidneys, brain, retina, etc.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intensive management often requires <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> and aggressive therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with a history of type 2 diabetes and hypertension presents to his primary care physician for a follow-up appointment. His blood pressure is 160/95 mmHg. The physician wants to start an antihypertensive medication. What is the target blood pressure for this patient?", "options": [{"label": "A", "text": "&amp;lt; 140/90 mmHg", "correct": false}, {"label": "B", "text": "&amp;lt; 135/85 mmHg", "correct": false}, {"label": "C", "text": "&amp;lt; 130/80 mmHg", "correct": true}, {"label": "D", "text": "&amp;lt; 150/90 mmHg", "correct": false}], "correct_answer": "C. &lt; 130/80 mmHg", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Target Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Recommended Medications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>General Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&lt; 135-140/85-90 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Initial: <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">Thiazide</span> diuretic, CCB, ACEI, or ARB<strong> (non-black)</strong>; <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">Thiazide</span> or CCB <strong>(black)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hypertension with <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> Nephropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&lt; 130/80 mmHg <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>ACEI/ARB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Malignant Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Reduce MAP by 20-25% over 2 hours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nitroprusside, labetalol, fenoldepam</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>End-Stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Disease (ESRD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&lt; 130/80 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>CCB (e.g., Amlodipine), <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">Alpha</span> blocker</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease (CKD) <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">Grade</span> I-III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&lt; 130/80 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>ACEI/ARB + <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">Thiazide</span> + CCB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>eGFR &lt; 30 ml/min</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&lt; 130/80 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Diuretics (e.g., Metolazone)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is incorrect regarding the image given?", "options": [{"label": "A", "text": "Can help identify the white-coat effect in patients", "correct": false}, {"label": "B", "text": "Continuous readings for a full 24-hour period", "correct": false}, {"label": "C", "text": "Measures both awake and sleep averages", "correct": false}, {"label": "D", "text": "Used to investigate hypertension only", "correct": true}], "correct_answer": "D. Used to investigate hypertension only", "question_images": ["https://image.prepladder.com/notes/n4BW2x6XC6Feb2Lsj0nq1744305739.png"], "explanation_images": ["https://image.prepladder.com/notes/kA7VxU1XTxY9fDGbiu631744305835.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Ambulatory BP Monitoring (ABPM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Home <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">Blood Pressure</span> Monitoring (HBPM)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Device Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Oscillometric</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Oscillometric</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Operation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Worn by patient, preprogrammed, fully automatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Self-administered by the patient</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Monitoring Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>24 hours <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>7 days (morning and evening)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Data Transfer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Transfers data to computer for report generation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Patient documents and shares readings at discretion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mean Overall BP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Present in report</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Average of 6 days if &gt; 135/85 mmHg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mean Awake BP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Present in report</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Average of readings during the day</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mean Sleep BP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Present in the report <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not typically calculated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nocturnal Dip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yes (percentage reduction at night)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not applicable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Morning Surge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not applicable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>BP Load</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yes (percentage of readings above threshold)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not applicable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>HTN Criteria (Awake BP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&gt; 135/85 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&gt; 135/85 mmHg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>HTN Criteria (Sleep BP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&gt; 120/75 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not applicable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Applications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>White-coat <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> <strong>(Option A ruled out)</strong></li>\n<li>Confirm <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> in children</li>\n<li>Resistant hypertension</li>\n<li>Labile hypertension</li>\n<li>Hypotensive episodes <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Self-monitoring for <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> management</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 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Which biochemical marker would be most useful in confirming reinfarction in this patient?", "options": [{"label": "A", "text": "Troponin", "correct": false}, {"label": "B", "text": "Creatine Kinase-MB", "correct": true}, {"label": "C", "text": "Lactate Dehydrogenase", "correct": false}, {"label": "D", "text": "Heart-type Fatty Acid-Binding Protein", "correct": false}], "correct_answer": "B. Creatine Kinase-MB", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/g5BAA2iH2ESUA641cjWZ1744300076.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Preferred biochemical markers due to their sensitivity and specificity.</li><li>↳ Preferred biochemical markers</li><li>↳ Criteria for ACS: Requires rise and/or fall in biomarker values, with at least one value above the 99th percentile upper reference limit.</li><li>↳ Criteria for ACS:</li><li>↳ Troponin T (cTnT) and Troponin I (cTnI ) increase significantly after STEMI.</li><li>↳ Troponin T (cTnT)</li><li>↳ Troponin I (cTnI</li><li>↳ Can detect concentrations &lt;1 ng/L in non-ischemic conditions.</li><li>↳ &lt;1 ng/L</li><li>↳ Troponin levels: Increase within 3-6 hours. Peak at around 36 hours. Remains elevated for 7-10 days after STEMI.</li><li>↳ Troponin levels:</li><li>↳ Increase within 3-6 hours. Peak at around 36 hours. Remains elevated for 7-10 days after STEMI.</li><li>↳ Increase within 3-6 hours.</li><li>↳ Peak at around 36 hours.</li><li>↳ Remains elevated for 7-10 days after STEMI.</li><li>↳ 7-10 days</li><li>↳ Troponin should be measured at presentation and repeated at 1-3 hours (high-sensitivity assays) or 3-6 hours (conventional assays).</li><li>↳ Further troponin tests are advised beyond 3-6 hours if AMI remains a possibility or there is diagnostic uncertainty.</li><li>↳ Causes of elevated Serum Troponin other AMI Cardiorespiratory Causes Non-Cardiorespiratory Causes Pulmonary embolism Aortic dissection Acute pulmonary edema Tachyarrhythmias Myocarditis/Myopericarditis Cardiac trauma Cardiac surgery/ablation Prolonged hypotension Severe sepsis Severe burns Stroke Subarachnoid hemorrhage End-stage renal failure</li><li>↳ Causes of elevated Serum Troponin other AMI</li><li>↳ Causes of elevated Serum Troponin other AMI</li><li>↳ Causes of elevated Serum Troponin other AMI</li><li>↳ Causes of elevated Serum Troponin other AMI</li><li>↳ Cardiorespiratory Causes Non-Cardiorespiratory Causes</li><li>↳ Cardiorespiratory Causes</li><li>↳ Cardiorespiratory Causes</li><li>↳ Cardiorespiratory Causes</li><li>↳ Non-Cardiorespiratory Causes</li><li>↳ Non-Cardiorespiratory Causes</li><li>↳ Non-Cardiorespiratory Causes</li><li>↳ Pulmonary embolism Aortic dissection Acute pulmonary edema Tachyarrhythmias Myocarditis/Myopericarditis Cardiac trauma Cardiac surgery/ablation Prolonged hypotension Severe sepsis Severe burns Stroke Subarachnoid hemorrhage End-stage renal failure</li><li>↳ Pulmonary embolism Aortic dissection Acute pulmonary edema Tachyarrhythmias Myocarditis/Myopericarditis Cardiac trauma Cardiac surgery/ablation</li><li>↳ Pulmonary embolism Aortic dissection Acute pulmonary edema Tachyarrhythmias Myocarditis/Myopericarditis Cardiac trauma Cardiac surgery/ablation</li><li>↳ Pulmonary embolism</li><li>↳ Aortic dissection</li><li>↳ Acute pulmonary edema</li><li>↳ Tachyarrhythmias</li><li>↳ Myocarditis/Myopericarditis</li><li>↳ Cardiac trauma</li><li>↳ Cardiac surgery/ablation</li><li>↳ Prolonged hypotension Severe sepsis Severe burns Stroke Subarachnoid hemorrhage End-stage renal failure</li><li>↳ Prolonged hypotension Severe sepsis Severe burns Stroke Subarachnoid hemorrhage End-stage renal failure</li><li>↳ Prolonged hypotension</li><li>↳ Severe sepsis</li><li>↳ Severe burns</li><li>↳ Stroke</li><li>↳ Subarachnoid hemorrhage</li><li>↳ End-stage renal failure</li><li>↳ Cardiac troponin levels remain elevated for several days after an acute myocardial infarction (AMI), making them unreliable for detecting reinfarction.</li><li>↳ Cardiac troponin levels remain elevated for several days after an acute myocardial infarction (AMI), making them unreliable for detecting reinfarction.</li><li>↳ unreliable for detecting reinfarction.</li><li>↳ Creatine Phosphokinase (CK) and CK-MB: (Option B)</li><li>↳ Creatine Phosphokinase (CK) and</li><li>↳ CK-MB: (Option B)</li><li>↳ CK rises within 4-8 hours. Peaks by 24 hours. Returns to normal within 48-72 hours. CK lacks specificity for STEMI since it can be elevated in skeletal muscle disease, trauma, or injections. CK-MB isoenzyme is more specific for the heart CK-MB elevated: Cardiac surgery Myocarditis Electrical cardioversion CK-MB/CK ratio &gt;2.5 suggests a myocardial source, though it's not diagnostic. CK-MB levels normalize within 48 to 72 hours , so a subsequent rise can confirm reinfarction.</li><li>↳ CK rises within 4-8 hours.</li><li>↳ Peaks by 24 hours.</li><li>↳ Returns to normal within 48-72 hours.</li><li>↳ CK lacks specificity for STEMI since it can be elevated in skeletal muscle disease, trauma, or injections.</li><li>↳ CK-MB isoenzyme is more specific for the heart</li><li>↳ CK-MB elevated: Cardiac surgery Myocarditis Electrical cardioversion</li><li>↳ CK-MB elevated:</li><li>↳ Cardiac surgery Myocarditis Electrical cardioversion</li><li>↳ Cardiac surgery</li><li>↳ Myocarditis</li><li>↳ Electrical cardioversion</li><li>↳ CK-MB/CK ratio &gt;2.5 suggests a myocardial source, though it's not diagnostic.</li><li>↳ CK-MB/CK ratio &gt;2.5</li><li>↳ CK-MB levels normalize within 48 to 72 hours , so a subsequent rise can confirm reinfarction.</li><li>↳ normalize within 48 to 72 hours</li><li>↳ confirm reinfarction.</li><li>↳ Lactate Dehydrogenase (LDH): (Option C)</li><li>↳ Lactate Dehydrogenase (LDH): (Option C)</li><li>↳ Increase in the blood 6 to 12 hours after ACS. Peak within 24 to 72 hours. Normalize within 8 to 14 days. LDH is no longer used to diagnose myocardial infarction because it is not specific to cardiac myocytes.</li><li>↳ Increase in the blood 6 to 12 hours after ACS.</li><li>↳ Peak within 24 to 72 hours.</li><li>↳ Normalize within 8 to 14 days.</li><li>↳ LDH is no longer used to diagnose myocardial infarction because it is not specific to cardiac myocytes.</li><li>↳ LDH</li><li>↳ not specific to cardiac myocytes.</li><li>↳ Heart-type Fatty Acid-Binding Protein (H-FABP): (Option D)</li><li>↳ Heart-type Fatty Acid-Binding Protein (H-FABP): (Option D)</li><li>↳ Sensitivity of H-FABP in detecting AMI within 4 hours of symptom onset was 60%, significantly higher than troponin (18.8%) and CK-MB (12.5%). But the specificity of H-FABP in detecting AMI was less than that of troponin and CK-MB.</li><li>↳ Sensitivity of H-FABP in detecting AMI within 4 hours of symptom onset was 60%, significantly higher than troponin (18.8%) and CK-MB (12.5%).</li><li>↳ But the specificity of H-FABP in detecting AMI was less than that of troponin and CK-MB.</li><li>↳ specificity</li><li>↳ in detecting AMI was less than that of troponin and CK-MB.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">Troponin</span> other AMI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiorespiratory Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Cardiorespiratory Causes </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary embolism</li>\n<li>Aortic dissection</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</li>\n<li>Tachyarrhythmias</li>\n<li>Myocarditis/Myopericarditis</li>\n<li>Cardiac trauma</li>\n<li>Cardiac surgery/ablation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolonged hypotension</li>\n<li>Severe sepsis</li>\n<li>Severe burns</li>\n<li>Stroke</li>\n<li>Subarachnoid hemorrhage</li>\n<li>End-stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 49-year-old woman comes at night with chest pain that started earlier that evening and has progressively worsened. She describes the pain as a burning sensation accompanied by a sour taste in her mouth, which began shortly after dinner. She has had similar experiences previously, but not as severe as now. Initial laboratory tests and an ECG show normal results. What is the most likely cause of this patient's chest pain?", "options": [{"label": "A", "text": "Myocarditis", "correct": false}, {"label": "B", "text": "Pulonary embolism", "correct": false}, {"label": "C", "text": "Costochondritis", "correct": false}, {"label": "D", "text": "Gastroesophageal reflux disease", "correct": true}], "correct_answer": "D. Gastroesophageal reflux disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cardiopulmonary causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Non-cardiopulmonary causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac causes:</strong></p>\n<ul>\n<li>Myocardial ischemia</li>\n<li>Pericarditis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal causes:</strong></p>\n<ul>\n<li>Esophageal reflux</li>\n<li>Esophageal spasm</li>\n<li>Peptic ulcer</li>\n<li>Gallbladder disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular causes:</strong></p>\n<ul>\n<li>Acute aortic syndrome</li>\n<li>Pulmonary embolism</li>\n<li>Pulmonary hypertension</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuromuscular causes:</strong></p>\n<ul>\n<li>Costochondritis</li>\n<li>Cervical disc disease</li>\n<li>Trauma or strain</li>\n<li>Herpes zoster</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary causes:</strong></p>\n<ul>\n<li>Pneumonia or pleuritis</li>\n<li>Spontaneous pneumothorax</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Psychological causes:</strong></p>\n<ul>\n<li>Emotional and psychiatric conditions</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:323px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>History </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly suspicious</p>\n<p>Moderately suspicious</p>\n<p>Slightly suspicious</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n<p>1</p>\n<p>0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant ST depression</p>\n<p>Nonspecific abnormality</p>\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n<p>1</p>\n<p>0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥65 years</p>\n<p>45 to &lt;65 years</p>\n<p>&lt;45 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n<p>1</p>\n<p>0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥3 risk factors</p>\n<p>1-2 risk factors</p>\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n<p>1</p>\n<p>0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TOTAL</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low risk: 0-3</strong></p>\n<p><strong>Not low risk: ≥4</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male presents with acute onset of severe dyspnea and shock 5 days after a STEMI. On examination, a loud pansystolic murmur is heard at the apex. Echocardiography reveals valvular dysfunction. What is the most likely cause of his condition?", "options": [{"label": "A", "text": "Ventricular septal rupture", "correct": false}, {"label": "B", "text": "Papillary muscle rupture", "correct": true}, {"label": "C", "text": "Ventricular aneurysm", "correct": false}, {"label": "D", "text": "Ventricular rupture", "correct": false}], "correct_answer": "B. Papillary muscle rupture", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemodynamic Failure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pump Failure</strong>: Leading cause of in-hospital death after STEMI; severity correlates with <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> size.</li>\n<li><strong>Signs</strong>: <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> rales, S3/S4 <span class=\"customMeta\" data-dictid=\"91e41050fc1692777188741342606b\">gallop</span> sounds, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> on chest x-ray. Elevated LV <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> pressures due to diastolic/systolic dysfunction.</li>\n</ul>\n<h4><strong>Killip Classification:</strong></h4>\n<ul>\n<li><strong>Class I</strong>: No pulmonary/venous congestion.</li>\n<li><strong>Class II</strong>: Moderate <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> (rales, S3 gallop, right-sided heart failure).</li>\n<li><strong>Class III</strong>: Severe <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> with <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema.</li>\n<li><strong>Class IV</strong>: <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">Cardiogenic</span> shock with <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP &lt;90 mmHg, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> vasoconstriction.</li>\n</ul>\n<h4><strong>Management:</strong></h4>\n<ul>\n<li>Use of balloon catheters and <span class=\"customMeta\" data-dictid=\"c7c5b5c17a16927771905ab1f7f8c2\">intra-arterial</span> pressure monitoring.</li>\n<li><strong>Diuresis</strong> for <strong>elevated LV pressure</strong>, volume expansion for lower LV pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Ventricular <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">Aneurysm</span> </strong><strong>(Option C)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs in ~10% of MI patients, especially with persistent vessel occlusion.</p>\n<ul>\n<li><strong>Clinical Signs</strong>: <span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\">Paradoxical</span> <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> impulse, <strong>persistent ST <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> on ECG</strong>, and <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"980c8bc3ce1692777198a4c20033fd\">silhouette</span> on chest X-ray.</li>\n<li><strong>Diagnosis</strong>: Confirmed by echocardiography.</li>\n<li><strong>Complications</strong>: Includes heart failure, <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> arrhythmias, <span class=\"customMeta\" data-dictid=\"b61dc1c68d1692777193f8a6b8809b\">mural</span> thrombus, and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> embolism.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rupture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Papillary Muscle Rupture</strong><strong> (Option B)</strong></p>\n<ul>\n<li>Presents with <strong>acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</strong> and<strong> shock</strong> due to sudden severe <strong>mitral regurgitation</strong>.</li>\n<li>Often associated with a <strong>pansystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> </strong>and <strong>3rd heart sound</strong>.</li>\n<li>Confirmed with echocardiography; emergency <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement may be required.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Ventricular <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">Septum</span> <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">Rupture</span> </strong><strong>(Option A)</strong></p>\n<ul>\n<li>Characterized by <strong>sudden <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> deterioration</strong> and a <strong>loud <span class=\"customMeta\" data-dictid=\"529e0aff291692777194cbe766b6de\">pansystolic</span> murmur</strong> radiating to the right sternal border.</li>\n<li>Causes left-to-right shunting through a <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> septal defect, often leading to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"72421e3a581692777197a98d00066c\">right heart</span> failure.</li>\n<li>Confirmed by <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> and <span class=\"customMeta\" data-dictid=\"72421e3a581692777197a98d00066c\">right heart</span> catheterization.</li>\n<li>Emergency <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> repair is essential.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Ventricular <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">Rupture</span> </strong><strong>(Option D)</strong></p>\n<ul>\n<li>Leads to <strong>cardiac tamponade</strong> and is usually fatal.</li>\n<li>incomplete ruptures may allow for emergency <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> repair.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Embolism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thrombus can <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> on infarcted myocardium, leading to <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> embolism, which may cause stroke or ischemic limb.</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> are less common with<strong> <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> anticoagulants</strong> and <strong>early mobilization</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular Remodelling</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs after a <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">transmural</span> MI, with thinning and stretching of the infarcted area leading to <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and hypertrophy.</li>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> increases wall stress, reducing efficiency and potentially causing heart failure.</li>\n<li><strong>ACE inhibitors </strong>and <strong>mineralocorticoid <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists</strong> can reduce late <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"c182a5c58f1692777197ad47b9c2ef\">remodeling</span> and help prevent heart failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Death </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cause of death after MI</li>\n<li>According to time after MI\n\t\t\t\t<ul>\n<li>1st hour- <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">Fibrillation</span> /Ventricular Tachycardia</li>\n<li>1st day- <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">Cardiogenic</span> shock</li>\n<li>3rd day- <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> rupture</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient presents 6 weeks after experiencing an ST-elevation myocardial infarction (STEMI). He reports malaise, fever, and chest discomfort that worsens with deep breathing. On examination, a pericardial friction rub is heard. Laboratory tests reveal leukocytosis and an elevated ESR. What is the most appropriate initial treatment for this condition?", "options": [{"label": "A", "text": "Glucocorticosteroids", "correct": false}, {"label": "B", "text": "Aspirin", "correct": true}, {"label": "C", "text": "NSAIDs", "correct": false}, {"label": "D", "text": "Antibiotics", "correct": false}], "correct_answer": "B. Aspirin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Arrhythmias</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arrhythmias are common soon after symptom onset, due to factors like <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> <span class=\"customMeta\" data-dictid=\"2cc844bc9c1692777189739abf1dc5\">imbalance</span> and ischemia.</p>\n<ul>\n<li><strong>Ventricular <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">Premature</span> Beats (VPBs):</strong> <strong>Beta-blockers </strong>are recommended to reduce <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> activity and prevent <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> fibrillation.</li>\n<li><strong>Ventricular <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">Tachycardia</span> (VT) &amp; <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">Fibrillation</span> (VF):</strong></li>\n</ul>\n<ul>\n<li>VT and VF can occur within the first 24 hours without warning.</li>\n<li><strong>Prophylactic <span class=\"customMeta\" data-dictid=\"1e7b24ec0d16927771912170997efa\">lidocaine</span> </strong>is <strong>no longer recommended</strong> as it does not reduce mortality and may increase the risk of <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> and asystole.</li>\n<li><strong>Amiodarone</strong> is the preferred treatment for<strong> sustained VT</strong>, with <strong>electroversion</strong> for <strong>severe cases</strong>.</li>\n<li>VT or VF<strong> refractory</strong> to <span class=\"customMeta\" data-dictid=\"eef5721f13169277718749f123b80a\">electroshock</span> may respond to<strong> <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> </strong>or<strong> amiodarone</strong>.</li>\n</ul>\n<ul>\n<li><strong>Accelerated <span class=\"customMeta\" data-dictid=\"a4f90dcd3b1692777189b67cf3d15a\">Idioventricular</span> Rhythm (AIVR):</strong></li>\n</ul>\n<ul>\n<li>AIVR, also known as<strong> \"slow <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> tachycardia,\"</strong> is a <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rhythm with a rate of<strong> 60–100 beats</strong> per minute.</li>\n<li>It commonly occurs transiently<strong> during fibrinolytic</strong> therapy, especially at the time of <strong>reperfusion</strong>.</li>\n<li>Benign and not indicative of more serious arrhythmias.</li>\n<li>Rarely progresses to classic VT.</li>\n<li>Requires no treatment with careful monitoring.</li>\n</ul>\n<ul>\n<li><strong>Torsades <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> pointes</strong> may be due to<strong> <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalances</strong> or <strong>drug toxicity</strong>. Investigate and address underlying causes in these cases.</li>\n<li><strong>Sinus <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> </strong>is the<strong> most common</strong>, often secondary to other conditions (e.g., fever, heart failure). Treat underlying causes first.</li>\n<li><strong>Sinus Bradycardia: </strong>Treated with<strong> atropine</strong> if it causes <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> compromise. <strong>Persistent bradycardia</strong> may require<strong> pacing</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dressler Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is also known as <strong>post-myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> syndrome</strong>, it typically occurs <strong>1 to 8 weeks</strong> after MI.</li>\n<li><strong>Symptoms</strong>: Patients may experience malaise, fever, <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> discomfort, leukocytosis, elevated ESR, and <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion.</li>\n<li><strong>Pathology</strong>: <span class=\"customMeta\" data-dictid=\"d58cc1b03f1692777203673089eba8\">Fibrinous pericarditis</span> with <span class=\"customMeta\" data-dictid=\"0d0b0bf80b1692777196a0d5a44e03\">polymorphonuclear</span> leukocytes (PMNs) is often found at autopsy.</li>\n<li><strong>Cause</strong>: Likely involves an <strong>immunopathologic process</strong>.</li>\n<li><strong>Treatment</strong>:</li>\n</ul>\n<ul>\n<li><strong>Aspirin (650 mg every 4 hours)</strong> is the main treatment. <strong>(Option B)</strong></li>\n<li><strong>Glucocorticosteroids </strong>and<strong> NSAIDs</strong> should be <strong>avoided</strong> within 4 weeks of <span class=\"customMeta\" data-dictid=\"a4d4a0e12c1692777199cc73b5d6cc\">STEMI</span> due to risks of impaired <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> healing, <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rupture. <strong>(Option A &amp; C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old female with a history of hypertension and hyperlipidemia presents with severe chest pain for 1 hour. Her ECG shows ST-elevation indicating a STEMI. She has a blood pressure of 180/110 mmHg and a history of active peptic ulcer disease. What is the most appropriate treatment option for this patient?", "options": [{"label": "A", "text": "Streptokinase", "correct": false}, {"label": "B", "text": "Tissue plasminogen activator", "correct": false}, {"label": "C", "text": "Coronary artery bypass surgery", "correct": false}, {"label": "D", "text": "Percutaneous coronary intervention", "correct": true}], "correct_answer": "D. Percutaneous coronary intervention", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/zvSt8jw79CHQlIFQ2yQh1744300214.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a history of hypertension and hyperlipidemia presents with chest pain lasting 45 minutes. His ECG confirms a STEMI, and he is stable with a blood pressure of 130/85 mmHg. Which of the following statements about his acute myocardial infarction management is true?", "options": [{"label": "A", "text": "Beta blockers should be avoided in all patients with acute MI.", "correct": false}, {"label": "B", "text": "ACE inhibitors are contraindicated due to his blood pressure.", "correct": false}, {"label": "C", "text": "LMWH provides more reliable anticoagulation than UFH.", "correct": true}, {"label": "D", "text": "Glycoprotein IIb/IIIa inhibitors are not useful in acute MI.", "correct": false}], "correct_answer": "C. LMWH provides more reliable anticoagulation than UFH.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with severe chest pain lasting 30 minutes. His ECG is taken and shown below. He has no known allergies, his blood pressure is 145/85 mmHg, and his oxygen saturation is 98%. Which of the following drugs should be avoided in this patient?", "options": [{"label": "A", "text": "Administer morphine 2-4 mg IV for pain relief", "correct": false}, {"label": "B", "text": "Administer nifedipine 20 mg to relieve chest pain", "correct": true}, {"label": "C", "text": "Administer clopidogrel (300 mg loading dose) for platelet inhibition", "correct": false}, {"label": "D", "text": "Administer sublingual nitroglycerin (0.4 mg) to reduce myocardial oxygen demand", "correct": false}], "correct_answer": "B. Administer nifedipine 20 mg to relieve chest pain", "question_images": ["https://image.prepladder.com/notes/nNlj9nNKtmhz8bb4nFZ31746009129.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents to the emergency department with chest pain and is suspected of having an acute myocardial infarction (MI). Which of the following imaging techniques would provide the most accurate diagnosis of the MI?", "options": [{"label": "A", "text": "Echocardiography", "correct": false}, {"label": "B", "text": "Gadolinium-enhanced cardiac MRI", "correct": true}, {"label": "C", "text": "Myocardial perfusion imaging with Tc-sestamibi", "correct": false}, {"label": "D", "text": "Radionuclide ventriculography", "correct": false}], "correct_answer": "B. Gadolinium-enhanced cardiac MRI", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/DC7tpgcNlIlKGIMNdZqi1744300137.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male presents with chest pain, and an ECG reveals the following changes. Based on these findings, which coronary artery is most likely affected?", "options": [{"label": "A", "text": "Left Circumflex Artery", "correct": false}, {"label": "B", "text": "Right Coronary Artery", "correct": false}, {"label": "C", "text": "Anterior Interventricular Artery", "correct": true}, {"label": "D", "text": "Posterior Descending Artery", "correct": false}], "correct_answer": "C. Anterior Interventricular Artery", "question_images": ["https://image.prepladder.com/notes/pnGXy5iCGlXVTuC4qbEI1744371103.png"], "explanation_images": ["https://image.prepladder.com/notes/qEdRvA2il31v3qBEYOl01746519432.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infarct Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leads </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral Wall MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\">Circumflex</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LCx) <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>V5, V6, I, aVL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Septal Wall MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Septal Branch of Left <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LAD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>V1, V2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Wall MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LAD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>V1-V4, I, aVL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extensive <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Wall MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left Main <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LMCA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>V1-V6, I, aVL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Wall MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (PDA) <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>V1-V4 (ST depression), V7, V8, V9 (ST elevation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior Wall MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (RCA) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leads II, III, aVF</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NSTEMI (Anterior Wall)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LAD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often subtle changes in V1-V4</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient with a history of coronary artery disease undergoes angiography, which reveals a thrombus in the right coronary artery (RCA). Based on this finding, which area of the heart is most likely to be affected by an infarct?", "options": [{"label": "A", "text": "Anterior wall", "correct": false}, {"label": "B", "text": "Lateral wall", "correct": false}, {"label": "C", "text": "Inferior wall", "correct": true}, {"label": "D", "text": "Septal wall", "correct": false}], "correct_answer": "C. Inferior wall", "question_images": ["https://image.prepladder.com/notes/V30PHNNuDjFjWN6sQUs41744299859.png"], "explanation_images": ["https://image.prepladder.com/notes/f81uHaLuHewBRyIWfgBe1744299885.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:602px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location of Infarct</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LCA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anterior Wall MI (most common) <strong>(Option A ruled out)</strong></li>\n<li>Extensive <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Wall MI</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\">Circumflex</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LCX)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral Wall MI <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> (LAD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anterior Wall MI</li>\n<li>Septal MI<strong> (Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (RCA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior Wall MI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (PDA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inferior Wall MI</li>\n<li>Posterior Wall MI</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient presents with acute chest pain radiating to his left arm. An ECG is performed, but upon review, the physician notices that Lead II has been incorrectly connected. To ensure accurate representation of the heart's electrical activity, the physician asks you to correct the lead placement. Which of the following connections should be made to achieve the correct placement for Lead II on the ECG?", "options": [{"label": "A", "text": "Left arm (+) to Left arm (−)", "correct": false}, {"label": "B", "text": "Right arm (+) to Left arm (−)", "correct": false}, {"label": "C", "text": "Left arm (−) to Left leg (+)", "correct": false}, {"label": "D", "text": "Right arm (−) to Left leg (+)", "correct": true}], "correct_answer": "D. Right arm (−) to Left leg (+)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/KSZt6ENQeoshqNgiIdez1744299747.png", "https://image.prepladder.com/notes/zhzZNj80Dm6t1ECL3ozT1744299818.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old male presents to the emergency department with chest pain radiating to his left shoulder, which did not relieve with rest. An ECG is conducted. What is the earliest sign of myocardial infarction that is most likely to be seen on the ECG?", "options": [{"label": "A", "text": "Hyperacute T waves", "correct": true}, {"label": "B", "text": "Deep Q waves", "correct": false}, {"label": "C", "text": "Pardee sign", "correct": false}, {"label": "D", "text": "T Wave Inversions", "correct": false}], "correct_answer": "A. Hyperacute T waves", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/43kmYupaSdQtEer8MYcp1744299595.png", "https://image.prepladder.com/notes/tRv6gVXz1cpdTSq9qdni1744299625.png", "https://image.prepladder.com/notes/WOOhTsVaUDQDqITB83SH1744299664.png", "https://image.prepladder.com/notes/HH6v1TdpQNrVMvQcoPPu1744299692.png", "https://image.prepladder.com/notes/irYuhoQhU0lN17AUWiqP1744299720.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with a sudden onset of severe chest pain that radiates to his left arm. This pain started about 30 minutes ago while he was at rest. His medical history includes hypertension and hyperlipidemia. An ECG has been performed and cardiac biomarkers are significantly elevated. What is the most likely cause of his presentation?", "options": [{"label": "A", "text": "Coronary artery spasm", "correct": false}, {"label": "B", "text": "Coronary artery embolism", "correct": false}, {"label": "C", "text": "Spontaneous coronary artery dissection", "correct": false}, {"label": "D", "text": "Plaque rupture", "correct": true}], "correct_answer": "D. Plaque rupture", "question_images": ["https://image.prepladder.com/notes/sayDRiKyUB53DVer9b6k1746009264.png"], "explanation_images": ["https://image.prepladder.com/notes/a9KqhOBVJog59TWPtrzo1744310389.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old man present with chest pain and shortness of breath. He has a history of coronary artery disease and underwent a percutaneous coronary intervention (PCI) two days ago. An ECG shows ST-segment depression, and initial cTn values are found to be normal. Later, the cTn levels rise to five times the 99th percentile of the upper limit. What is the diagnosis here?", "options": [{"label": "A", "text": "Type 1", "correct": false}, {"label": "B", "text": "Type 2", "correct": false}, {"label": "C", "text": "Type 5", "correct": false}, {"label": "D", "text": "Type 4a", "correct": true}], "correct_answer": "D. Type 4a", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Universal definition of MI</li><li>↳ Universal definition of MI</li><li>↳ Universal definition of MI</li><li>↳ Universal definition of MI</li><li>↳ Myocardial injury is when there is evidence of elevated cardiac troponin (cTn) levels with at least one value above the 99th percentile upper reference limit (URL). Myocardial injury can be considered acute if the cTn values rise and/or fall.</li><li>↳ Myocardial injury is when there is evidence of elevated cardiac troponin (cTn) levels with at least one value above the 99th percentile upper reference limit (URL). Myocardial injury can be considered acute if the cTn values rise and/or fall.</li><li>↳ Myocardial injury is when there is evidence of elevated cardiac troponin (cTn) levels with at least one value above the 99th percentile upper reference limit (URL). Myocardial injury can be considered acute if the cTn values rise and/or fall.</li><li>↳ Myocardial injury is when there is evidence of elevated cardiac troponin (cTn) levels with at least one value above the 99th percentile upper reference limit (URL).</li><li>↳ Myocardial injury can be considered acute if the cTn values rise and/or fall.</li><li>↳ Types of MI</li><li>↳ Types of MI</li><li>↳ Types of MI</li><li>↳ Types of MI</li><li>↳ Type 1 MI (Option A) It is defined when there is a rise and/or fall of cardiac troponin (cTn) with at least one value above the 99th percentile of the upper limit. With at least one of the following: Symptoms of acute myocardial injury . New ischemic ECG changes. Development of pathological Q waves . Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality consistent with ischemia. Identification of a coronary thrombus by angiography, intracoronary imaging, or autopsy.</li><li>↳ Type 1 MI (Option A)</li><li>↳ Type 1 MI (Option A)</li><li>↳ Type 1 MI</li><li>↳ (Option A)</li><li>↳ It is defined when there is a rise and/or fall of cardiac troponin (cTn) with at least one value above the 99th percentile of the upper limit. With at least one of the following: Symptoms of acute myocardial injury . New ischemic ECG changes. Development of pathological Q waves . Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality consistent with ischemia. Identification of a coronary thrombus by angiography, intracoronary imaging, or autopsy.</li><li>↳ It is defined when there is a rise and/or fall of cardiac troponin (cTn) with at least one value above the 99th percentile of the upper limit. With at least one of the following: Symptoms of acute myocardial injury . New ischemic ECG changes. Development of pathological Q waves . Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality consistent with ischemia. Identification of a coronary thrombus by angiography, intracoronary imaging, or autopsy.</li><li>↳ It is defined when there is a rise and/or fall of cardiac troponin (cTn) with at least one value above the 99th percentile of the upper limit.</li><li>↳ rise and/or fall of cardiac troponin (cTn)</li><li>↳ With at least one of the following: Symptoms of acute myocardial injury . New ischemic ECG changes. Development of pathological Q waves . Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality consistent with ischemia. Identification of a coronary thrombus by angiography, intracoronary imaging, or autopsy.</li><li>↳ Symptoms of acute myocardial injury . New ischemic ECG changes. Development of pathological Q waves . Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality consistent with ischemia. Identification of a coronary thrombus by angiography, intracoronary imaging, or autopsy.</li><li>↳ Symptoms of acute myocardial injury .</li><li>↳ acute myocardial injury</li><li>↳ New ischemic ECG changes.</li><li>↳ New ischemic ECG</li><li>↳ Development of pathological Q waves .</li><li>↳ Q waves</li><li>↳ Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality consistent with ischemia.</li><li>↳ new loss of viable myocardium</li><li>↳ Identification of a coronary thrombus by angiography, intracoronary imaging, or autopsy.</li><li>↳ coronary thrombus</li><li>↳ Type 2 MI (Option B) This does not include the identification of coronary thrombus. Develops secondary to another illness or process. Possible mechanisms include: Fixed coronary atherosclerosis Coronary spasm Coronary embolism Coronary artery dissection Sustained tachyarrhythmia Severe bradyarrhythmia Severe hypertension Respiratory failure Shock Severe anemia or hypotension</li><li>↳ Type 2 MI (Option B)</li><li>↳ Type 2 MI (Option B)</li><li>↳ Type 2 MI</li><li>↳ (Option B)</li><li>↳ This does not include the identification of coronary thrombus. Develops secondary to another illness or process. Possible mechanisms include: Fixed coronary atherosclerosis Coronary spasm Coronary embolism Coronary artery dissection Sustained tachyarrhythmia Severe bradyarrhythmia Severe hypertension Respiratory failure Shock Severe anemia or hypotension</li><li>↳ This does not include the identification of coronary thrombus. Develops secondary to another illness or process. Possible mechanisms include: Fixed coronary atherosclerosis Coronary spasm Coronary embolism Coronary artery dissection Sustained tachyarrhythmia Severe bradyarrhythmia Severe hypertension Respiratory failure Shock Severe anemia or hypotension</li><li>↳ This does not include the identification of coronary thrombus.</li><li>↳ does not include the identification of coronary thrombus.</li><li>↳ Develops secondary to another illness or process.</li><li>↳ secondary</li><li>↳ Possible mechanisms include: Fixed coronary atherosclerosis Coronary spasm Coronary embolism Coronary artery dissection Sustained tachyarrhythmia Severe bradyarrhythmia Severe hypertension Respiratory failure Shock Severe anemia or hypotension</li><li>↳ Fixed coronary atherosclerosis Coronary spasm Coronary embolism Coronary artery dissection Sustained tachyarrhythmia Severe bradyarrhythmia Severe hypertension Respiratory failure Shock Severe anemia or hypotension</li><li>↳ Fixed coronary atherosclerosis</li><li>↳ Coronary spasm</li><li>↳ Coronary embolism</li><li>↳ Coronary artery dissection</li><li>↳ Sustained tachyarrhythmia</li><li>↳ Severe bradyarrhythmia</li><li>↳ Severe hypertension</li><li>↳ Respiratory failure</li><li>↳ Shock</li><li>↳ Severe anemia or hypotension</li><li>↳ Type 3 MI Very rare, constituting 3–4% of all MIs. Defined as death from probable cardiac causes. Distinction from non-cardiac causes of sudden death is important. Autopsy findings of fresh or recent thrombus in the infarct-related artery confirm Type 1 MI instead of Type 3 MI.</li><li>↳ Type 3 MI</li><li>↳ Type 3 MI</li><li>↳ Type 3 MI</li><li>↳ Very rare, constituting 3–4% of all MIs. Defined as death from probable cardiac causes. Distinction from non-cardiac causes of sudden death is important. Autopsy findings of fresh or recent thrombus in the infarct-related artery confirm Type 1 MI instead of Type 3 MI.</li><li>↳ Very rare, constituting 3–4% of all MIs. Defined as death from probable cardiac causes. Distinction from non-cardiac causes of sudden death is important. Autopsy findings of fresh or recent thrombus in the infarct-related artery confirm Type 1 MI instead of Type 3 MI.</li><li>↳ Very rare, constituting 3–4% of all MIs.</li><li>↳ Defined as death from probable cardiac causes.</li><li>↳ death from probable cardiac causes.</li><li>↳ Distinction from non-cardiac causes of sudden death is important.</li><li>↳ Autopsy findings of fresh or recent thrombus in the infarct-related artery confirm Type 1 MI instead of Type 3 MI.</li><li>↳ Type 4a MI related to percutaneous coronary intervention (PCI) Requires a fivefold increase in cTn values if initial values are normal. If initial cTn values are above the 99th percentile URL, a 20% rise is needed , with final values exceeding five times the 99th percentile.</li><li>↳ Type 4a MI related to percutaneous coronary intervention (PCI)</li><li>↳ Type 4a MI related to percutaneous coronary intervention (PCI)</li><li>↳ Type 4a MI</li><li>↳ related to percutaneous coronary intervention (PCI)</li><li>↳ Requires a fivefold increase in cTn values if initial values are normal. If initial cTn values are above the 99th percentile URL, a 20% rise is needed , with final values exceeding five times the 99th percentile.</li><li>↳ Requires a fivefold increase in cTn values if initial values are normal. If initial cTn values are above the 99th percentile URL, a 20% rise is needed , with final values exceeding five times the 99th percentile.</li><li>↳ Requires a fivefold increase in cTn values if initial values are normal.</li><li>↳ fivefold increase in cTn</li><li>↳ If initial cTn values are above the 99th percentile URL, a 20% rise is needed , with final values exceeding five times the 99th percentile.</li><li>↳ 20% rise is needed</li><li>↳ Type 4b MI This is associated with a stent thrombosis .</li><li>↳ Type 4b MI</li><li>↳ Type 4b MI</li><li>↳ Type 4b MI</li><li>↳ This is associated with a stent thrombosis .</li><li>↳ This is associated with a stent thrombosis .</li><li>↳ This is associated with a stent thrombosis .</li><li>↳ stent thrombosis</li><li>↳ Type 4c MI Associated with focal or diffuse restenosis after PCI . Defined by a rise and/or fall of cTn values above the 99th percentile URL. Diagnosis aligns with the criteria for Type 1 MI.</li><li>↳ Type 4c MI</li><li>↳ Type 4c MI</li><li>↳ Type 4c MI</li><li>↳ Associated with focal or diffuse restenosis after PCI . Defined by a rise and/or fall of cTn values above the 99th percentile URL. Diagnosis aligns with the criteria for Type 1 MI.</li><li>↳ Associated with focal or diffuse restenosis after PCI . Defined by a rise and/or fall of cTn values above the 99th percentile URL. Diagnosis aligns with the criteria for Type 1 MI.</li><li>↳ Associated with focal or diffuse restenosis after PCI .</li><li>↳ focal or diffuse restenosis after PCI</li><li>↳ Defined by a rise and/or fall of cTn values above the 99th percentile URL.</li><li>↳ Diagnosis aligns with the criteria for Type 1 MI.</li><li>↳ Type 5 MI related to coronary artery bypass grafting (CABG) (Option C) Requires a tenfold increase in cTn values if initial values are normal. If initial cTn values are above the 99th percentile URL, a 20% rise is needed, with final values exceeding ten times the 99th percentile.</li><li>↳ Type 5 MI related to coronary artery bypass grafting (CABG) (Option C)</li><li>↳ Type 5 MI related to coronary artery bypass grafting (CABG) (Option C)</li><li>↳ Type 5 MI related to coronary artery bypass grafting (CABG)</li><li>↳ (Option C)</li><li>↳ Requires a tenfold increase in cTn values if initial values are normal. If initial cTn values are above the 99th percentile URL, a 20% rise is needed, with final values exceeding ten times the 99th percentile.</li><li>↳ Requires a tenfold increase in cTn values if initial values are normal. If initial cTn values are above the 99th percentile URL, a 20% rise is needed, with final values exceeding ten times the 99th percentile.</li><li>↳ Requires a tenfold increase in cTn values if initial values are normal.</li><li>↳ tenfold increase in cTn values</li><li>↳ If initial cTn values are above the 99th percentile URL, a 20% rise is needed, with final values exceeding ten times the 99th percentile.</li></ul>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:704px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Universal definition of MI </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myocardial injury is when there is evidence of elevated <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">troponin</span> (cTn) levels with at least one value above the 99th <span class=\"customMeta\" data-dictid=\"8b22fa5ed1169277719587132297ce\">percentile</span> upper reference limit (URL).</li>\n<li>Myocardial injury can be considered <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> if the cTn values rise and/or fall.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of MI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1 MI </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is defined when there is a<strong> rise and/or fall of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">troponin</span> (cTn)</strong> with at least one value above the 99th <span class=\"customMeta\" data-dictid=\"8b22fa5ed1169277719587132297ce\">percentile</span> of the upper limit.</li>\n<li>With at least one of the following:\n\t\t\t\t<ul>\n<li>Symptoms of <strong>acute myocardial injury</strong>.</li>\n<li><strong>New ischemic ECG</strong> changes.</li>\n<li>Development of <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> <strong>Q waves</strong>.</li>\n<li>Imaging evidence of <strong>new loss of <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> myocardium</strong> or new regional wall motion <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> consistent with ischemia.</li>\n<li>Identification of a <strong>coronary thrombus</strong> by angiography, intracoronary imaging, or autopsy.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2 MI </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This <strong>does not include the identification of <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> thrombus.</strong></li>\n<li>Develops <strong>secondary </strong>to another illness or process.</li>\n<li>Possible mechanisms include:\n\t\t\t\t<ul>\n<li>Fixed <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> atherosclerosis</li>\n<li>Coronary spasm</li>\n<li>Coronary embolism</li>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> dissection</li>\n<li>Sustained tachyarrhythmia</li>\n<li>Severe bradyarrhythmia</li>\n<li>Severe hypertension</li>\n<li>Respiratory failure</li>\n<li>Shock</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> or hypotension</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3 MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Very rare, constituting 3–4% of all MIs.</li>\n<li>Defined as <strong>death from probable <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> causes.</strong></li>\n<li>Distinction from non-cardiac causes of sudden death is important.</li>\n<li>Autopsy findings of fresh or recent <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> in the infarct-related <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> confirm <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> MI instead of <span class=\"customMeta\" data-dictid=\"6f809a27121692777201d1ccde5ace\">Type 3</span> MI.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4a MI</strong><strong> related to <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> intervention (PCI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires a <strong>fivefold increase in cTn</strong> values if initial values are normal.</li>\n<li>If initial cTn values are above the 99th <span class=\"customMeta\" data-dictid=\"8b22fa5ed1169277719587132297ce\">percentile</span> URL, a<strong> 20% rise is needed</strong>, with final values exceeding five times the 99th percentile.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4b MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This is associated with a <strong>stent thrombosis</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4c MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with <strong>focal or <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"46b2c025701692777197ebd5938ea9\">restenosis</span> after PCI</strong>.</li>\n<li>Defined by a rise and/or fall of cTn values above the 99th <span class=\"customMeta\" data-dictid=\"8b22fa5ed1169277719587132297ce\">percentile</span> URL.</li>\n<li>Diagnosis aligns with the criteria for <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> MI.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 5 MI related to <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> (CABG) </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires a<strong> tenfold increase in cTn values </strong>if initial values are normal.</li>\n<li>If initial cTn values are above the 99th <span class=\"customMeta\" data-dictid=\"8b22fa5ed1169277719587132297ce\">percentile</span> URL, a 20% rise is needed, with final values exceeding ten times the 99th percentile.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vessels is at the greatest risk of atherosclerosis, arranged from highest to lowest?", "options": [{"label": "A", "text": "Popliteal arteries &amp;gt; Coronary arteries &amp;gt; Circle of Willis &amp;gt; Abdominal aorta", "correct": false}, {"label": "B", "text": "Coronary arteries &amp;gt; Abdominal aorta &amp;gt; Circle of Willis &amp;gt; Popliteal arteries", "correct": false}, {"label": "C", "text": "Abdominal aorta &amp;gt; Coronary arteries &amp;gt; Popliteal arteries &amp;gt; Circle of Willis", "correct": true}, {"label": "D", "text": "Coronary arteries &amp;gt; Circle of Willis &amp;gt; Abdominal aorta &amp;gt; Popliteal arteries", "correct": false}], "correct_answer": "C. Abdominal aorta &gt; Coronary arteries &gt; Popliteal arteries &gt; Circle of Willis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/KgHpmn0cxtArzduk8t5U1744298522.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old man presents with chest pain similar to episodes he experienced in the past. He has a history of hypertension and hyperlipidemia. The ECG shows ST-segment depression &amp;lt;0.5mm, and his cardiac troponin levels are elevated. Using the TIMI risk scoring system, what is the most appropriate next step in managing this patient's condition?", "options": [{"label": "A", "text": "Immediate coronary artery bypass grafting (CABG)", "correct": false}, {"label": "B", "text": "Discharge with a referral for outpatient stress testing", "correct": false}, {"label": "C", "text": "Initiate high-dose atorvastatin and schedule for follow-up in one month", "correct": false}, {"label": "D", "text": "Administer sublingual nitroglycerin and start intravenous beta-blockers", "correct": true}], "correct_answer": "D. Administer sublingual nitroglycerin and start intravenous beta-blockers", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/2CwzZ0Fh7PkKMsoXZdAk1744299300.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:457px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk factors</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age ≥65 years</li>\n<li>Known <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</li>\n<li>ST <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> &gt;0.5mm on presenting ECG</li>\n<li>Raised <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> markers</li>\n<li>≥2 original episodes in the prior 24 hours</li>\n<li>Prior angina</li>\n<li>≥3 <span class=\"customMeta\" data-dictid=\"4c453b57b51692777183ad486096a9\">CAD</span> risk factors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Number of risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Incidence of adverse <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> events (%)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">0/1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>8</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">20</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">26</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">6/7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">41</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medical management</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-ischemic therapy:</strong></p>\n<ul>\n<li><strong>Sublingual <span class=\"customMeta\" data-dictid=\"2da084cc151692777188fe899c0c5f\">glyceryl</span> trinitrate/nitroglycerin:</strong>\n<ul>\n<li><strong>DOC</strong> for unstable angina</li>\n<li>For <strong>ischemic discomfort </strong></li>\n</ul>\n</li>\n<li>IV beta-blockers (Atenolol, Metoprolol):\n\t\t\t\t<ul>\n<li>They <strong>reduce the oxygen demand of the myocardium</strong></li>\n<li>They relieve pain, reduce arrhythmias, and reduce short-term mortality</li>\n</ul>\n</li>\n<li><strong>Verapamil and diltiazem:</strong>\n<ul>\n<li>Given if symptoms are not relieved by full dose <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> blockers and nitrates</li>\n<li>They decrease the heart rate</li>\n</ul>\n</li>\n<li><strong>IV <span class=\"customMeta\" data-dictid=\"27d6d97dc51692777192f1043b6a79\">morphine</span> <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> or diamorphine:</strong>\n<ul>\n<li>For analgesia</li>\n</ul>\n</li>\n<li>Antiemetics like<strong> metoclopramide</strong> (For <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief)</li>\n<li>Nifedipine or amlodipine (If chest discomfort persists)</li>\n<li><strong>Atorvastatin and other HMG-CoA <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">reductase</span> inhibitors:</strong> Reduces occurrence of MI and recurrences of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome</li>\n<li>Ezetimibe or alirocumab, evolocumab:\n\t\t\t\t<ul>\n<li>Given if unresponsive to full dose statins</li>\n<li>They reduce <span class=\"customMeta\" data-dictid=\"4e4438ab5c16927771919ca536a59f\">LDL</span> cholesterol and prevent further <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> events</li>\n</ul>\n</li>\n</ul>\n<p><strong>Antithrombotic therapy: </strong></p>\n<ul>\n<li>Antiplatelet drugs:\n\t\t\t\t<ul>\n<li>Cyclooxygenase inhibitor: aspirin</li>\n<li>Platelet P2Y12 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> inhibitor: clopidogrel</li>\n</ul>\n</li>\n</ul>\n<p><strong>Anticoagulants:</strong></p>\n<ul>\n<li>Unfractionated heparin.</li>\n<li>Low molecular heparin: enoxaparin.</li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitor: bivalirudin.</li>\n<li>Synthetic factor Xa inhibitor: fondaparinux.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Invasive management</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Done if the medical management fails and symptoms do not improve. <strong>(Option A) </strong></li>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"baea202dec1692777182a0723c23ea\">arteriography</span> must be done within 48 hours of presentation.</li>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"854508a102169277719784ea065dd0\">revascularization</span> includes <strong>PCI (percutaneous <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> intervention)</strong> or <strong>coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> (CABG)</strong>.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>NSTE-ACS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>NSTEMI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>STEMI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-ST-segment <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome</li>\n<li>Include both NSTEMI and unstable angina</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-ST-segment <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> myocardial infarction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ST-segment <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> myocardial infarction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ST-segment <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ST-segment depression or T-wave inversions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant ST-segment elevation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">troponin</span> levels (in unstable angina) or elevated (in NSTEMI)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myocardial <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is present (NSTEMI) / absent (unstable angina)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myocardial <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myocardial <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk for myocardial infarction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serious ischemia, further evaluation needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urgent <span class=\"customMeta\" data-dictid=\"910e53d9bf1692777197e57fd0c1b6\">reperfusion</span> therapy required</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"NORMAL , STEMI, NSTEMI ECG\" data-author=\"NA\" data-hash=\"8691\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/2CwzZ0Fh7PkKMsoXZdAk1744299300.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 59-year-old woman with type 2 diabetes presents to your office with chest discomfort at rest, jaw pain, and nausea. On examination, she appears anxious, with cool, pale skin. The symptoms occurred suddenly 2 hours ago and are getting worse. She has a 20-pack-year smoking history. An ECG shows multiple T wave inversions and ST depressions in contiguous leads, and lab reports show raised Trop-I. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Stable angina", "correct": false}, {"label": "B", "text": "Unstable angina", "correct": false}, {"label": "C", "text": "Non-ST elevation MI", "correct": true}, {"label": "D", "text": "ST elevation MI", "correct": false}], "correct_answer": "C. Non-ST elevation MI", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/KqdVjV6SpsJdqO6ra6m21744299251.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with chest pain. ECG is given below. Considering this presentation, which of the following conditions could be responsible for the observed ST elevations? Hyperkalemia Variant Angina Digoxin (Therapeutic doses) Left Ventricular Hypertrophy (LVH) Chronic Stable Angina", "options": [{"label": "A", "text": "1 and 3", "correct": false}, {"label": "B", "text": "1, 2, and 4", "correct": true}, {"label": "C", "text": "2, 3, and 5", "correct": false}, {"label": "D", "text": "All are correct", "correct": false}], "correct_answer": "B. 1, 2, and 4", "question_images": ["https://image.prepladder.com/notes/bHGJDygde38aQYBgJxL51744299080.png"], "explanation_images": ["https://image.prepladder.com/notes/hYVPHxObFedbjm6mTlIC1744299197.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>ST <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">Elevation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>ST Depression</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"ST &lt;span class=\" custommeta\"=\"\" data-dictid=\"a1f256489a16927771870ddd296574\"/>Elevation - Answer\" data-author=\"NA\" data-hash=\"8685\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"384\" src=\"https://image.prepladder.com/notes/3D6CmFhfrh6BiNcm4ZJ51744299120.png\" width=\"384\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"ST Depression\" data-author=\"NA\" data-hash=\"8687\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"381\" src=\"https://image.prepladder.com/notes/hYVPHxObFedbjm6mTlIC1744299197.png\" width=\"381\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">Infarction</span> (STEMI)</li>\n<li>Prinzmetal Angina <strong>(Option 2)</strong></li>\n<li>Left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">Bundle</span> Branch Block (LBBB)</li>\n<li>Brugada syndrome</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">Hypertrophy</span> (LVH) <strong>(Option 4)</strong></li>\n<li>Pericarditis</li>\n<li>Benign early repolarization</li>\n<li>Takotsubo Cardiomyopathy</li>\n<li>Aortic Dissection</li>\n<li>Hyperkalemia <strong>(Option 1)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-ST-Elevation Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">Infarction</span> (NSTEMI)</li>\n<li>Digoxin (Therapeutic doses) <strong>(Option 3 ruled out)</strong></li>\n<li>Chronic Stable Angina <strong>(Option 5 ruled out)</strong></li>\n<li>Chronic Obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Disease (COPD)</li>\n<li>Hypokalemia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presents to the emergency department with episodes of chest pain occurring at rest, particularly during the night. His symptoms are often triggered by emotional stress and are relieved by nitroglycerin. An ECG was performed and is given below. There is no elevation of cardiac markers. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Stable angina", "correct": false}, {"label": "B", "text": "Unstable angina", "correct": false}, {"label": "C", "text": "Prinzmetal angina", "correct": true}, {"label": "D", "text": "Myocardial infarction", "correct": false}], "correct_answer": "C. Prinzmetal angina", "question_images": ["https://image.prepladder.com/notes/OmgtfMz5E0tajnMFX0qJ1744299058.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male presents to the emergency department with episodes of chest pain at rest that lasts for about 15 minutes and shortness of breath. The pain is central and radiates to the left arm and jaw. His medical history includes hypertension and hyperlipidemia. Investigations show normal enzyme levels. Which of the following is the most appropriate initial management for this patient's condition?", "options": [{"label": "A", "text": "Immediate coronary revascularization", "correct": false}, {"label": "B", "text": "Administration of sublingual nitroglycerin", "correct": true}, {"label": "C", "text": "Initiation of atorvastatin therapy", "correct": false}, {"label": "D", "text": "Administration of oral beta-blockers", "correct": false}], "correct_answer": "B. Administration of sublingual nitroglycerin", "question_images": ["https://image.prepladder.com/notes/Se2Vs9nOb8iLzvWrLLw51744299027.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman presents to the emergency department with a 30-minute episode of chest discomfort that occurred while she was watching television. She describes the pain as a tightness in his chest, radiating to her left arm. She has a history of diabetes and high cholesterol. An ECG reveals inverted T-waves. Which of the following investigations is considered the most crucial next step in evaluating her condition?", "options": [{"label": "A", "text": "Troponin test", "correct": true}, {"label": "B", "text": "Cardiac catheterization", "correct": false}, {"label": "C", "text": "Cardiac stress test", "correct": false}, {"label": "D", "text": "Myocardial perfusion imaging", "correct": false}], "correct_answer": "A. Troponin test", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/AGT12KJD58foeFtq4EVv1744298968.png", "https://image.prepladder.com/notes/RYmahvdtudwGmDxYwCDe1744298993.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ECG is the first and must investigation in this case, and it shows:\n\t\t\t\t<ul>\n<li>Hyperacute T-waves</li>\n<li>Flat T-waves</li>\n<li>Inverted T-waves (25% cases)</li>\n<li>ST depression (25% cases)</li>\n<li>Normal ST wave (50%)</li>\n<li>Most commonly, <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> rhythm is seen in unstable angina</li>\n</ul>\n</li>\n<li>Blood investigations:</li>\n</ul>\n<ul>\n<li>CBC, <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> profile</li>\n<li>Troponin test for <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (normal or slightly elevated)</li>\n<li>Coagulation studies</li>\n</ul>\n<ul>\n<li>Chest X-ray to rule out other conditions.</li>\n<li>Cardiac stress tests: <strong>(Option C)</strong></li>\n</ul>\n<ul>\n<li>Walking treadmill stress test</li>\n<li>Stress echocardiogram</li>\n</ul>\n<ul>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <strong>(Option D)</strong></li>\n<li>Cardiac CT/MRI</li>\n<li>Cardiac <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> (<strong>Gold</strong> <strong>standard</strong>) <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the revascularization procedure of choice for triple vessel disease and left main coronary artery disease, respectively?", "options": [{"label": "A", "text": "CABG; PCI with stenting", "correct": false}, {"label": "B", "text": "CABG for both", "correct": true}, {"label": "C", "text": "PCI with stenting; CABG", "correct": false}, {"label": "D", "text": "PCI with stenting; PCI with stenting", "correct": false}], "correct_answer": "B. CABG for both", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Preferred Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Single or two-vessel disease (non-proximal LAD, non-left main)</li>\n<li>High <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> risk (comorbidities)</li>\n<li>Contraindication to surgery</li>\n<li>Elderly patients (&gt;80 years or frailty)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PCI</strong> (Percutaneous <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> Intervention)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Multivessel disease </strong></li>\n<li>Proximal <span class=\"customMeta\" data-dictid=\"ad5f8a44f91692777191f70a74cc50\">LAD</span> involvement</li>\n<li><strong>Left main <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> artery</strong> involvement</li>\n<li>In-stent <span class=\"customMeta\" data-dictid=\"46b2c025701692777197ebd5938ea9\">restenosis</span> (with <span class=\"customMeta\" data-dictid=\"30a274b23d1692777186e34e778543\">DES</span> in major arteries)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CABG </strong>(Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">Bypass</span> Grafting)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with chronic stable angina presents with worsening chest pain during routine activities. His current medications include aspirin, clopidogrel, metoprolol, and atorvastatin, but his symptoms persist. ECG shows ST-segment depression in V5-V6, and coronary angiography reveals 80% stenosis of the left anterior descending (LAD) artery. What is the most appropriate intervention?", "options": [{"label": "A", "text": "Increase the dose of beta-blockers", "correct": false}, {"label": "B", "text": "Add ranolazine to medical therapy", "correct": false}, {"label": "C", "text": "Percutaneous coronary intervention (PCI) with drug-eluting stent (DES)", "correct": true}, {"label": "D", "text": "Refer for coronary artery bypass grafting (CABG)", "correct": false}], "correct_answer": "C. Percutaneous coronary intervention (PCI) with drug-eluting stent (DES)", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:782px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medication Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function/Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side Effects/</strong></p>\n<p style=\"text-align: center;\"><strong>Contraindication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nitrates</strong></p>\n<p>Sublingual <span class=\"customMeta\" data-dictid=\"7cfca041201692777193da668f40be\">nitroglycerin</span> (0.4 or 0.6 mg)</p>\n<p>Long-acting forms (oral, transdermal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic venodilation</li>\n<li>Reduces LV <span class=\"customMeta\" data-dictid=\"437bfd6ffb1692777187b5a7a706d5\">end-diastolic volume</span> and pressure</li>\n<li>Releases <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> (NO) to relax <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> smooth muscle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina relief</li>\n<li>Preemptive use before activities</li>\n<li>Improves exercise tolerance</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Tolerance</strong> development</li>\n<li>Headaches, dizziness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-Blocker</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces heart rate, arterial pressure, and myocardial contractility</li>\n<li>Improves survival post-MI</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina relief</li>\n<li><strong>Reduces mortality </strong>and reinfarction rates</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Asthma</strong></li>\n<li>AV <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> disturbances</li>\n<li>Severe bradycardia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Channel Blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coronary vasodilators</li>\n<li>Reduces myocardial oxygen demand and arterial pressure</li>\n<li>Dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., verapamil)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina treatment when <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> blockers are ineffective</li>\n<li>Variant angina</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bradyarrhythmias</li>\n<li>May aggravate LV failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiplatelet Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aspirin</strong>: inhibits <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> activation</li>\n<li><strong>Clopidogrel 75mg</strong>: blocks <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> aggregation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> events in high-risk populations</li>\n<li>Stent placement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk of bleeding</li>\n<li>Gastrointestinal issues, allergies</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Percutaneous <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> Intervention (PCI) </strong><strong> (Option C)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCI involves balloon <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and stenting for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> <span class=\"customMeta\" data-dictid=\"b72de43dd6169277718942f907b87c\">IHD</span> with suitable stenoses in epicardial <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> arteries.</p>\n<ul>\n<li><strong>Indications</strong>:\n\n\t\t\t\t<ul>\n<li>Symptom-limiting <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> despite <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> medical therapy.</li>\n<li>Evidence of <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> during stress tests.</li>\n</ul>\n</li>\n<li><strong>Post-PCI Management</strong>:\n\t\t\t\t<ul>\n<li><strong>Aspirin </strong>is administered indefinitely, and P2Y12 antagonists for 1-3 months.</li>\n<li>Current-generation<strong> drug-eluting stents</strong> reduce <span class=\"customMeta\" data-dictid=\"46b2c025701692777197ebd5938ea9\">restenosis</span> but require prolonged dual <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> therapy (DAPT).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">Bypass</span> <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">Grafting</span> (CABG) </strong><strong> (Option D)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves bypassing obstructive lesions using<strong> internal mammary arteries</strong>, <strong>radial arteries</strong>, or <strong>saphenous veins</strong>.</p>\n<ul>\n<li><strong>Indications</strong>:\n\n\t\t\t\t<ul>\n<li>Safe with low mortality in patients without serious comorbidities and normal LV function.</li>\n<li>Effective for patients with <strong>left main <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</strong>, <strong>multivessel disease</strong>, or <strong>impaired LV function</strong>.</li>\n</ul>\n</li>\n<li><strong>Outcomes</strong>:\n\t\t\t\t<ul>\n<li>Angina relief in ~90% of patients after complete revascularization.</li>\n<li>Long-term survival benefits in specific populations, particularly those with <strong>diabetes</strong> or<strong> impaired LV function</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man with a history of CAD presents with recurrent syncope. He has no obvious structural heart disease on echocardiography. Considering his intermediate to high risk for CAD, which imaging modality would be most appropriate for further evaluation?", "options": [{"label": "A", "text": "Myocardial Perfusion Imaging with Thallium-201 (Tl-201)", "correct": true}, {"label": "B", "text": "Stress Echocardiography", "correct": false}, {"label": "C", "text": "Multigated Acquisition (MUGA) Scanning", "correct": false}, {"label": "D", "text": "PET", "correct": false}], "correct_answer": "A. Myocardial Perfusion Imaging with Thallium-201 (Tl-201)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myocardial <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> imaging</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Done with <strong>Technetium-99m (Tc-99m) or Thallium-201 (Tl-201).</strong></p>\n<p><strong>Indications</strong>:</p>\n<ul>\n<li><strong>CAD Detection</strong></li>\n<li><strong>Heart Failure Assessment</strong></li>\n<li><strong>Ventricular Tachycardia</strong>: Investigating high-risk patients for CAD.</li>\n<li><strong>Syncope Evaluation</strong>: Assessing <span class=\"customMeta\" data-dictid=\"9f04fb3f2f1692777199272e3daf84\">syncope</span> in those at <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> to high risk for CAD.</li>\n<li><strong>Indeterminate Previous Results</strong></li>\n<li><strong>Angina Symptoms</strong></li>\n<li><strong>Post-Revascularization Assessment</strong>: Risk assessment for patients with ischemic symptoms, incomplete <span class=\"customMeta\" data-dictid=\"854508a102169277719784ea065dd0\">revascularization</span> in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> individuals, or those more than 5 years post-CABG.</li>\n<li><strong>Myocardial Viability</strong>: Determining <span class=\"customMeta\" data-dictid=\"854508a102169277719784ea065dd0\">revascularization</span> candidacy based on myocardial viability.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stress <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">Echocardiography</span> </strong><strong> (Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used in patients who cannot exercise or have resting <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> abnormalities, preferred for evaluating LV function and ischemia.</li>\n<li>Image quality can be affected by <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> and COPD.</li>\n<li>Technician-dependent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Positron Emission <span class=\"customMeta\" data-dictid=\"8d4f2a375b1692777200f41db641bc\">Tomography</span> (PET) </strong><strong> (Option D ruled out)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Functionality</strong> assesses myocardial <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> through <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> metabolism.</p>\n<p><strong>Advantages</strong>:</p>\n<ul>\n<li>High sensitivity and contrast resolution for detecting ischemia.</li>\n<li>High <span class=\"customMeta\" data-dictid=\"758b4503bf1692777196b4872a0e36\">predictive value</span> for future <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> events.</li>\n<li>Enhanced <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of multi-vessel disease and active atherosclerotic plaques with new radiotracers.</li>\n<li>Potential to avoid unnecessary interventions, despite high costs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Multigated Acquisition (MUGA) <span class=\"customMeta\" data-dictid=\"c497b556951692777198b599e4ba86\">Scanning</span> </strong><strong> (Option C ruled out)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Indications:</strong></h3>\n<ul>\n<li><strong>Cardiac Function in Chemotherapy</strong>: Evaluates <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> function in patients receiving potentially <span class=\"customMeta\" data-dictid=\"6bfc8ecaa9169277718345b55b3bd5\">cardiotoxic</span> chemotherapy.</li>\n<li><strong>Anatomical Assessment</strong>: Assesses the orientation of the heart and <span class=\"customMeta\" data-dictid=\"fa1831d5c016927771886f0447bc65\">great vessels</span> in the chest.</li>\n<li><strong>Ischemic Disease Detection</strong>: Identifies undiagnosed ischemic disease in patients with <span class=\"customMeta\" data-dictid=\"c8c8c2bac4169277718940c35c3f88\">hypodynamic</span> wall motion without prior myocardial infarction.</li>\n<li><strong>Heart Failure Evaluation</strong>: Determines <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> or diastolic <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> in undiagnosed <span class=\"customMeta\" data-dictid=\"b0eb48bbf6169277718568c051e6ad\">congestive heart failure</span> by analyzing <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> and contraction.</li>\n<li><strong>Valvular Function and COPD</strong>: Evaluates <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> motion and associated <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> function, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> function in patients with <span class=\"customMeta\" data-dictid=\"cc2003e35d1692777184a26dae1a68\">chronic obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease</span> (COPD), and checks for <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> shunts</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hibernating myocardium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stunned myocardium</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ischemic <span class=\"customMeta\" data-dictid=\"c64e23ddb8169277719344010b3fc0\">myocardium</span> where cells remain <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> but have chronically depressed <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood supply from a narrowed artery.</li>\n<li><strong>Viable</strong>, <strong>chronically <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> contraction</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Viable <span class=\"customMeta\" data-dictid=\"c64e23ddb8169277719344010b3fc0\">myocardium</span> that shows prolonged <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> after <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> has been restored (reperfusion).</li>\n<li><strong>Viable</strong>, <strong>post-ischemic dysfunction</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with chronic stable angina that has progressively worsened despite optimal medical therapy. He underwent myocardial stress testing, which indicated ischemia. What is the next best step in diagnosing the extent of his coronary artery disease?", "options": [{"label": "A", "text": "Stress echocardiography", "correct": false}, {"label": "B", "text": "Myocardial perfusion imaging", "correct": false}, {"label": "C", "text": "Coronary angiography", "correct": true}, {"label": "D", "text": "Coronary computed tomography angiography", "correct": false}], "correct_answer": "C. Coronary angiography", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CDuxCFxlJHl4ie0mYRe21744298925.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:756px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Exercise Treadmill Test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Initial test for intermediate-risk patients without resting <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> abnormalities; used for risk <span class=\"customMeta\" data-dictid=\"151522bdc71692777199067bd828cb\">stratification</span> and diagnosis of CAD.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Non-diagnostic in patients with LBBB, LVH, paced rhythm, or <span class=\"customMeta\" data-dictid=\"508c1bf22216927771860525d4ef6f\">digoxin</span> use.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stress <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">Echocardiography</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Used in patients who cannot exercise or have resting <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> abnormalities; preferred for evaluating LV function and ischemia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Image quality can be affected by <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> and COPD; technician-dependent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Myocardial <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> Imaging</strong><strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Preferred for patients with prior revascularization, resting <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> abnormalities, or high risk of ischemia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Expensive; exposes patients to ionizing radiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cardiac Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Indicated for comprehensive assessment of myocardial function, perfusion, structural heart disease, and <span class=\"customMeta\" data-dictid=\"f2c10bf89a16927771993672083876\">subendocardial</span> ischemia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Contraindicated in patients with <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> implants; long acquisition times.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Coronary <span class=\"customMeta\" data-dictid=\"44b07c254816927771855a12777513\">Computed Tomography</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> (CCTA)</strong><strong> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Alternative for patients with inconclusive ETT results or lower risk; also evaluates <span class=\"customMeta\" data-dictid=\"983d9763cb16927771838199d022fd\">CABG</span> <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> and <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> anomalies.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">May not detect all critical stenoses; exposes patients to radiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Coronary Angiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Gold standard for <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> diagnosis of <span class=\"customMeta\" data-dictid=\"4c453b57b51692777183ad486096a9\">CAD</span> in patients with confirmed <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> or medically <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> angina.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Invasive, high cost,</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male undergoes a treadmill ECG stress test and develops 2 mm of horizontal ST-segment depression after 8 minutes of exercise. He reports non-limiting chest pain (angina index = 1). What is his Duke Treadmill Score (DTS) and his risk category?", "options": [{"label": "A", "text": "DTS = 0; Intermediate risk", "correct": false}, {"label": "B", "text": "DTS = 5; Low risk", "correct": false}, {"label": "C", "text": "DTS = -2; Intermediate risk", "correct": true}, {"label": "D", "text": "DTS = -8; High risk", "correct": false}], "correct_answer": "C. DTS = -2; Intermediate risk", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:500px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>DTS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Interpretation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Low Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>≥ 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">No need for further <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> angiography.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intermediate Risk </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>+4 to –10</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">May need further tests, such as myocardial <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> <span class=\"customMeta\" data-dictid=\"c497b556951692777198b599e4ba86\">scanning</span> or <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> angiography.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>High Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>&lt; –10</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Requires further investigation with <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> angiography.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly male with a history of cigarette smoking and hypertension develops chest pain after an evening walk. The pain is relieved after lying down for a few minutes. A treadmill stress test reveals ST-segment depression. What is the most likely cause attributed to this clinical presentation?", "options": [{"label": "A", "text": "Hypertrophic Cardiomyopathy", "correct": false}, {"label": "B", "text": "Prinzmetal Angina", "correct": false}, {"label": "C", "text": "Non-ST-Elevation Myocardial Infarction (NSTEMI)", "correct": false}, {"label": "D", "text": "Chronic Stable Angina", "correct": true}], "correct_answer": "D. Chronic Stable Angina", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arrange the following structures of an atherosclerotic plaque from the innermost to the outermost layer: Fibrous cap Necrotic core Foam cell layer Media", "options": [{"label": "A", "text": "Fibrous cap → Foam cell layer→ Necrotic core → Media", "correct": true}, {"label": "B", "text": "Necrotic core → Media → Foam cell layer → Fibrous cap", "correct": false}, {"label": "C", "text": "Foam cell layer → Fibrous cap → Media→ Necrotic core", "correct": false}, {"label": "D", "text": "Foam cell layer → Necrotic core → Fibrous cap → Media", "correct": false}], "correct_answer": "A. Fibrous cap → Foam cell layer→ Necrotic core → Media", "question_images": ["https://image.prepladder.com/notes/M4hZFlTmmngH5zgL5Ue31744298747.png"], "explanation_images": ["https://image.prepladder.com/notes/IaIkzM0EzfC8kTCizNzD1744298812.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Endothelium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">The innermost arterial lining that regulates blood flow, prevents <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> formation, and controls inflammation. Damage to the <span class=\"customMeta\" data-dictid=\"b9a776cad316927771878445d3a99f\">endothelium</span> due to factors like hypertension, hyperlipidemia, and smoking initiates <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibrous Cap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Smooth muscle cells from the media migrate to the <span class=\"customMeta\" data-dictid=\"3ccbd45fb116927771904b9e0cd006\">intima</span> and <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> collagen, forming a protective <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> cap over the <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> core. Cap stability determines <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> vulnerability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Foamy Cell Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Lipoproteins like <span class=\"customMeta\" data-dictid=\"4e4438ab5c16927771919ca536a59f\">LDL</span> accumulate in the <span class=\"customMeta\" data-dictid=\"debc628674169277719936b6424a58\">subendothelial</span> space after endothelial injury. Macrophages engulf oxidized LDL, becoming <span class=\"customMeta\" data-dictid=\"40d72689211692777203fca86e25c9\">foam</span> cells, forming lipid-rich <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> streaks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Necrotic Core</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Foam cells die, releasing lipids and forming a necrotic core, consisting of dead cells and cholesterol crystals. A large necrotic core increases <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> instability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">The smooth muscle-rich middle arterial layer thins and weakens during <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> development as muscle cells move to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> cap.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 38 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 31 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 65 y/o woman with a history of mitral valve prolapse presents with fever and malaise. Blood cultures reveal a typical organism causing infective endocarditis. Echocardiography shows a 2 cm vegetation on the mitral valve. Based on the 2023 Duke-ISCVID criteria, which of the following is considered a typical organism strongly associated with infective endocarditis (IE)?", "options": [{"label": "A", "text": "Enterococcus faecalis", "correct": true}, {"label": "B", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "D", "text": "Streptococcus pyogenes", "correct": false}], "correct_answer": "A. Enterococcus faecalis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2023 Duke-ISCVID criteria for <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> (IE) - Typical and Non-typical Organisms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Typical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Typical </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For General cases:</strong></p>\n<ul>\n<li>Staphylococcus aureus, <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> lugdunensis</li>\n<li><strong>Enterococcus faecalis (Option A)</strong></li>\n<li>All <span class=\"customMeta\" data-dictid=\"8876d7c56816927771999e61073f60\">streptococci</span> (except <span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\">Streptococcus</span> pneumoniae and <span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\">Streptococcus</span> pyogenes)</li>\n<li>Granulicatella, Abiotrophia, <span class=\"customMeta\" data-dictid=\"b285f9f97a16927771881321941728\">Gemella</span> species</li>\n<li>HACEK group (e.g., Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>For cases involving<strong> <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> material</strong>, additional typical organisms include:</p>\n<ul>\n<li>Coagulase-negative staphylococci</li>\n<li>Corynebacterium striatum, <span class=\"customMeta\" data-dictid=\"5c14de20c01692777185f63bede46f\">Corynebacterium</span> jeikeium</li>\n<li>Serratia marcescens, Cutibacterium acnes</li>\n<li>Pseudomonas aeruginosa <strong>(Option C ruled out)</strong></li>\n<li>Non-tuberculous <span class=\"customMeta\" data-dictid=\"46f768d2e41692777193d69cbc7eec\">mycobacteria</span> (e.g., <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> chimaera)</li>\n<li>Candida species</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Organisms classified as non-typical are less frequently associated with IE and require three or more positive blood cultures for diagnosis.</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Streptococcus pneumoniae <strong>(Option B ruled out)</strong></li>\n<li>Streptococcus pyogenes <strong>(Option D ruled out)</strong></li>\n<li>Non-faecalis enterococci</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 78 y/o male, 3 months post-Transcatheter Aortic Valve Replacement (TAVR), presents with fever and signs of systemic infection. What is the most common causative organism in TAVR-associated infective endocarditis?", "options": [{"label": "A", "text": "Streptococcus viridans", "correct": false}, {"label": "B", "text": "Enterococcus spp", "correct": true}, {"label": "C", "text": "Staphylococcus aureus", "correct": false}, {"label": "D", "text": "Candida spp.", "correct": false}], "correct_answer": "B. Enterococcus spp", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common pathogens</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early PVE (Within the First 2 Months Post-Surgery)</strong></p>\n<p>(Often due to direct <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> or <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread.)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coagulase-negative <span class=\"customMeta\" data-dictid=\"0520f732541692777199acffcfd9ba\">staphylococci</span> (Staphylococcus epidermidis, often methicillin-susceptible) (most common)</li>\n<li>Staphylococcus aureus</li>\n<li>Gram-negative bacilli</li>\n<li>Candida species <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intermediate PVE (2-12 Months Post-Surgery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coagulase-negative <span class=\"customMeta\" data-dictid=\"0520f732541692777199acffcfd9ba\">staphylococci</span> (S.epidermidis)</li>\n<li>Staphylococcus aureus</li>\n<li>Streptococci</li>\n<li>Enterococci</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late PVE (After 12 Months Post-Surgery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>S.viridans (most common)</li>\n<li>Staphylococcus aureus</li>\n<li>Coagulase-negative staphylococci</li>\n<li>Enterococci</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72 y/o man presents with fever and night sweats. Blood cultures are repeatedly negative, but PCR testing from a sterile joint aspirate identifies Staphylococcus aureus. Echocardiography reveals mitral regurgitation. Based on the 2023 Duke-ISCVID criteria, which of the following is a minor criterion for diagnosing infective endocarditis?", "options": [{"label": "A", "text": "Negative blood cultures", "correct": false}, {"label": "B", "text": "Echocardiogram revealing mitral regurgitation", "correct": false}, {"label": "C", "text": "PCR from a sterile body site identifying a typical pathogen", "correct": true}, {"label": "D", "text": "Fever and night sweats", "correct": false}], "correct_answer": "C. PCR from a sterile body site identifying a typical pathogen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<thead>\n<tr>\n<th colspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>The 2023 Duke-International Society for <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">Cardiovascular</span> <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">Infectious</span> Diseases (ISCVID) Criteria for <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">Infective</span> <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">Endocarditis</span> - Minor Criteria Updates</strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predisposing Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Expanded to include <span class=\"customMeta\" data-dictid=\"c39699b4e51692777200464bc9ac1a\">transcatheter</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> procedures, <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> leads of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> implantable devices, and a history of IE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes splenic and cerebral abscesses.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunological Phenomena</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clarifies immune complex-mediated glomerulonephritis, with a practical definition involving unexplained <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury, hematuria, proteinuria, or a <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> showing immune complex disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microbiological Evidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PCR, amplicon or metagenomic sequencing of typical pathogens from <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> sites other than <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tissue is now a minor criterion. (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity detected by [18F]FDG PET/CT within three months of <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> or device <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> is included.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Exam</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A new <span class=\"customMeta\" data-dictid=\"00f5a32045169277719710bd9dd167\">regurgitant</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> is considered a minor <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> when <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> is unavailable.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 y/o man with a prosthetic aortic valve has a fever, positive blood cultures for Enterococcus faecalis, valve vegetation, and regurgitation on ECHO. Cardiac Computed Tomography shows a valve abscess. Which finding is a new major criterion for infective endocarditis in the 2023 Duke-ISCVID criteria?", "options": [{"label": "A", "text": "Cardiac computed tomography (CCT) showing valvular abscess", "correct": true}, {"label": "B", "text": "Echocardiogram revealing vegetation", "correct": false}, {"label": "C", "text": "Positive blood cultures with Enterococcus faecalis", "correct": false}, {"label": "D", "text": "Development of a new valve regurgitation", "correct": false}], "correct_answer": "A. Cardiac computed tomography (CCT) showing valvular abscess", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The 2023 Duke-International Society for <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">Cardiovascular</span> <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">Infectious</span> Diseases (ISCVID) Criteria for <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">Infective</span> <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">Endocarditis</span> - Major Criteria Updates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microbiological Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Expanded \"Typical\" Pathogens</strong>:\n\t\t\t\t<ul>\n<li>The list now includes <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> lugdunensis, <span class=\"customMeta\" data-dictid=\"0d41f61a301692777187afebabcf09\">Enterococcus</span> faecalis, and other streptococci, excluding S. pneumoniae and S. pyogenes.</li>\n<li>Additionally, Granulicatella, Abiotrophia, and <span class=\"customMeta\" data-dictid=\"b285f9f97a16927771881321941728\">Gemella</span> species are now recognised as typical IE pathogens.</li>\n</ul>\n</li>\n<li><strong>Prosthetic Material-Associated Pathogens</strong>:\n\t\t\t\t<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> devices, certain bacteria like <span class=\"customMeta\" data-dictid=\"cc520058161692777185da0fc11a45\">coagulase-negative staphylococci</span> and <span class=\"customMeta\" data-dictid=\"5c14de20c01692777185f63bede46f\">Corynebacterium</span> species, as well as <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa, are considered typical.</li>\n</ul>\n</li>\n<li><strong>Simplified <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">Blood Culture</span> Protocol</strong>:\n\t\t\t\t<ul>\n<li>Timing and separate <span class=\"customMeta\" data-dictid=\"6c81d74f4d1692777201b42f106cb9\">venipuncture</span> rules have been removed, though separate draws are still ideal.</li>\n</ul>\n</li>\n<li><strong>Fastidious Pathogens</strong>:\n\t\t\t\t<ul>\n<li>New criteria account for hard-to-culture organisms like <span class=\"customMeta\" data-dictid=\"c9ed7c1a9f1692777185cc193f7ec1\">Coxiella</span> burnetii, Bartonella, and <span class=\"customMeta\" data-dictid=\"a71df6ae4d16927772008263b77cc6\">Tropheryma</span> whipplei, diagnosed via <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> or specific serology.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cardiac CT (CCT): </strong>\n<ul>\n<li><strong>Findings like valvular vegetation, perforation, aneurysm, <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> or abscesses on CCT are now considered major criteria. (Option A)</strong></li>\n</ul>\n</li>\n<li><strong>[18F]FDG PET/CT</strong>:\n\t\t\t\t<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity on [18F]FDG PET/CT, especially around <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valves or <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> devices, is recognised as a major <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> criterion.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Evidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Intraoperative Findings</strong>:\n\t\t\t\t<ul>\n<li>Direct visual evidence of IE during surgery, such as vegetations or abscesses, qualifies as a major <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> in cases without other <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> findings.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 y/o male patient with a history of rheumatic heart disease presents to the dental clinic for a tooth extraction. He has a prosthetic heart valve placed two years ago and reports a penicillin allergy. He is otherwise healthy. Which of the following prophylactic antibiotic regimens should be administered to this patient before his dental procedure to prevent infective endocarditis?", "options": [{"label": "A", "text": "Amoxicillin 2g orally 1 hour before the procedure", "correct": false}, {"label": "B", "text": "Ampicillin 2g IV or IM within 1 hour before the procedure", "correct": false}, {"label": "C", "text": "Clarithromycin 500 mg orally 1 hour before the procedure", "correct": true}, {"label": "D", "text": "Cefazolin 1g IV or IM 30 minutes before the procedure", "correct": false}], "correct_answer": "C. Clarithromycin 500 mg orally 1 hour before the procedure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-risk <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> Lesions for <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> before <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> procedures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prophylactic <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">Antibiotic</span> Regimens for <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> in adults with high-risk <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> lesions</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic <span class=\"customMeta\" data-dictid=\"1a060c24961692777189bcbbf1d2cd\">heart valves</span> or material</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> assist devices or implantable <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> defibrillator.</li>\n<li>Prior endocarditis.</li>\n<li>Unrepaired cyanotic <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart disease, including <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> shunts or conduits.</li>\n<li>Completely repaired <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart defects during the 6 months after repair.</li>\n<li>Repaired <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart disease with <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> defects adjacent to the <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> material.</li>\n<li>Surgical or <span class=\"customMeta\" data-dictid=\"c39699b4e51692777200464bc9ac1a\">transcatheter</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> or <span class=\"customMeta\" data-dictid=\"2533659200169277718431206e4029\">conduit</span> placement</li>\n<li>Valvulopathy developing after <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> transplantation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Standard oral <span class=\"customMeta\" data-dictid=\"988bd8e7c71692777197b9f1d5d5ca\">regimen</span> </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n<p>Amoxicillin: 2g oral 1hr before procedure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inability to take oral medication </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n<p>Ampicillin: 2g IV or IM within 1hr before procedure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Penicillin allergy</strong></p>\n<ol>\n<li>Clarithromycin or Azithromycin: 500 mg PO 1hr before procedure.</li>\n<li>Cephalexin: 2g oral 1hr before procedure.</li>\n<li>Doxycycline: 100 mg oral 1hr before procedure.</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Penicillin allergy, inability to take oral medication </strong><strong>(Option D ruled out)</strong></p>\n<p>Cefazolin or Ceftriaxone: 1g IV or IM 30 mins before the procedure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 y/o man with a history of prosthetic valve presents with fever, chills, and fatigue. Blood cultures reveal methicillin-resistant Staphylococcus aureus (MRSA). The patient has a prosthetic valve and shows evidence of vegetation on echocardiography. What is the appropriate antibiotic regimen for managing this patient’s infection?", "options": [{"label": "A", "text": "Vancomycin + Gentamicin + Rifampin", "correct": true}, {"label": "B", "text": "Vancomycin + Daptomycin", "correct": false}, {"label": "C", "text": "Nafcillin + Gentamicin + Rifampin", "correct": false}, {"label": "D", "text": "Ampicillin + Gentamicin", "correct": false}], "correct_answer": "A. Vancomycin + Gentamicin + Rifampin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methicillin-resistant <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> aureus (MRSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>NVE</u>: Vancomycin or <span class=\"customMeta\" data-dictid=\"58f184a7cb169277718588c750d37c\">Daptomycin</span> for 6 weeks. <strong>(Option B ruled out)</strong></li>\n<li><strong><u>PVE</u></strong><strong>: Vancomycin + Rifampin(both for 6-8 weeks)+ Gentamicin(for 2 weeks) </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methicillin-sensitive <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> aureus (MSSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PVE: Nafcillin + <span class=\"customMeta\" data-dictid=\"0a8c2e2c42169277719721608c50a4\">Rifampin</span> (both for 6-8 weeks)</li>\n</ul>\n<p>+ Gentamicin(for 2 weeks) <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enterococcal Endocarditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ampicillin + <span class=\"customMeta\" data-dictid=\"ca244a562f16927771884ac81c7d2e\">Gentamicin</span> both for 4-6 weeks <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Streptococcal Endocarditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ceftriaxone/Penicillin + Gentamicin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Q fever (Coxiella burnetii)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Doxycycline + Hydroxychloroquine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bartonella Endocarditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Doxycycline + Gentamicin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fungal <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">Endocarditis</span> (Candida species)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>IV <span class=\"customMeta\" data-dictid=\"2aca559df7169277718182de664e44\">Amphotericin B</span> + Flucytosine.\n\t\t\t\t<ul>\n<li>If PVE, early surgery is recommended due to rapid progression.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a minor criterion under the Modified Duke’s Criteria for infective endocarditis?", "options": [{"label": "A", "text": "Positive echocardiographic findings of vegetation", "correct": false}, {"label": "B", "text": "Two positive blood cultures with a typical organism", "correct": false}, {"label": "C", "text": "Presence of a prosthetic valve", "correct": true}, {"label": "D", "text": "Abscess formation on echocardiogram", "correct": false}], "correct_answer": "C. Presence of a prosthetic valve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Duke’s Criteria</strong> - <strong>Minor criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predisposing heart condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any pre-existing valvular or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> abnormality, such as valvular disease, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart defects, or <strong>prosthetic valves. (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous drug use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognised as a significant risk factor for IE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever ≥ 38°C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly seen in patients with IE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular phenomena</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Such as <span class=\"customMeta\" data-dictid=\"acd7af7f74169277718736b038fb02\">embolic</span> events (stroke, <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infarcts), <span class=\"customMeta\" data-dictid=\"39f702525516927771939b0791cac7\">mycotic</span> aneurysms, <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> haemorrhages and Janeway lesions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunological phenomena</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rheumatoid factor, Osler’s nodes, Roth's spots or glomerulonephritis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">blood culture</span> not meeting major criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isolation of organisms typical of IE in a single culture or other non-major findings.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suggestive echocardiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal findings that raise suspicion but do not meet the criteria for a major criterion. (D529)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o man with a mechanical aortic valve presents with 2 weeks of fever, fatigue, and shortness of breath. He has a history of a dental procedure done 3 weeks back. Blood cultures are negative. FDG-PET/CT shows abnormal uptake around the valve. Which major criterion from the Modified Duke’s Criteria does this patient meet?", "options": [{"label": "A", "text": "Negative blood culture for a typical organism", "correct": false}, {"label": "B", "text": "Evidence of endocardial involvement by FDG-PET/CT", "correct": true}, {"label": "C", "text": "Abscess formation", "correct": false}, {"label": "D", "text": "Recent history of dental procedure", "correct": false}], "correct_answer": "B. Evidence of endocardial involvement by FDG-PET/CT", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Duke’s Criteria - Major criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive blood cultures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Identification of a typical organism from two cultures, or persistent positive cultures drawn more than 12 hours apart.</li>\n<li>Three or more positive cultures that have been taken over at least one hour apart.</li>\n<li>A single positive <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">blood culture</span> for <span class=\"customMeta\" data-dictid=\"c9ed7c1a9f1692777185cc193f7ec1\">Coxiella</span> burnetii or a phase I <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> <span class=\"customMeta\" data-dictid=\"6c8421504e1692777200e552c3b421\">titre</span> &gt; 1:800.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Evidence of endocardial involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Positive echocardiographic findings such as vegetations, abscesses, or new valvular regurgitation.</li>\n<li>Oscillating <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> masses or partial <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> of a <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valve.</li>\n<li><strong>Additional <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tools like FDG-PET/CT or EKG-gated <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> CT angiograms also meet major criteria for <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> endocarditis. (Added by the European Society of Cardiology)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60- y/o woman with a history of RHD presents to the OPD with complaints of persistent fatigue, fever, and visual disturbances. O/E multiple linear red to brownish streaks under her fingernails and a pale-centred retinal haemorrhage were observed. Blood cultures reveal the presence of Staphylococcus aureus . Which peripheral lesions associated with the patient’s condition are described by the patient's symptoms?", "options": [{"label": "A", "text": "Janeway lesions and Osler's nodes", "correct": false}, {"label": "B", "text": "Roth spots and splinter haemorrhages", "correct": true}, {"label": "C", "text": "Ulcerative lesions and petechiae", "correct": false}, {"label": "D", "text": "Aneurysms and ischemic ulcers", "correct": false}], "correct_answer": "B. Roth spots and splinter haemorrhages", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/3qhJrFh96rkRAsfqsWgn1744308320.png", "https://image.prepladder.com/notes/VYYWtubxJ1ZCgHGZA6yz1744308595.png", "https://image.prepladder.com/notes/CG12N0DgQ9HhxH4cz9zK1744308743.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Janeway lesions:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painless, erythematous macules on palms and soles. Related to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> microembolization,</p>\n<p><strong>(Option A ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Janeway lesions\" data-author=\"Warfieldian - Own work\" data-hash=\"8841\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Janeway_lesion#/media/File:Janeway_lesion.JPG\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/3qhJrFh96rkRAsfqsWgn1744308320.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osler’s nodes: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small painful pea-shaped nodules located at the <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">tips</span> of fingers and toes (Immune complex mediated). <strong>(Option A ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osler’s nodes\" data-author='\" Roberto J. Galindo - Own work\"' data-hash=\"8843\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Osler%27s_node#/media/File:Osler_Nodules_Hand.jpg\" data-tags=\"April2025\" height=\"347\" src=\"https://image.prepladder.com/notes/VYYWtubxJ1ZCgHGZA6yz1744308595.png\" width=\"284\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subungual haemorrhages/Splinter haemorrhages:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> S. aureus IE. Haemorrhages below nails- multiple <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> lesions, initially red then turning brown or black.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Subungual hemorrhage or &lt;span class=\" custommeta\"=\"\" data-dictid=\"2bb63f81301692777199461e9fc6f4\"/>Splinter hemorrhages\" data-author=\"\" Splarka - Own work\"\" data-hash=\"8844\" data-license=\"OPEN ACESS\" data-source=\"https://en.wikipedia.org/wiki/Splinter_hemorrhage#/media/File:Splinter_hemorrhage.jpg\" data-tags=\"April2025\" height=\"330\" src=\"https://image.prepladder.com/notes/4wwzy51cNNejMMqhXwRU1744308670.png\" width=\"284\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Roth spots: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pale-centred <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> haemorrhages that are seen in the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> examination</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Roth spots\" data-author=\"Community Eye Health. Published by the International Centre for Eye Health www.iceh.org.uk, London School of Hygiene &amp; Tropical Medicine.\" data-hash=\"8845\" data-license=\"CC BY-NC 2.0\" data-source=\"https://www.flickr.com/photos/communityeyehealth/7603597760\" data-tags=\"April2025\" height=\"294\" src=\"https://image.prepladder.com/notes/CG12N0DgQ9HhxH4cz9zK1744308743.png\" width=\"294\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the context of infective endocarditis, what role do MSCRAMMs play in the disease process?", "options": [{"label": "A", "text": "They enhance the immune response against pathogens during bacteremia.", "correct": false}, {"label": "B", "text": "They facilitate bacterial adherence to nonbacterial thrombotic endocarditis (NBTE) or injured endothelium.", "correct": true}, {"label": "C", "text": "They are responsible for the formation of emboli that lead to tissue infarction.", "correct": false}, {"label": "D", "text": "They promote the breakdown of vegetation formed in the heart.", "correct": false}], "correct_answer": "B. They facilitate bacterial adherence to nonbacterial thrombotic endocarditis (NBTE) or injured endothelium.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 y/o male with a history of benign prostatic hyperplasia (BPH) presents with fever, malaise, and a new heart murmur. He recently underwent a urinary catheterisation for urinary retention. Blood cultures are positive for gram-positive cocci. What is the most likely causative organism of his infective endocarditis?", "options": [{"label": "A", "text": "Staphylococcus aureus", "correct": false}, {"label": "B", "text": "Streptococcus gallolyticus", "correct": false}, {"label": "C", "text": "Enterococcus faecalis", "correct": true}, {"label": "D", "text": "Haemophilus species", "correct": false}], "correct_answer": "C. Enterococcus faecalis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Portals of entry</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral cavity:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The entry point for viridans streptococci.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common entry point for <span class=\"customMeta\" data-dictid=\"0520f732541692777199acffcfd9ba\">staphylococci</span> and S.epidermidis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> tract:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Source for HACEK organisms (Haemophilus, Aggregatibacter, <span class=\"customMeta\" data-dictid=\"73455a7c831692777183f191884b1a\">Cardiobacterium</span> hominis, <span class=\"customMeta\" data-dictid=\"52d63b146416927771879cd9183a66\">Eikenella</span> corrodens, Kingella). <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal tract:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Streptococcus gallolyticus (formerly S. bovis) is associated with <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> polyps and tumours. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genitourinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and GI <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> procedures ( catheterization, colonoscopy):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Source for enterococci.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nosocomial (hospital-acquired) sources:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>S. aureus, <span class=\"customMeta\" data-dictid=\"cc520058161692777185da0fc11a45\">coagulase-negative staphylococci</span> (CoNS), and enterococci are often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to healthcare-associated <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> endocarditis. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prosthetic <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> infections (PVE):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intraoperative <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> or <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> infection, especially with S. aureus, CoNS, and <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> bacilli.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous drug use:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> for S. aureus infections, especially in <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> involvement. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68 y/o male with a prosthetic valve presents with fever, night sweats, and fatigue 6 months post-surgery. Blood cultures are negative, and he was exposed to a contaminated heater-cooler device during valve replacement. Which organism is most likely responsible for his prosthetic valve endocarditis?", "options": [{"label": "A", "text": "Staphylococcus epidermidis", "correct": false}, {"label": "B", "text": "Coxiella burnetii", "correct": false}, {"label": "C", "text": "Mycobacterium chimaera", "correct": true}, {"label": "D", "text": "Enterococcus faecalis", "correct": false}], "correct_answer": "C. Mycobacterium chimaera", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 y/o female with a history of patent ductus arteriosus (PDA) presents with fever, fatigue, and a new-onset systolic murmur. Her recent echocardiogram shows vegetation along the inner lining of her aorta. She is an intravenous drug user and has been experiencing unexplained weight loss over the past month. Which of the following conditions is the most likely diagnosis for this patient based on her symptoms and history?", "options": [{"label": "A", "text": "Acute bacterial endocarditis", "correct": false}, {"label": "B", "text": "Subacute bacterial endocarditis", "correct": false}, {"label": "C", "text": "Infective endarteritis", "correct": true}, {"label": "D", "text": "Myocardial infarction", "correct": false}], "correct_answer": "C. Infective endarteritis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72 y/o female with a history of mitral valve prolapse presents with a low-grade fever, night sweats, and fatigue persisting for over a month. Physical examination reveals a new heart murmur and petechiae on her extremities. Blood cultures are sent. What is the leading organism associated with this patient's probable condition?", "options": [{"label": "A", "text": "Staphylococcus aureus", "correct": false}, {"label": "B", "text": "Streptococcus viridans", "correct": true}, {"label": "C", "text": "Enterococcus faecalis", "correct": false}, {"label": "D", "text": "HACEK organisms", "correct": false}], "correct_answer": "B. Streptococcus viridans", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3 style=\"text-align: center;\"><strong>Acute Bacterial Endocarditis</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3 style=\"text-align: center;\"><strong>Subacute <span class=\"customMeta\" data-dictid=\"8396f4dfb61692777182ba80e5da76\">Bacterial Endocarditis</span> (SBE)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aggressive course</strong> compared to <span class=\"customMeta\" data-dictid=\"159e1426d61692777199d9361738d0\">subacute</span> endocarditis.</li>\n<li><strong>Causative organisms</strong>: <strong>S. aureus</strong> (Most common cause) (including MRSA), S. pneumoniae, L. monocytogenes, <span class=\"customMeta\" data-dictid=\"e8810d5c6b169277718827849b05a3\">Haemophilus</span> species, <span class=\"customMeta\" data-dictid=\"8876d7c56816927771999e61073f60\">streptococci</span> (groups A, B, G).</li>\n<li><strong>Risk factors</strong>: <span class=\"customMeta\" data-dictid=\"843b8ecd5416927771842bc110b4e3\">Comorbid</span> conditions like malignancy, diabetes mellitus, IV drug use, or alcoholism.</li>\n<li><strong>Presentation</strong>:\n\t\t\t\t<ul>\n<li>Fever, fatigue, and <span class=\"customMeta\" data-dictid=\"851667fa1916927771918db28ab877\">malaise</span> <strong>within &lt;2 weeks of infection.</strong></li>\n<li>Changing heart murmur, potential congestive heart failure.</li>\n<li>Possible signs: Janeway lesions (hemorrhagic macules on palms/soles), petechiae, Roth’s spots, <span class=\"customMeta\" data-dictid=\"2bb63f81301692777199461e9fc6f4\">splinter</span> haemorrhages, <span class=\"customMeta\" data-dictid=\"b3eb52fe3b1692777199de8465eea8\">splenomegaly</span> (rare).</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Slow <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> </strong>compared to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> endocarditis</li>\n<li><strong>Causative organism: <span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\">Streptococcus</span> viridans</strong> (Most common cause)</li>\n<li><strong>Presentation</strong>:\n\t\t\t\t<ul>\n<li>Gradual onset over weeks to months <strong>(&gt;2 weeks)</strong> but can be life-threatening if untreated.</li>\n<li>Symptoms: unexplained fever, chills, night sweats, fatigue, weight loss, joint/muscle aches, chest/back pain, and skin rashes.</li>\n</ul>\n</li>\n<li><strong>Risk Factors</strong>:\n\t\t\t\t<ul>\n<li>Periodontal disease, IV drug use, prolonged IV medication.</li>\n<li>Congenital heart defects, prior endocarditis, <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> surgery, or <span class=\"customMeta\" data-dictid=\"e70797a893169277719467eb262506\">pacemaker</span> implants.</li>\n<li>More common in men, especially over age 60.</li>\n</ul>\n</li>\n<li><strong>Treatment</strong>:\n\t\t\t\t<ul>\n<li>High-dose IV antibiotics for 2-6 weeks.</li>\n<li>Surgery may be needed for <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> or <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> repair/replacement.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following lists the valves in order of frequency of involvement in infective endocarditis, from most to least commonly affected?", "options": [{"label": "A", "text": "Mitral valve &amp;gt; Aortic valve &amp;gt; Tricuspid valve &amp;gt; Pulmonic valve", "correct": true}, {"label": "B", "text": "Aortic valve &amp;gt; Mitral valve &amp;gt; Pulmonic valve &amp;gt; Tricuspid valve", "correct": false}, {"label": "C", "text": "Tricuspid valve &amp;gt; Mitral valve &amp;gt; Aortic valve &amp;gt; Pulmonic valve", "correct": false}, {"label": "D", "text": "Pulmonic valve &amp;gt; Aortic valve &amp;gt; Tricuspid valve &amp;gt; Mitral valve", "correct": false}], "correct_answer": "A. Mitral valve &gt; Aortic valve &gt; Tricuspid valve &gt; Pulmonic valve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding right-sided infective endocarditis (IE)?", "options": [{"label": "A", "text": "Right-sided infective endocarditis is more commonly associated with enterococci than left-sided infective endocarditis.", "correct": true}, {"label": "B", "text": "Staphylococcus aureus is the most common pathogen in right-sided infective endocarditis", "correct": false}, {"label": "C", "text": "Injecting particles are more likely to reach the right-sided valves compared to the left-sided valves", "correct": false}, {"label": "D", "text": "Right-sided infective endocarditis has a better long-term prognosis compared to left-sided infective endocarditis", "correct": false}], "correct_answer": "A. Right-sided infective endocarditis is more commonly associated with enterococci than left-sided infective endocarditis.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right-Sided IDU-Associated IE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left-Sided IDU-Associated IE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Valve Involvement</strong>: Predominantly affects the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve.</li>\n<li><strong>Causative Pathogen</strong>: <em>Staphylococcus aureus</em> (Especially MRSA) is responsible for 85% of cases , primarily due to poor <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> hygiene. <strong>(Option B ruled out)</strong></li>\n<li><strong>Pathophysiology</strong>: <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">Injected</span> particles damage right-sided valves. <span class=\"customMeta\" data-dictid=\"15d05b2ff4169277718205c0916590\">Bacteremia</span> from skin bacteria (like <em>S. aureus</em>) easily colonizes these valves.</li>\n<li><strong>Surgical Intervention</strong>: Surgery is rare and <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> is generally well tolerated.</li>\n<li><strong>Prognosis</strong>: Right-sided IE has a better long-term prognosis. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Valve Involvement</strong>: Affects the aortic or <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valves, occurring in about 20-30% of IDU-related IE cases.</li>\n<li><strong>Causative Pathogen</strong>: <em>S. aureus</em> causes 46% of cases, but alpha-hemolytic <span class=\"customMeta\" data-dictid=\"8876d7c56816927771999e61073f60\">streptococci</span> and enterococci are more common than in right-sided IE. <strong>(Option A)</strong></li>\n<li><strong>Pathophysiology</strong>: Left-sided IE often occurs in individuals with underlying <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease or degenerative changes, which are more common in older patients. <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">Injected</span> particles are less likely to reach the left-sided valves because they often get trapped in the lungs. <strong>(Option C ruled out)</strong></li>\n<li><strong>Surgical Intervention</strong>: Surgery is much more common due to the more severe nature of left-sided lesions (e.g., <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation, severe heart failure).</li>\n<li><strong>Prognosis</strong>: Left-sided IE has a worse prognosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72 y/o woman presents with severe chest pain and shortness of breath after a stressful argument. She is post-menopausal with no history of heart disease. O/E, she is slightly tachycardic with normal blood pressure. An echocardiogram shows left ventricular ballooning during systole, and cardiac enzymes are minimally elevated. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypertensive Heart Disease", "correct": false}, {"label": "B", "text": "Takotsubo Cardiomyopathy", "correct": true}, {"label": "C", "text": "Coronary Artery Disease", "correct": false}, {"label": "D", "text": "Pulmonary Embolism", "correct": false}], "correct_answer": "B. Takotsubo Cardiomyopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Takotsubo <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> (Gebrochenes-Herz syndrome)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Takotsubo cardiomyopathy, also known as broken-heart syndrome or stress-induced cardiomyopathy, is a non-ischemic condition primarily affecting post-menopausal women.</li>\n<li>It features temporary left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> that resembles a <span class=\"customMeta\" data-dictid=\"881eca638f16927771889ba405ef07\">heart attack</span> but with minimal <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> release and no significant obstructive <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease.</li>\n<li>The name \"Takotsubo\" is derived from Japanese, meaning <span class=\"customMeta\" data-dictid=\"73fcea5285169277719431e7e4e696\">octopus</span> trap, reflecting the <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> shape of the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> during contraction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Catecholamine Hypothesis:</strong> Elevated catecholamines (norepinephrine, epinephrine, dopamine) indicate stress-induced <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> overdrive, leading to <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> spasms and myocardial injury.</li>\n<li><strong>Microvascular Dysfunction:</strong> Impaired function is suggested by abnormalities in <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> flow reserve and <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> resistance.</li>\n<li><strong>Inflammation:</strong> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> may show myocardial oedema, necrosis, and fibrosis, with conditions like <span class=\"customMeta\" data-dictid=\"b37b57210716927771933ee216a834\">myocarditis</span> and <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases potentially triggering TC.</li>\n<li><strong>Estrogen Deficiency:</strong> Exaggerated <span class=\"customMeta\" data-dictid=\"3f0b42b17016927772014c586d44b7\">vasoconstriction</span> and increased <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> activity in post-menopausal women contribute to TC.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Takotsubo <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> often mimics <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome.(MI)</li>\n<li><strong>Common Triggers:</strong>\n<ul>\n<li><strong>Emotional Stress:</strong> Events like the unexpected death of a loved one, domestic abuse, or financial loss.</li>\n<li><strong>Physical Stress:</strong> Serious medical diagnoses or natural disasters.</li>\n</ul>\n</li>\n<li><strong>Symptoms:</strong> Chest pain, dyspnea, and syncope. Some patients may have signs of heart failure, such as tachyarrhythmias or bradyarrhythmias.</li>\n<li>A late-peaking <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> may be present due to LVOTO (Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> Obstruction).</li>\n<li>About 10% of patients may develop <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> shock.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common echocardiographic finding associated with rheumatic carditis?", "options": [{"label": "A", "text": "Aortic regurgitation", "correct": false}, {"label": "B", "text": "Mitral regurgitation", "correct": true}, {"label": "C", "text": "Left ventricular hypertrophy", "correct": false}, {"label": "D", "text": "Pericardial effusion", "correct": false}], "correct_answer": "B. Mitral regurgitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Incidence/Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mitral regurgitation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>94% in first episodes, 84% in recurrences</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ventricular dilatation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>54% in first episodes, 74% in recurrences</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restricted <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> mobility</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>37% of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> cases</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Valvular Abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Valvular thickening</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thickened <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> leaflets</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focal valvular nodules</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>25%, usually resolved over time</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> function</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal despite <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> regurgitation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congestive <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> (CHF)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>17% of first episodes, 40% of recurrences</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Follow-Up</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Valvular <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> outcomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>69% unchanged, 22% decreased, 9% disappeared</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> dimensions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decrease over time</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12 y/o girl presents with a recent onset of involuntary, jerky movements in her hands and face, worsening with stress or purposeful tasks. Her mother recalls multiple untreated sore throats months ago. O/E, she has irregular, rapid, non-rhythmic hand movements, difficulty with facial control, and trouble sustaining muscle contraction. Her motor function is otherwise normal. What is the most appropriate initial treatment?", "options": [{"label": "A", "text": "Penicillin prophylaxis", "correct": true}, {"label": "B", "text": "Haloperidol", "correct": false}, {"label": "C", "text": "Intravenous immunoglobulin (IVIG)", "correct": false}, {"label": "D", "text": "Carbamazepine", "correct": false}], "correct_answer": "A. Penicillin prophylaxis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Initial <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">Antibiotic</span> Prophylaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benzathine <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> G</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevent the <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> of rheumatic fever</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><u>Neuroleptics</u>: Pimozide, haloperidol, risperidone, <span class=\"customMeta\" data-dictid=\"db32c78ec1169277719403869f60ef\">olanzapine</span> <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Control <span class=\"customMeta\" data-dictid=\"46ce506e9d1692777184f7a4a276ad\">chorea</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><u>Anticonvulsants</u>: Valproate, <span class=\"customMeta\" data-dictid=\"83136ce53c1692777183ab554f66a5\">carbamazepine</span> <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Off-label use for symptom management</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunomodulatory Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Corticosteroids, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">Intravenous</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> (IVIG), <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> exchange <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For severe/persistent symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual tapering after 1 month of symptom-free</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduce side effects</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 y/o woman presents with h/o exertional dyspnea, palpitations, and episodes of syncope. She recalls experiencing multiple episodes of sore throat as a child, followed by joint pains, for which she received no definitive treatment. On auscultation, there is a diastolic murmur at the apex and a loud S1. She has heart rate of 75-80 bpm. An echocardiogram reveals significant mitral stenosis with left atrial enlargement. What is the next most appropriate step in management?", "options": [{"label": "A", "text": "Mitral balloon valvuloplasty", "correct": true}, {"label": "B", "text": "Mitral valve repair", "correct": false}, {"label": "C", "text": "ACE Inhibitors and rate control drugs", "correct": false}, {"label": "D", "text": "Immediate mitral valve replacement", "correct": false}], "correct_answer": "A. Mitral balloon valvuloplasty", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interventional/Surgical Options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mitral Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anticoagulation to prevent embolism.</li>\n<li>Rate control (e.g., digoxin, beta-blockers, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> antagonists) in AF.<strong>(Option C ruled out)</strong></li>\n<li>Diuretics for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> congestion.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Balloon valvuloplasty.</li>\n<li>Mitral valvotomy.</li>\n<li>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mitral Regurgitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics and vasodilators for symptom relief.</li>\n<li>Digoxin and anticoagulants in AF.</li>\n<li>ACE inhibitors/ARBs for hypertension. <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> repair (preferred). <strong>(Option B ruled out)</strong></li>\n<li>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement (if repair is not feasible).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aortic <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not applicable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aortic <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement (for severe <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> with symptoms like angina, syncope, or heart failure).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aortic Regurgitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not applicable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aortic <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement (indicated for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> cases, sometimes combined with <span class=\"customMeta\" data-dictid=\"636585f1a11692777182602515d2d4\">aortic root</span> replacement or <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> bypass).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Medical Therapy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medications to improve <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> function, reduce fluid overload, and control blood pressure. Eg. Diuretics, <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors and ARBs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Device Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ICD (Implantable <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> defibrillators)</strong>: For preventing sudden <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> death due to <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> arrhythmias.</p>\n<p><strong>CRT (Cardiac resynchronisation therapy)</strong>: For improving heart function in <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> with <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> abnormalities (e.g., left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Long-Term <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">Antibiotic</span> Prophylaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevents <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> attacks of rheumatic fever.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibiotic <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">Prophylaxis</span> for Procedures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be necessary before <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures to reduce the risk of <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> endocarditis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with progressive exertional dyspnea, fatigue, and occasional palpitations. She denies chest pain or fainting. O/E, she has an irregular pulse, a loud S1, an opening snap, and a low-pitched diastolic rumble at the apex. She recalls a childhood illness with fever and joint pain requiring hospitalization. No signs of recent infection are present. Which of the following investigations is NOT primarily used in diagnosing her condition?", "options": [{"label": "A", "text": "Echocardiography", "correct": false}, {"label": "B", "text": "Electrocardiogram (ECG)", "correct": false}, {"label": "C", "text": "Blood cultures", "correct": true}, {"label": "D", "text": "Chest X-ray", "correct": false}], "correct_answer": "C. Blood cultures", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis of RHD</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Blood Tests </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Leukocytosis, ESR, CRP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicators of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> illness.</li>\n<li>Raised <strong>ESR</strong> and <strong>CRP</strong> are common <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> markers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Throat <span class=\"customMeta\" data-dictid=\"b76c34e672169277719964ab6c1b56\">Swab</span> Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to identify <strong>group A β-haemolytic streptococci</strong>.</li>\n<li>Cultures may also be taken from family members and contacts to confirm the source of infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antistreptolysin O (ASO) titres</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"3e7108fe871692777182786921689e\">ASO</span> levels (&gt; 200 U in adults, &gt; 300 U in children) or rising titres support the diagnosis of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> rheumatic fever.</li>\n<li><strong>Normal ASO</strong> titres do not rule out the disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Electrocardiogram (ECG) </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shows first-degree, and rarely, second-degree <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">atrioventricular</span> block.</li>\n<li>Pericarditis features.</li>\n<li>T-wave inversion.</li>\n<li>QRS <span class=\"customMeta\" data-dictid=\"25ad895a231692777202f568bc6bfc\">voltage</span> reduction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Identifies <span class=\"customMeta\" data-dictid=\"5098fe73d116927771838b3dad7c36\">cardiomegaly</span> and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> congestion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Echocardiography</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reveals <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> dilatation.</li>\n<li>Detects <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> abnormalities: Commonly <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> with <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"2889a63cdd1692777181f9102ed608\">annulus</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> prolapse.</li>\n<li>Shows aortic regurgitation.</li>\n<li>Identifies <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Excluding Differentials</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Valvular Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Infective <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Blood cultures</strong>: Identify pathogens.</li>\n<li><strong>Echocardiography</strong>: Detects <span class=\"customMeta\" data-dictid=\"a55b16a09b169277720184a41c82c4\">vegetation</span> on valves.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Congenital heart defects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Doppler Echocardiography</strong>: Identifies defects and <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> patterns.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cardiomyopathies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Echocardiography/Cardiac MRI</strong>: Show structural/functional myocardial abnormalities to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> from RHD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pericardial diseases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Echocardiography</strong>: Detects <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> (pericarditis), and thickened <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">pericardium</span> (constrictive pericarditis).</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Cardiac Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pulmonary conditions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong>: Chest X-ray, ECG, CT <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"fa1da4abca1692777181b5898561f7\">angiogram</span> (pulmonary embolism).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Systemic illnesses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood tests</strong>: Haemoglobin (anaemia), <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> function, and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function to exclude other causes of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> symptoms.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the 2015 Modified Jones Criteria for Rheumatic Fever, which of the following is NOT part of the major criteria for a low-risk population?", "options": [{"label": "A", "text": "Carditis", "correct": false}, {"label": "B", "text": "Polyarthritis", "correct": false}, {"label": "C", "text": "Chorea", "correct": false}, {"label": "D", "text": "Polyarthralgia", "correct": true}], "correct_answer": "D. Polyarthralgia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Low-Risk Population</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>High-Risk Population</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Major Criteria</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carditis (clinical or subclinical) <strong>(Option A ruled out)</strong></li>\n<li>Polyarthritis <strong>(Option B ruled out)</strong></li>\n<li>Chorea <strong>(Option C ruled out)</strong></li>\n<li>Erythema marginatum</li>\n<li>Subcutaneous nodules</li>\n</ul>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carditis (clinical or subclinical)</li>\n<li>Monoarthritis or Polyarthritis</li>\n<li>Chorea</li>\n<li>Erythema marginatum</li>\n<li>Subcutaneous nodules</li>\n<li>Polyarthralgia <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Minor Criteria</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Polyarthralgia <strong>(Option D)</strong></li>\n<li>Hyperpyrexia <strong>(≥ 38.5ºC)</strong></li>\n<li>ESR ≥ <strong>60 mm/h</strong> and/or <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> ≥ 3.0 mg/dl</li>\n<li>Prolonged PR interval (if no there is no <span class=\"customMeta\" data-dictid=\"7b028d193416927771835d48b193f9\">carditis</span> in major criterion)</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Monoarthralgia</li>\n<li>Hyperpyrexia <strong>(≥ 38.0ºC)</strong></li>\n<li>ESR ≥ <strong>30 mm/h</strong> and/or <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> ≥ 3.0 mg/dl</li>\n<li>Prolonged PR interval (if no there is no <span class=\"customMeta\" data-dictid=\"7b028d193416927771835d48b193f9\">carditis</span> in major criterion)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statements describe the relationship between Sydenham's chorea and acute rheumatic fever?", "options": [{"label": "A", "text": "It is an early manifestation of rheumatic fever", "correct": false}, {"label": "B", "text": "It occurs in all patients with rheumatic fever", "correct": false}, {"label": "C", "text": "It is associated with emotional lability", "correct": true}, {"label": "D", "text": "It has no connection to previous infections", "correct": false}], "correct_answer": "C. It is associated with emotional lability", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10 y/o boy presents with fever, joint pain, and a new onset heart murmur. On auscultation, a soft mid-diastolic murmur is heard at the apex. Echocardiography reveals mitral valve inflammation. Which of the following murmurs is most likely present in this patient?", "options": [{"label": "A", "text": "Mitral stenosis murmur", "correct": false}, {"label": "B", "text": "Aortic regurgitation murmur", "correct": false}, {"label": "C", "text": "Carey Coombs murmur", "correct": true}, {"label": "D", "text": "Pericardial friction rub", "correct": false}], "correct_answer": "C. Carey Coombs murmur", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following clinical features is most commonly associated with Acute Rheumatic Fever (ARF) in the Indian population?", "options": [{"label": "A", "text": "Polyarthritis", "correct": true}, {"label": "B", "text": "Erythema Marginatum", "correct": false}, {"label": "C", "text": "Subcutaneous Nodules", "correct": false}, {"label": "D", "text": "Pulmonary Hypertension", "correct": false}], "correct_answer": "A. Polyarthritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Vea8bmTQyhG9tWt3xKtr1744307713.png", "https://image.prepladder.com/notes/bRT3QH8cScUJupfxuBNp1744307818.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The course of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Rheumatic Fever</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Latent Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Early Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>After upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection/ <span class=\"customMeta\" data-dictid=\"32a1e3c77516927771956ec2bbac4c\">pharyngitis</span> with GABHS, <span class=\"customMeta\" data-dictid=\"48093996911692777182dcce1e92b7\">ARF</span> symptoms typically develop after a<strong> <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> period of 3 weeks </strong>(range: 1–5 weeks).</li>\n<li>A <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat can occur.</li>\n<li>Chorea and <span class=\"customMeta\" data-dictid=\"2c27fdf0ed1692777190530a17c849\">indolent</span> <span class=\"customMeta\" data-dictid=\"7b028d193416927771835d48b193f9\">carditis</span> can manifest up to 6 months later following a prolonged <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> period.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Polyarthritis</strong>: <strong>Seen in 60-75% of <span class=\"customMeta\" data-dictid=\"48093996911692777182dcce1e92b7\">ARF</span> cases, often affecting large joints (knees, ankles, elbows). <span class=\"customMeta\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\">Migratory</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> is a key feature.</strong></li>\n<li><strong>Carditis</strong>: Occurs in 50-75% of cases, frequently leading to <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> damage (regurgitation initially). <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">Aortic valve</span> involvement is also common..</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Valvular damage can progress from <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> to <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> over time, leading to <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> in the long term.</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"48093996911692777182dcce1e92b7\">ARF</span> episodes increase the risk of chronic <span class=\"customMeta\" data-dictid=\"efba33a3fd1692777189906f884236\">heart valve</span> disease (rheumatic heart disease).</li>\n<li><strong>Chorea: </strong>Varies by population, from less than 2% to 30%. Predominantly affects females and often coexists with carditis.</li>\n<li><strong>Skin Manifestations</strong>: <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">Erythema</span> marginatum (rare, less than 5% of cases) and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> nodules (also less than 5%). <strong>(Options B and C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10 y/o boy presents with fever, joint pain, and a recent history of sore throat. Examination reveals a heart murmur suggestive of mitral regurgitation. Laboratory tests show elevated antistreptolysin O (ASO) titers. Which of the following best explains the pathogenesis of his condition?", "options": [{"label": "A", "text": "Direct invasion of heart valves by Streptococcus bacteria", "correct": false}, {"label": "B", "text": "Immune response triggered by molecular mimicry between bacterial antigens and heart tissue", "correct": true}, {"label": "C", "text": "Autoimmune destruction of heart valves due to viral infection", "correct": false}, {"label": "D", "text": "Genetic mutations in heart muscle proteins", "correct": false}], "correct_answer": "B. Immune response triggered by molecular mimicry between bacterial antigens and heart tissue", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16 y/o boy with a history of acute rheumatic fever (ARF) without carditis presents for follow-up. He has been on benzathine penicillin G for four years. Based on the AHA guidelines, what is the recommended duration for continuing secondary prophylaxis in this patient?", "options": [{"label": "A", "text": "Continue prophylaxis for 1 more year", "correct": false}, {"label": "B", "text": "Continue prophylaxis until the age of 25", "correct": false}, {"label": "C", "text": "Discontinue prophylaxis immediately", "correct": false}, {"label": "D", "text": "Continue prophylaxis until the age of 21", "correct": true}], "correct_answer": "D. Continue prophylaxis until the age of 21", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Prevention in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Rheumatic Fever</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preferred Antibiotic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benzathine <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> G</strong> is recommended as the first choice. <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">Dosage</span> is:</p>\n<ul>\n<li>1.2 million units for individuals &gt;27 kg.</li>\n<li>600,000 units for individuals ≤27 kg.</li>\n</ul>\n<p>Typically administered every 4 weeks, may increase to every 2–3 weeks for <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">adherence</span> issues.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral <span class=\"customMeta\" data-dictid=\"259b36252716927771879987e01054\">Erythromycin</span> (250 mg twice daily) is recommended for patients allergic to penicillin.</p>\n<p>Oral <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> V (250 mg twice daily) can be used but is less effective.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration of Prophylaxis</strong></p>\n<p>Determined by the presence and severity of carditis, age, and time since the last <span class=\"customMeta\" data-dictid=\"48093996911692777182dcce1e92b7\">ARF</span> episode</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No Carditis</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5 years or until 21 years of age, whichever is longer.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carditis without Valvular Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 years or until 21 years of age, whichever is longer.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Persistent Valvular Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 years or until 40 years of age, whichever is longer.</p>\n<p>Lifelong <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> may be needed in severe cases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An interventional cardiologist is planning to implant an ICD in several patients. Which of the following patients is NOT an indication for ICD implantation according to the American College of Cardiology/American Heart Rhythm Society guidelines?", "options": [{"label": "A", "text": "Chagas disease", "correct": false}, {"label": "B", "text": "Wolff-Parkinson-White syndrome", "correct": true}, {"label": "C", "text": "Hypertrophic cardiomyopathy", "correct": false}, {"label": "D", "text": "Long QT syndrome", "correct": false}], "correct_answer": "B. Wolff-Parkinson-White syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 y/o male presents to the ED with severe chest pain radiating to his left arm. His ECG is given below. Based on this information, which of the following changes is most likely present in this ECG?", "options": [{"label": "A", "text": "Wide QRS complexes", "correct": false}, {"label": "B", "text": "Saddleback ST elevation", "correct": false}, {"label": "C", "text": "Coved ST elevation", "correct": true}, {"label": "D", "text": "Tall T waves", "correct": false}], "correct_answer": "C. Coved ST elevation", "question_images": ["https://image.prepladder.com/notes/rRhq66QXSaIiP0wwrijq1744306907.png"], "explanation_images": ["https://image.prepladder.com/notes/GMUZJNmVeFZKW8fwHdSF1744307150.png", "https://image.prepladder.com/notes/GrvBQ15PTNwjsaybDUfp1744307320.png", "https://image.prepladder.com/notes/RTf2lg5B9LjutQWVzG881745565004.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o male presents to the ED after experiencing a brief episode of syncope. He reports occasional palpitations and dizziness. His family history is significant for sudden cardiac deaths at a young age. An ECG of leads V1-V3 is given below. Which of the following management options is most appropriate for this patient, given the findings?", "options": [{"label": "A", "text": "Prescribe a beta-blocker and advise lifestyle modifications", "correct": false}, {"label": "B", "text": "Perform a drug challenge test with procainamide", "correct": false}, {"label": "C", "text": "Refer for genetic testing for SCN5A mutations", "correct": false}, {"label": "D", "text": "Implant an implantable cardioverter-defibrillator.", "correct": true}], "correct_answer": "D. Implant an implantable cardioverter-defibrillator.", "question_images": ["https://image.prepladder.com/notes/uc4xcg3vQMCv7FdqNLiM1744306669.png"], "explanation_images": ["https://image.prepladder.com/notes/uNvCjTmZAUPDKur41Z9K1744306776.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Brugada Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rare, inherited disease that predisposes patients to potentially fatal <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, characterised by right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block and ST-segment elevations in the right <span class=\"customMeta\" data-dictid=\"5560fa76ff169277719645f5353fb7\">precordial leads</span> (V1-V3) on ECG.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms range from <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> to sudden <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> death, often during sleep.</li>\n<li>Syncope in 80% of patients with <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> or fibrillation.</li>\n<li>Other symptoms: palpitations, dizziness, and fever history may trigger symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Type I:</strong> Coved ST elevations &gt;2 mm with inverted T wave.</li>\n<li><strong>Type II: </strong>Saddleback-shaped ST <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> &gt;2 mm.</li>\n<li><strong>Type III: </strong>Saddleback-shaped ST elevations &lt;2 mm.</li>\n<li>Patients with a normal <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> and high-risk factors may need a drug challenge test to reveal ST elevations in leads V1 to V3. </li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Types of Brugada syndrome \" data-author=\"Napolitano C, Priori SG. Brugada syndrome. Orphanet J Rare Dis. 1, 35. 2006. doi:10.1186/1750-1172-1-35. \" data-hash=\"8830\" data-license=\"CC BY 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Brugada.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/uNvCjTmZAUPDKur41Z9K1744306776.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug challenge test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Drugs used in the challenge test:\n\t\t\t\t<ul>\n<li>Class <span class=\"customMeta\" data-dictid=\"45d7632a0216927771898df908d43b\">IA</span> antiarrhythmics (<strong>procainamide, ajmaline</strong>).</li>\n<li>IC antiarrhythmics (<strong>flecainide, propafenone</strong>).</li>\n</ul>\n</li>\n<li>Brugada <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> findings can also emerge from <strong>cocaine </strong>use or <strong>tricyclic antidepressant</strong> toxicity.</li>\n<li>Electrolyte abnormalities like <strong>hyperkalemia </strong>and <strong>hypercalcemia </strong>can reveal ST elevations in the right precordial leads.</li>\n<li>A normal drug challenge test in <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> patients may need to be repeated after <span class=\"customMeta\" data-dictid=\"c284c4252f16927771963c07a95e13\">puberty</span> due to hormonal influences.</li>\n<li>The <strong>\"full stomach test\" </strong>can also help expose ST elevations by increasing <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> tone.</li>\n<li>Additional <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> options include genetic testing for <strong>SCN5A</strong> mutations and <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> electrophysiology.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Implantable cardioverter-defibrillator (ICD)</strong> for high-risk patients.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68 y/o postmenopausal woman presents to the emergency department with chest pain and dyspnea after a recent stressful event. Her ECG shows ST-segment elevation and cardiac biomarkers are mildly elevated. After a thorough evaluation, she is diagnosed with a condition resembling acute coronary syndrome. What is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Administer intravenous anticoagulation therapy", "correct": false}, {"label": "B", "text": "Implant an implantable cardioverter-defibrillator.", "correct": false}, {"label": "C", "text": "Initiate inotropic support immediately.", "correct": false}, {"label": "D", "text": "Perform immediate coronary angiography and start aspirin.", "correct": true}], "correct_answer": "D. Perform immediate coronary angiography and start aspirin.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Takotsubo Cardiomyopathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>ECG Changes: </strong>Similar to <span class=\"customMeta\" data-dictid=\"607e653eef1692777195e56becea2c\">pericarditis</span> stages, with ST-segment elevation, T-wave inversions, and eventual normalization.</li>\n<li><strong>Cardiac Biomarkers:</strong> Mild <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of <strong>troponins </strong>(median initial troponin: 7.7 times normal) and elevated <span class=\"customMeta\" data-dictid=\"9ecd3e72f91692777183e158e62a35\">BNP</span> or <span class=\"customMeta\" data-dictid=\"87d6ffd69e1692777193d053d586ad\">N-terminal</span> pro-BNP levels.</li>\n<li><strong>Echocardiography: </strong>Systolic <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> of LV with mid-apical depression.</li>\n<li><strong>Cardiovascular Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> (CMR): </strong>Helps <strong>diagnose </strong>stress cardiomyopathy, showing myocardial oedema, necrosis, and fibrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk Factors for Adverse Outcomes: Physical triggers, neurologic/psychiatric conditions, high initial troponin, low <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> fraction, male gender.</li>\n<li><strong>Initial Treatment:</strong> Aspirin, beta-blockers, <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors, lipid-lowering agents, and <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> angiography.</li>\n<li><strong>Stable Patients:</strong>\n<ul>\n<li>Cardioselective beta-blockers and <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors for 3-6 months.</li>\n<li>Serial <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> to monitor wall motion and <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> fraction.</li>\n</ul>\n</li>\n<li><strong>Anticoagulation:</strong> Reserved for patients with <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> (5% occurrence). <strong>(Option A ruled out)</strong></li>\n<li><strong>Unstable Patients: </strong>Inotropes for <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> shock without left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> outflow obstruction. <strong>(Option C ruled out)</strong></li>\n<li><strong>Mechanical support (intra-aortic balloon pump or left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> assist devices)</strong> may be needed.</li>\n<li>If Outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> Present: Avoid inotropes; <span class=\"customMeta\" data-dictid=\"1283d2a60c1692777195ed6d63aa4b\">phenylephrine</span> is the preferred pressor, often combined with beta-blockers.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Echocardiogram showing \"apical ballooning\" pattern </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Echocardiogram showing &lt;span class=\" custommeta\"=\"\" data-dictid=\"c6223a27fb169277718147405290e1\"/>apical <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> pattern.png\" data-author=\"Demurtas, Elisabetta &amp; Restelli, Davide &amp; Pistelli, Lorenzo &amp; Parisi, Francesca &amp; Perna, Alessia &amp; Vinciguerra, Paolo &amp; Sarro, Rosalba &amp; Currò, Alessio &amp; Crosca, Sergio. (2022). Atypical presentation of Takotsubo syndrome early after pacemaker implantation. Cor et Vasa. 64. 549-553. 10.33678/cor.2022.001. \" data-hash=\"9117\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/A-Echocardiogram-performed-on-the-admission-day-with-normal-LV-function-EF-60-B_fig1_365017200\" data-tags=\"April2025\" height=\"406\" src=\"https://image.prepladder.com/notes/FgOMBMwHnmRQbB0iQiFk1744350233.png\" width=\"500\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"6af5a0978916927772019bbc58a62e\">ventriculography</span> during <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> showing <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> <span class=\"customMeta\" data-dictid=\"3933d2eb7b1692777180e2d51b1b6b\">akinesis</span> with <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> <span class=\"customMeta\" data-dictid=\"cd57c59439169277718933e14f4e77\">hyperkinesis</span> in a characteristic Takotsubo ventricle.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Left &lt;span class=\" custommeta\"=\"\" data-dictid=\"6af5a0978916927772019bbc58a62e\"/>ventriculography during systole\" data-author=\"Tara C Gangadhar, Elisabeth Von der Lohe, Stephen G Sawada and Paul R Helft\" data-hash=\"8827\" data-license=\"CC-BY-2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Takotsubo_ventriculography.gif\" data-tags=\"April2025\" height=\"462\" src=\"https://image.prepladder.com/notes/pY2wQVjlZKvrrqEywAOF1744306158.png\" width=\"462\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 41 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 24 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 52-year-old male presents with worsening shortness of breath and fatigue. An echocardiogram shows left ventricular dilation and significant aortic regurgitation. Which of the following are the possible conditions causing Aortic regurgitation? Ankylosing Spondylitis Aortic Dissection Marfan's Syndrome Syphilis", "options": [{"label": "A", "text": "1,2,3", "correct": false}, {"label": "B", "text": "2,3,4", "correct": false}, {"label": "C", "text": "1,3,4", "correct": false}, {"label": "D", "text": "1,2,3,4", "correct": true}], "correct_answer": "D. 1,2,3,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/51J0LgwTZCSKyN9oW8Gy1744311265.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aortic <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conditions affecting the <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> structure and its functions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conditions causing <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> root dilatation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bicuspid <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">Aortic valve</span> (Congenital)</li>\n<li>Infective Endocarditis</li>\n<li>Rheumatic fever</li>\n<li>Myxomatous <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> of the valve</li>\n<li>Scarring of the <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> by Syphilis <strong>(statement 4)</strong></li>\n<li>Ankylosing <span class=\"customMeta\" data-dictid=\"42d4868c2e1692777199353a7ad077\">spondylitis</span> <strong>(statement 1)</strong></li>\n<li>Radiation</li>\n<li>Trauma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic Dissection <strong>(statement 2)</strong></li>\n<li>Aortitis (Takayasu <span class=\"customMeta\" data-dictid=\"08d90ca11716927771828423b87d47\">arteritis</span> or GCA)</li>\n<li>Hypertension</li>\n<li>Marfan syndrome <strong>(statement 3)</strong></li>\n<li>Medial Degeneration</li>\n<li>Nonsyndromic <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> aneurysm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Pathophysiology of AR\" data-author=\"\" data-hash=\"8867\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"238\" src=\"https://image.prepladder.com/notes/51J0LgwTZCSKyN9oW8Gy1744311265.png\" width=\"415\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical symptoms</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually, it starts appearing only after 10 to 15 years.</li>\n<li><strong>Symptoms specific to AR</strong>:\n\t\t\t\t<ul>\n<li><strong>Palpitations (more in the <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> position)</strong></li>\n<li><strong>Head pounding sensation</strong></li>\n</ul>\n</li>\n<li>Other symptoms:\n\t\t\t\t<ul>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">Nocturnal</span> dyspnea<strong> </strong>(sometimes the early one to appear)</li>\n<li>Angina on rest or exertion &amp; breathlessness on exertion</li>\n<li>Orthopnea and diaphoresis</li>\n<li>Peripheral edema</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following murmurs with the respective conditions. S.No Murmur Condition 1) a) Mitral Stenosis 2) b) Aortic Stenosis 3) c) Mitral Regurgitation 4) d) Aortic Regurgitation", "options": [{"label": "A", "text": "1-b, 2-d, 3-a, 4-c", "correct": true}, {"label": "B", "text": "1-c, 2-a, 3-d, 4-b", "correct": false}, {"label": "C", "text": "1-a, 2-c, 3-b, 4-d", "correct": false}, {"label": "D", "text": "1-d, 2-b, 3-c, 4-a", "correct": false}], "correct_answer": "A. 1-b, 2-d, 3-a, 4-c", "question_images": ["https://image.prepladder.com/notes/XXQAic2OvlqG6NCDBCag1744312785.png", "https://image.prepladder.com/notes/E3E43NHkqel59TN3PW3l1744312876.png", "https://image.prepladder.com/notes/pMZOPoGTj8iRm001qfbX1744312964.png", "https://image.prepladder.com/notes/wOsMxa8Y1moebOOIoSvE1744313044.png"], "explanation_images": ["https://image.prepladder.com/notes/7uGQWI9Cer4xczdLwuGE1744313148.png", "https://image.prepladder.com/notes/7QoeMZYArDlBBzlZOjMm1744313241.png", "https://image.prepladder.com/notes/ZZElX27llAcSNAIVAZkK1744313348.png", "https://image.prepladder.com/notes/pPNwH3jB2FqJmsrYUOaR1744313463.png", "https://image.prepladder.com/notes/jXfzha2FmV2dyCN3Vk101744313561.png", "https://image.prepladder.com/notes/n2BUEOmjNBTiRBvX0w5F1744313670.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic Stenosis:</strong></p>\n<ul>\n<li>Crescendo-decrescendo <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Murmur of Aortic Stenosis\" data-author=\"\" data-hash=\"8885\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"321\" src=\"https://image.prepladder.com/notes/7uGQWI9Cer4xczdLwuGE1744313148.png\" width=\"311\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral/Tricuspid Regurgitation:</strong></p>\n<ul>\n<li>Holosystolic, high-pitched “blowing” murmur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Murmur of Mitral Regurgitation \" data-author=\"\" data-hash=\"8887\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"316\" src=\"https://image.prepladder.com/notes/7QoeMZYArDlBBzlZOjMm1744313241.png\" width=\"316\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic Regurgitation:</strong></p>\n<ul>\n<li>Early diastolic, decrescendo, high-pitched “blowing” murmur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Murmur of Aortic Regurgitation\" data-author=\"\" data-hash=\"8890\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"367\" src=\"https://image.prepladder.com/notes/ZZElX27llAcSNAIVAZkK1744313348.png\" width=\"326\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral Stenosis:</strong></p>\n<ul>\n<li>Delayed rumbling mid-to-late <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> with opening snap</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Murmur of Mitral Stenosis\" data-author=\"\" data-hash=\"8893\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"327\" src=\"https://image.prepladder.com/notes/pPNwH3jB2FqJmsrYUOaR1744313463.png\" width=\"327\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> prolapse:</strong></p>\n<ul>\n<li>Late <span class=\"customMeta\" data-dictid=\"3fe8d11dec1692777185b76fd73244\">crescendo murmur</span> with <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> click (MC) that occurs after <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> pulse</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Murmur of MVP\" data-author=\"\" data-hash=\"8896\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"321\" src=\"https://image.prepladder.com/notes/jXfzha2FmV2dyCN3Vk101744313561.png\" width=\"321\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular septal defect:</strong></p>\n<ul>\n<li>Holosystolic, harsh-sounding murmur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Murmur of VSD\" data-author=\"\" data-hash=\"8898\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"325\" src=\"https://image.prepladder.com/notes/n2BUEOmjNBTiRBvX0w5F1744313670.png\" width=\"325\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 y/o patient with h/o pulmonary hypertension presents with exertional dyspnea. You auscultate a high-pitched, decrescendo diastolic murmur at the second left intercostal space, radiating along the left sternal border that increases with inspiration. Which of the following murmurs is this?", "options": [{"label": "A", "text": "Graham Steell murmur", "correct": true}, {"label": "B", "text": "Austin Flint murmur", "correct": false}, {"label": "C", "text": "Carey-Coombs murmur", "correct": false}, {"label": "D", "text": "Gibson’s murmur", "correct": false}], "correct_answer": "A. Graham Steell murmur", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ccATMTssmlI9tnv9ezUU1744312144.png", "https://image.prepladder.com/notes/nOsMwJYDpVwunAEw7gsd1744312233.png", "https://image.prepladder.com/notes/LoTwQqbljmMyey24DrIn1744312551.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents to the clinic with complaints of left arm pain and intermittent dizziness. O/E, you find a notable difference in blood pressure readings: 150/90 mmHg in the right arm and 100/60 mmHg in the left arm. Which condition is least likely to cause this variation?", "options": [{"label": "A", "text": "Coarctation of the aorta", "correct": false}, {"label": "B", "text": "Aortic dissection", "correct": false}, {"label": "C", "text": "Supravalvular aortic stenosis", "correct": true}, {"label": "D", "text": "Takayasu arteritis", "correct": false}], "correct_answer": "C. Supravalvular aortic stenosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following cardiac valvular disorders with their specific murmur type: Valvular defect Murmur 1. Aortic stenosis a. Pansystolic murmur increasing with inspiration 2. Mitral regurgitation b. Mid-diastolic rumble with opening snap 3. Mitral stenosis c. Harsh systolic murmur radiating to the carotids 4. Tricuspid regurgitation d. Holosystolic murmur radiating to the axilla", "options": [{"label": "A", "text": "1-b, 2-a, 3-d, 4-c", "correct": false}, {"label": "B", "text": "1-c, 2-b, 3-a, 4-d", "correct": false}, {"label": "C", "text": "1-c, 2-d, 3-b, 4-a", "correct": false}, {"label": "D", "text": "1-d, 2-a, 3-c, 4-b", "correct": true}], "correct_answer": "D. 1-d, 2-a, 3-c, 4-b", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:752px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Valvular disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG findings </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>JVP findings </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specific features </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rheumatic heart disease</li>\n<li>Degenerative</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> may be present</li>\n<li>P-mitrale &gt; 120 seconds (enlarged left atrium)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p>Changes are seen only in advanced cases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Holosystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> </strong>radiating to the axilla.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wide variable <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> of S2</li>\n<li>A2 appears early as less blood is flowing through the aortic valve; thus, the S2 split is wide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rheumatic heart disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> deviation</p>\n<p>RV hypertrophy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mid-diastolic rumble with an opening snap. </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loud S1</p>\n<p>Malar rash</p>\n<p>Distended neck veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tricuspid <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rheumatic</p>\n<p>(coexist with <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> stenosis)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Tall P waves in the lead II</p>\n<p>Right <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> deviation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large ‘a’ wave</p>\n<p>Blunted ‘y’ wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mid-diastolic murmur</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carvallo’s sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tricuspid <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rheumatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>‘<strong>C-v’ wave</strong></p>\n<p><strong>Steep ‘y’ <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blowing <span class=\"customMeta\" data-dictid=\"b1b77428461692777189ac124a6fa6\">holosystolic</span> murmur</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic liver pulsation</p>\n\t\t\t \n\n\t\t\t<p>Carvallo’s sign</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infective endocarditis</li>\n<li>Bicuspid aortic valve</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> deviation</p>\n<p><strong>LV <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Changes are seen only in advanced cases</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decrescendo diastolic murmur</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wide pulse pressure</li>\n<li><strong>Water <span class=\"customMeta\" data-dictid=\"72db2f68b616927771880970425404\">hammer</span> pulse</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Degenerative calcification</p>\n<p>53% of cases have <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"9461b5b89b16927771839fb979168f\">bicuspid</span> aortic valve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Accentuated “a” wave</strong> due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> RV <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> <span class=\"customMeta\" data-dictid=\"381ab780231692777186a9011d8a74\">distensibility</span> from the hypertrophied <span class=\"customMeta\" data-dictid=\"769fa5be3616927771906f8ae8b053\">interventricular</span> septum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crescendo-decrescendo <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gallavardin effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary hypertension</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Right <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> deviation</p>\n<p>RV hypertrophy.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Large ‘a’ wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>End–diastolic murmur</p>\n<p><strong>(Graham Steel murmur)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac MRI</strong> is the IOC rather than echocardiography</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wide split S2</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old girl with a history of Tetralogy of Fallot repair 12 months ago presents with abdominal swelling and pedal oedema. Cardiac auscultation reveals an early diastolic murmur, and ECG shows right ventricular and atrial enlargement. Considering the suspicion of pulmonary regurgitation, which investigation is most appropriate for further evaluation?", "options": [{"label": "A", "text": "Transthoracic echocardiography", "correct": false}, {"label": "B", "text": "Cardiac magnetic resonance imaging", "correct": true}, {"label": "C", "text": "Transesophageal echocardiography", "correct": false}, {"label": "D", "text": "Cardiac catheterisation", "correct": false}], "correct_answer": "B. Cardiac magnetic resonance imaging", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PULMONARY REGURGITATION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> - <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> valve</li>\n<li>Post-repair of <span class=\"customMeta\" data-dictid=\"225bbf4bd416927772003bf64ffa1f\">Tetralogy</span> of Fallot</li>\n<li>Post balloon valvotomy</li>\n<li>Marfan syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> (PR) results in right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> and <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> due to increased <span class=\"customMeta\" data-dictid=\"628ed9c26316927771964889249b3b\">preload</span> and afterload.</li>\n<li>A reverse pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> from the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> to the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> drives the regurgitation, leading to a reduction in <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output over time.</li>\n<li>As the condition progresses, right atrial involvement may occur, elevating <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fatigue, dyspnea, ascites, and <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> oedema</li>\n<li>Auscultation reveals an early <strong>diastolic murmur</strong><strong> (Graham steel murmur)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray:</strong> Enlarged right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> shadow</li>\n<li><strong>Cardiac MRI:</strong> Investigation of choice, especially in patients with repaired <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart defects.</li>\n<li><strong>Echocardiography (transthoracic):</strong> It helps assess <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> and the direction of blood flow.<strong> (Option A and C)</strong></li>\n<li>Cardiac catheterisation is not usually done but can be done during <span class=\"customMeta\" data-dictid=\"c39699b4e51692777200464bc9ac1a\">transcatheter</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> procedures.<strong> (Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medical: </strong>Diuretics for symptoms of right-sided heart failure</li>\n</ul>\n<ul>\n<li><strong>Surgical: </strong><strong>Transcatheter <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement. </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old girl presents with exercise intolerance and occasional chest pain. Examination reveals a systolic ejection murmur at the left upper sternal border and elevated jugular venous pressure. An echocardiogram shows a peak systolic gradient of 70 mmHg across the pulmonary valve, raising suspicion for pulmonary valve stenosis. Which of the following set of statements is true regarding this condition? Pulmonic stenosis is always congenital. Dysplastic valves leading to pulmonary stenosis are seen in Noonan syndrome. Severe PS is defined by peak systolic gradient across the PV&amp;gt;64 mmHg Percutaneous balloon valvuloplasty is indicated for all patients. Pulmonic stenosis usually leads to right ventricular hypertrophy.", "options": [{"label": "A", "text": "2 and 5", "correct": false}, {"label": "B", "text": "3 and 4", "correct": false}, {"label": "C", "text": "2,3 and 5", "correct": true}, {"label": "D", "text": "1,2 and 5", "correct": false}], "correct_answer": "C. 2,3 and 5", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PULMONARY STENOSIS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is essentially a <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> disease, but it may be acquired<strong> (Statement 1 ruled out)</strong></p>\n<ul>\n<li>Noonan syndrome (dysplastic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> valve) <strong>(Statement 2)</strong></li>\n<li>Tetralogy of Fallot</li>\n<li>Carcinoids</li>\n<li>Bulky <span class=\"customMeta\" data-dictid=\"a55b16a09b169277720184a41c82c4\">vegetation</span> or tumours</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> obstructs <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> from the right ventricle, resulting in increased chamber pressure and subsequent<strong> right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy.</strong> <strong> (Statement 5)</strong></li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> occurs early and at lower pressures due to its <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> adaptability to <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> burden compared to the left ventricle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defined by the <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between the RV and PA</p>\n<ul>\n<li>Severe: Peak <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> &gt;64 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm hg</span> <strong>(Statement 3)</strong></li>\n<li>Moderate: Peak <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> 36-64 mm hg</li>\n<li>Mild: Peak <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> &lt;36 hh mg</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild to moderate PS are asymptomatic.</li>\n<li>Severe PS: Exertional dyspnea, fatigue, <span class=\"customMeta\" data-dictid=\"e9fd0df8d31692777181d17788d36d\">anginal</span> pain and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion</li>\n<li>Syncope may occur during stress.</li>\n</ul>\n<ul>\n<li><strong>Auscultation:</strong> <strong>Mid-systolic, crescendo-decrescendo <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> preceded by an <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> click.</strong></li>\n<li><strong>JVP:</strong><strong> Prominent ‘a’ wave</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>ECG: </strong>Right <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> + Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy</li>\n<li><strong>Chest X-ray: </strong>Post-stenotic <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of the main PA and RV enlargement.</li>\n<li><strong>Echocardiography: </strong>\n<ul>\n<li><strong>Transthoracic</strong>: Helps assess jet velocity, gradients, <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> function</li>\n<li><strong>Transesophageal</strong> (for detailed assessment of RV outflow tract)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medical: </strong>Diuretics for symptoms of right-sided heart failure</li>\n</ul>\n<ul>\n<li><strong>Surgical: </strong>Percutaneous <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> balloon valvuloplasty<strong> (Statement 4 ruled out) </strong>is done when\n\n\t\t\t\t<ul>\n<li>Symptomatic patients with moderate to severe PS</li>\n<li>Asymptomatic patients with peak <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> &gt;64 mmHg or mean <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> &gt; 35 mmHg.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old male with a history of long-standing hypertension and atrial fibrillation presents with progressive fatigue &amp;amp; bilateral leg swelling. O/E, the patient has distended neck veins with the following waveform with a blowing holosystolic murmur that increases with inspiration. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pulmonary hypertension", "correct": false}, {"label": "B", "text": "Tricuspid regurgitation", "correct": true}, {"label": "C", "text": "Pulmonary stenosis", "correct": false}, {"label": "D", "text": "Mitral regurgitation", "correct": false}], "correct_answer": "B. Tricuspid regurgitation", "question_images": ["https://image.prepladder.com/notes/qfgvbTsJ55PNd4punbEe1744311617.png"], "explanation_images": ["https://image.prepladder.com/notes/57JIR98UeHnl3LCPcncH1744311731.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TRICUSPID <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">REGURGITATION</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Primary (organic)</strong>\n<ul>\n<li>Rheumatic disease</li>\n<li>Infective endocarditis</li>\n<li>Myxomatous - <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> prolapse</li>\n<li>Carcinoid</li>\n<li>Radiation</li>\n<li>Congenital (Ebstein’s anomaly)</li>\n<li>Trauma</li>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (Papillary muscle rupture)</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Secondary (functional)</strong>\n<ul>\n<li>Long-standing <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</li>\n<li>Left-sided heart disease</li>\n<li>Cardiomyopathy</li>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> - functional <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> regurgitation</li>\n<li>Chronic RV <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> <span class=\"customMeta\" data-dictid=\"ceb4fc4ada1692777194e3daffa3e9\">pacing</span> (dyssynchrony)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>An <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> </strong>allows blood to flow back from the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> (RV) into the right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> (RA) during systole, increasing RA and <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressures, seen as <strong>prominent C-V waves</strong>.</li>\n<li>Severe TR causes ventricularization of the RA <span class=\"customMeta\" data-dictid=\"19d250592b1692777202f372a17f05\">waveform</span> and RA dilation, resulting in <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output that does not improve with exercise.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Features of right-sided heart failure\n\t\t\t\t<ul>\n<li>Distended neck veins</li>\n<li>Hepatomegaly</li>\n<li>Ascites</li>\n<li>Edema</li>\n<li>Positive <span class=\"customMeta\" data-dictid=\"0c4fdfb70116927771884e3b1e25e8\">hepatojugular</span> reflex</li>\n<li>Pulsatile liver (Systolic pulsation)</li>\n</ul>\n</li>\n<li><strong>Auscultation:</strong> <strong>Blowing <span class=\"customMeta\" data-dictid=\"b1b77428461692777189ac124a6fa6\">holosystolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> </strong>along the lower left sternal border, which intensifies with inspiration<strong> (Carvallo’s sign)</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"Tricuspid regurgitation\" data-author=\"\" data-hash=\"8872\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"396\" src=\"https://image.prepladder.com/notes/57JIR98UeHnl3LCPcncH1744311731.png\" width=\"396\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray</strong>: Right atrial and right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> seen.</li>\n<li><strong>ECG</strong>: Tall P waves in <span class=\"customMeta\" data-dictid=\"d0608700301692777191bd714ff49a\">lead II</span> (RA enlargement) and Right <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> deviation.</li>\n<li><strong>Echocardiogram</strong><strong> (Gold standard)</strong>\n<ul>\n<li>Right atrial and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> dilation.</li>\n<li>Tricuspid <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> dilation.</li>\n<li>Regurgitant jet from RV to RA on <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> imaging.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medical therapy</strong> :\n\t\t\t\t<ul>\n<li>Diuretics are used to manage the symptoms of right-sided heart failure</li>\n<li>Aldosterone antagonists may be added in cases of significant volume overload.</li>\n</ul>\n</li>\n<li><strong>Surgical intervention</strong>: <strong>Tricuspid <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> repair or replacement </strong>may be considered for patients with severe TR</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 66-year-old female presents with fatigue, abdominal discomfort, and swelling in her legs. On examination, she has jugular venous distention with giant ‘a’ waves, hepatomegaly, and ascites. Auscultation reveals a diastolic murmur at the lower left sternal border, which increases in intensity with inspiration. What’s the most likely diagnosis?", "options": [{"label": "A", "text": "Mitral stenosis", "correct": false}, {"label": "B", "text": "Tricuspid stenosis", "correct": true}, {"label": "C", "text": "Constrictive pericarditis", "correct": false}, {"label": "D", "text": "Aortic stenosis", "correct": false}], "correct_answer": "B. Tricuspid stenosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/eX6UKc2ryibJbRGPuaMg1744311496.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TRICUSPID <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">STENOSIS</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital</li>\n<li>Rheumatic origin (often coexists with <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> stenosis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>RA pressure <strong>↑ , </strong>due to the <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">diastolic pressure</span> <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between RA and RV, results in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion.</li>\n<li>Restricted forward flow of blood leads to <strong>↓ </strong>cardiac output.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"Pathophysiology of TS\" data-author=\"\" data-hash=\"8869\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"397\" src=\"https://image.prepladder.com/notes/eX6UKc2ryibJbRGPuaMg1744311496.png\" width=\"397\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fatigue</li>\n<li>Mild dyspnea</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> (right-side heart failure): Hepatomegaly, ascites, oedema and may lead to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> cirrhosis.</li>\n<li>Physical examination:\n\t\t\t\t<ul>\n<li>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> distension with <strong>prominent ‘a’ waves</strong></li>\n<li>Auscultation: <strong>Mid-diastolic murmur</strong> at left lower sternal border</li>\n<li><strong>Murmur increases with inspiration </strong><strong>(Carvallo's sign).</strong></li>\n</ul>\n</li>\n<li>If <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> coexist\n\t\t\t\t<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> hypertension</li>\n<li>Orthopnea due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray</strong> and <strong>ECG </strong>show features of RA enlargement</li>\n<li><strong>Echocardiogram: </strong>Thickened <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> with diastolic doming and increased pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between RV and RA.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medical management: </strong>To reduce <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> symptoms\n\t\t\t\t<ul>\n<li>Dietary salt restriction</li>\n<li>Loop diuretics</li>\n</ul>\n</li>\n<li><strong>Surgical intervention: </strong>Valvular repair or <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">Prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 69-year-old man presents with severe aortic regurgitation. He reports increasing fatigue, breathlessness, and episodes of dizziness. On auscultation, a diastolic murmur is heard along with a water-hammer pulse, and an echocardiogram shows significant left ventricular dilation and an ejection fraction of 55%. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Medical management", "correct": false}, {"label": "B", "text": "Transcatheter aortic valve implantation", "correct": false}, {"label": "C", "text": "Intra-aortic balloon counterpulsation", "correct": false}, {"label": "D", "text": "Aortic valve replacement", "correct": true}], "correct_answer": "D. Aortic valve replacement", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>LV Hypertrophy</strong></li>\n<li>Left <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> is noted</li>\n<li>QRS prolongation is seen occasionally</li>\n<li>LV Strain - ST wave depression and T wave <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> in I, aVL, V5, V6 leads</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inferolateral <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the apex</strong> is noted</li>\n<li>Aortic root dilation, often associated with aortic regurgitation, can be visible on a <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> as it fills the <span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\">retrosternal</span> space.</li>\n<li>It is not very sensitive to <span class=\"customMeta\" data-dictid=\"636585f1a11692777182602515d2d4\">Aortic root</span> conditions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Echocardiogram</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Rapid fluttering of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> </strong>during <span class=\"customMeta\" data-dictid=\"11d448b6c4169277718635a922383c\">diastole</span> because of the regurgitation.</li>\n<li>A dilated left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> is noted.</li>\n<li>It is the <strong>investigation of choice in Severe AR</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">Catheterization</span> and Angiography</strong></p>\n<p><strong>(Occasionally done)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>To evaluate the LV function and regurgitation</li>\n<li>Done before surgery, but CT <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">angiography</span> can be done instead.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute AR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic AR</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IV Diuretics</strong> (Furosemide) and <strong>Vasodilators </strong>(Sodium Nitroprusside) are used to stabilise the patient.</li>\n<li><strong>Beta Blockers </strong>are <strong>contraindicated </strong>as they worsen the symptoms and reduce the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics and Vasodilators like\n\t\t\t\t<ul>\n<li>ACEi, CCB,</li>\n<li>Hydralazine,</li>\n<li>ARBs (can be used in chronic AR) to manage HTN; Target <span class=\"customMeta\" data-dictid=\"29e7d0f8b21692777198c303b6dc41\">SBP</span> &lt;140 mm/Hg.</li>\n</ul>\n</li>\n<li>For Angina: Nitrates</li>\n<li>For Syphilis: <strong>Benzathine Penicillin, 2.4 million units IM, three doses given with one week gap.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aortic <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement (AVR) </strong>is the treatment of choice, usually within 24 hours of diagnosis.</li>\n<li><strong>Intra-Aortic Balloon pum</strong>p is contraindicated as it worsens the <span class=\"customMeta\" data-dictid=\"00f5a32045169277719710bd9dd167\">regurgitant</span> flow. <strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>AVR is indicated when developing <strong>LV <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> or</strong> <strong>symptoms</strong>.</li>\n<li><strong>Transcatheter <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> implantation</strong> <strong>(Option B)</strong><strong> </strong>is <strong>not suggeste</strong>d due to its limited success in chronic conditions.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following signs with specific features Signs Features 1. Muller Sign a) Systolic pulsations of the Spleen 2. Rosenbach sign b) Visible systolic pulsation of the uvula 3. Gerhardt's sign c) Jarring motion of the head with each heartbeat 4. De-Musset sign d) Systolic pulsations of the Liver", "options": [{"label": "A", "text": "1-b, 2-d, 3-a, 4-c", "correct": true}, {"label": "B", "text": "1-a, 2-c, 3-b, 4-d", "correct": false}, {"label": "C", "text": "1-c, 2-a, 3-d, 4-b", "correct": false}, {"label": "D", "text": "1-d, 2-b, 3-c, 4-a", "correct": false}], "correct_answer": "A. 1-b, 2-d, 3-a, 4-c", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:416px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Signs of Aortic Regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muller Sign </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a visible <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <strong>pulsation of the uvula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rosenbach sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic pulsations of the Liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gerhardt's sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic pulsations of the Spleen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quincke's sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repeatedly <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> blushing and blanching of capillaries in the nail folds upon <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> <strong>(Capillary Pulsations)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Landolphi sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alternating <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> and diastolic <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of pupils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Traube Sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is pistol shot sounds that are heard while auscultating over the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Water-Hammer pulse</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong pulse that rises quickly and then drops off suddenly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duroziez Sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a <strong>to-and-fro murmur</strong> heard while auscultating the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>De-Musset sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The jarring motion of the head with each heartbeat</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examination Findings of Aortic Regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> pressure and decreased <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">diastolic pressure</span> result in <strong>increased arterial pulse pressure</strong>.</li>\n<li><strong>Atrio-ventricular malformation</strong> and <strong>Atrio-ventricular fistula</strong> also show low diastolic BP due to continuous Korotkoff sounds.</li>\n<li><strong>Positive Hill’s sign</strong> is an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> difference in BP in the <span class=\"customMeta\" data-dictid=\"0bc1ae5070169277720193a2852d9c\">upper limb</span> and lower limb.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>On Palpation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Heaving LV impulse</strong> is noted, which is displaced laterally and inferiorly</li>\n<li><strong>Diastolic and <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> Thrills</strong> were noticed at the left lower sternal border and <span class=\"customMeta\" data-dictid=\"751ea5589f1692777199db9f2ec233\">suprasternal</span> notch, respectively.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>On Auscultation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Heart Sounds</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A2 is absent</li>\n<li>In the <span class=\"customMeta\" data-dictid=\"9461b5b89b16927771839fb979168f\">Bicuspid</span> aortic valve, <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> sound is present</li>\n<li>Sometimes, A4 is also heard</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Murmurs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A Decrescendo diastolic murmur, </strong>best heard when sitting up and leaning forward,<strong> </strong>is<strong> </strong>an early <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> that becomes holo-diastolic as the condition progresses to a severe stage.</li>\n<li><strong>Musical <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> </strong>is aortic <span class=\"customMeta\" data-dictid=\"390b319abc16927771852902093fde\">cusp</span> fluttering in the <span class=\"customMeta\" data-dictid=\"00f5a32045169277719710bd9dd167\">regurgitant</span> flow.</li>\n<li><strong>Mid-diastolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> </strong></li>\n<li><strong>Austin Flint murmur</strong> is a soft, low-pitched, mid- to end-diastolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> caused by <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> due to AR.</li>\n<li><strong>Ejection <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> murmur</strong><strong> </strong>is commonly heard in AR along with AS<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old male with a two-year history of severe aortic regurgitation presents with complaints of worsening dyspnea, angina and orthopnea. Physical examination reveals a loud diastolic murmur at the left sternal border and a widened pulse pressure. An echocardiogram indicates significant left ventricular dilation. What is the likely estimated regurgitant volume in this condition?", "options": [{"label": "A", "text": "&amp;lt; 35 ml/beat", "correct": false}, {"label": "B", "text": "&amp;gt; 35 ml/beat", "correct": false}, {"label": "C", "text": "&amp;lt; 60 ml/beat", "correct": false}, {"label": "D", "text": "&amp;gt; 60 ml/beat", "correct": true}], "correct_answer": "D. &gt; 60 ml/beat", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Echocardiogram Findings for Aortic Regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe Aortic regurgitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progressive Aortic regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Regurgitant Volume is <strong>&gt; 60 ml/beat</strong></li>\n<li>Regurgitant fraction is <strong>≥50%</strong></li>\n<li><strong>Holodiastolic aortic flow <span class=\"customMeta\" data-dictid=\"82343f61171692777197b4a08bc719\">reversal</span> </strong>- blood flows backwards into the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> throughout the diastolic phase.</li>\n<li><strong>Diastolic flow <span class=\"customMeta\" data-dictid=\"82343f61171692777197b4a08bc719\">reversal</span> in the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> aorta.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ejection Fraction is <strong>55 - 60 %</strong></li>\n<li>Left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> end-systolic dimension (LVESD) is <strong>&gt;50 mm</strong></li>\n<li>Left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> end-diastolic dimension</li>\n</ul>\n<p>(LVEDD) is <strong>&gt; 65 mm</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Aortic Regurgitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Aortic Regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is a sudden onset of significant <span class=\"customMeta\" data-dictid=\"bbee2f1b011692777182d9b84068ec\">backflow</span> from the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> into the left ventricle, causing LV dilatation.</li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema, which can progress to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> heart failure.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The presence of <strong>a water-hammer pulse/Corrigan’s pulse</strong> is a <span class=\"customMeta\" data-dictid=\"3f103808781692777199bd8f1df982\">strong pulse</span> that rises quickly and then drops off suddenly.</li>\n<li><strong>Quincke's pulse</strong> (Capillary pulsations)</li>\n<li><strong>The Frank-Starling</strong> law explains that blood flowing back into the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> increases its contractions due to stretching of the <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> walls.</li>\n<li><strong>Reduced <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> output at rest.</strong></li>\n<li>Both <span class=\"customMeta\" data-dictid=\"628ed9c26316927771964889249b3b\">Preload</span> and <span class=\"customMeta\" data-dictid=\"38d395efa2169277718025e142bd0e\">Afterload</span> are increased (<strong>Laplace law)</strong></li>\n<li>LVH is common.</li>\n<li>High myocardial oxygen demand can lead to <strong>Myocardial ischemia.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female presents with intermittent palpitations, chest discomfort, and fatigue. A mid-systolic click and late systolic murmur are heard at the apex. Echocardiography shows mitral valve leaflets billowing into the left atrium during systole. Which of the following best explains the pathophysiology of this condition?", "options": [{"label": "A", "text": "Inflammation of the mitral valve due to rheumatic fever", "correct": false}, {"label": "B", "text": "Fibrotic changes affecting the mitral valves", "correct": false}, {"label": "C", "text": "Rupture of the tendinae of the mitral valve", "correct": false}, {"label": "D", "text": "Myxomatous degeneration of mitral valve apparatus.", "correct": true}], "correct_answer": "D. Myxomatous degeneration of mitral valve apparatus.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:660px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MITRAL <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">VALVE</span> PROLAPSE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most cases are idiopathic</li>\n<li><strong>Myxomatous <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> apparatus</strong> (Reduced <strong>type III collagen</strong> production)</li>\n<li>Marfan syndrome<strong> (Fibrillin-1 protein defect)</strong></li>\n<li>Ehler Danlos syndrome</li>\n<li>Osteogenesis imperfecta</li>\n<li><strong>Straight back syndrome</strong> (<strong>reduced <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> kyphosis</strong>) compresses the heart between the <span class=\"customMeta\" data-dictid=\"a5428882a916927771992a8a0335bf\">sternum</span> and vertebrae, altering its position and increasing the likelihood of <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> (MVP).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Pathophysiology of &lt;span class=\" custommeta\"=\"\" data-dictid=\"d93de7238d16927771922b27cb6086\"/>mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> prolapse\" data-author=\"\" data-hash=\"8847\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"230\" src=\"https://image.prepladder.com/notes/zNqtoziid3ggvNttuHvn1744309432.png\" width=\"462\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Incidence\n\t\t\t\t<ul>\n<li>More in females: 15-30 years</li>\n<li>Males: 50 years</li>\n</ul>\n</li>\n<li>Severity: More severe in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> than women</li>\n<li>Symptoms:\n\t\t\t\t<ul>\n<li>Initially asymptomatic</li>\n<li>Palpitation and <span class=\"customMeta\" data-dictid=\"9f04fb3f2f1692777199272e3daf84\">syncope</span> due to <strong>premature <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> contraction.</strong></li>\n<li>Atypical features\n\t\t\t\t\t<ul>\n<li>Substernal pain without exertion.</li>\n<li>Transient ischemic attack.</li>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> and Sudden <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> death.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">Mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> (MR) occurs, it can lead to increased pressure in the lungs, causing frank <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Valsalva or Sudden Standing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Squatting, Leg Raising, Standing to Supine, <span class=\"customMeta\" data-dictid=\"884cd935ab169277719057c0ace385\">Isometric</span> Exercises</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preload and Afterload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↓ </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↑ </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cavity size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↓ </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↑ </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chordae tendineae stretching</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↓ </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↑ </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing of click</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The click occurs earlier, closer to S1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The click occurs later, away from S1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Murmur duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↑ </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↓ </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman reports experiencing mild chest pain and shortness of breath on exertion. Upon examination, a prominent ejection-type systolic murmur is noted, best heard at the right second intercostal space and radiating to the carotids. An Echocardiogram shows an aortic valve area of 0.9 cm², and ECG reveals Left ventricular hypertrophy. Which stage of aortic stenosis is suspected, and what is the ideal management? (TAVR: Transcatheter Aortic Valve Replacement)", "options": [{"label": "A", "text": "Stage B and TAVR", "correct": false}, {"label": "B", "text": "Stage D and Statins", "correct": false}, {"label": "C", "text": "Stage B and Statins", "correct": false}, {"label": "D", "text": "Stage D and TAVR", "correct": true}], "correct_answer": "D. Stage D and TAVR", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/sJBzWeAz2rEGCKgDLl9L1744311144.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> area </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patient with normal <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> and presence of risk factors like:</p>\n<ul>\n<li>Old age</li>\n<li>Congenital valvular disease</li>\n<li>History of rheumatic fever</li>\n<li>History of endocarditis</li>\n<li>Genetic Polymorphisms</li>\n<li>HTN, DM, CKD, Smoking &amp; High LDL.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Stage B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5 - 2 cm² (Mild)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It involves <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> patients with mild to moderate stenosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 - 1.5 cm² (Moderate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 1 cm²</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymptomatic severe aortic stenosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 1 cm²</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptomatic severe aortic stenosis</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage/Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asymptomatic with HTN or CAD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Start <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors or beta-blockers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consider <span class=\"customMeta\" data-dictid=\"a7b34909c8169277720021221b4f22\">TAVR</span> if LVEF <strong>&lt; 60%</strong> (based on three readings).</li>\n<li>Regular monitoring with <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> <span class=\"customMeta\" data-dictid=\"36376dc3a81692777186a5d60f88cd\">echocardiogram</span> every 1-2 years to evaluate progression.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Avoid strenuous exercise, hypovolemia, and <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">dehydration</span> to maintain adequate <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n<li>Indications for <strong>TAVR</strong>:\n\t\t\t\t<ul>\n<li><strong>LVEF &lt; 50%.</strong></li>\n<li><strong>Ejection <span class=\"customMeta\" data-dictid=\"12c4510e191692777201c23ec126a3\">velocity</span> &gt; 5 m/sec.</strong></li>\n<li><strong>Transvalvular <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> (LV-AO) &gt; 60 mmHg. </strong></li>\n</ul>\n</li>\n<li>Statins should be started to prevent the <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of atherosclerosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>TAVR is indicated.</li>\n<li>For <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> patients with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> aortic stenosis, <strong>aortic <span class=\"customMeta\" data-dictid=\"eaa9464e821692777182d5ea19be91\">balloon valvuloplasty</span> </strong>is the preferred treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patients in <strong>Stage B </strong>and<strong> Stage C </strong>are monitored regularly with <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> echocardiograms every 1 to 2 years to assess disease progression.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old patient presents with angina and shortness of breath on exertion. Physical examination reveals a slow-rising carotid pulse and a systolic ejection murmur. An echocardiogram shows thickened and calcified aortic valve leaflets with reduced opening. Which of the following findings is most likely to be observed on the ECG in this patient?", "options": [{"label": "A", "text": "Left ventricular hypertrophy", "correct": true}, {"label": "B", "text": "Right atrial enlargement", "correct": false}, {"label": "C", "text": "ST-segment elevation", "correct": false}, {"label": "D", "text": "Atrial fibrillation", "correct": false}], "correct_answer": "A. Left ventricular hypertrophy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/amxkYnPUGU0XETzChef11744310906.png", "https://image.prepladder.com/notes/iPj7dQr0yhkPeBewfy7U1744310992.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generally regular until late stages.</li>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> (AF) may indicate associated <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is commonly elevated in older adults with <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">aortic stenosis</span> (AS).</li>\n<li>In late stages, <span class=\"customMeta\" data-dictid=\"b7eed7d7e816927771995e0a067401\">stroke volume</span> declines, leading to potential <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> pressure drop and narrowed pulse pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carotid Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by a slow rise and delayed peak <strong>(pulsus parvus et tardus/Anacrotic pulse)</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"Pulsus parvus et tardus\" data-author=\"\" data-hash=\"8864\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"382\" src=\"https://image.prepladder.com/notes/amxkYnPUGU0XETzChef11744310906.png\" width=\"382\"/></p>\n<ul>\n<li><strong>A <span class=\"customMeta\" data-dictid=\"7deb9070e81692777200227c178c2f\">thrill</span> or <span class=\"customMeta\" data-dictid=\"0102cd39391692777181d686026c79\">anacrotic</span> “shudder”</strong> may be felt over the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> arteries, often more prominent on the left</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>JVP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Accentuated “a” wave</strong> due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> (RV) <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> <span class=\"customMeta\" data-dictid=\"381ab780231692777186a9011d8a74\">distensibility</span> from the hypertrophied <span class=\"customMeta\" data-dictid=\"769fa5be3616927771906f8ae8b053\">interventricular</span> septum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LV Impulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lateral displacement</strong> in advanced stages.</li>\n<li>A double <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> impulse and <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> S4 may be noted, especially in the left <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"ece1d5637c169277719789b25ff95b\">recumbent</span> position.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient presents to the clinic with increasing fatigue and shortness of breath on exertion. O/E a harsh, systolic crescendo-decrescendo ejection murmur is noted at the right second intercostal space. Which of the following symptoms is not part of the classic triad associated with this condition?", "options": [{"label": "A", "text": "Exertional dyspnea", "correct": false}, {"label": "B", "text": "Angina pectoris", "correct": false}, {"label": "C", "text": "Syncope", "correct": false}, {"label": "D", "text": "Orthopnea", "correct": true}], "correct_answer": "D. Orthopnea", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old woman presents with fatigue and progressive shortness of breath, particularly when climbing stairs. During the physical examination, a harsh, systolic ejection murmur is heard at the right second intercostal space, radiating to the carotids. Which of the following factors is least likely to be associated with the development of the condition?", "options": [{"label": "A", "text": "Mediastinal irradiation", "correct": false}, {"label": "B", "text": "Mutation in NOTCH1", "correct": false}, {"label": "C", "text": "Prior rheumatic inflammation", "correct": false}, {"label": "D", "text": "Systemic lupus erythematosus", "correct": true}], "correct_answer": "D. Systemic lupus erythematosus", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ESTbIvGpd8TfOihyJ66q1744310740.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Degenerative Calcification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"011fad823816927771969cdd48df1a\">primary cause</span> of <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">aortic stenosis</span> (AS) in adults, often due to:</p>\n<ul>\n<li><strong>Congenital <span class=\"customMeta\" data-dictid=\"9461b5b89b16927771839fb979168f\">Bicuspid</span> <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">Aortic Valve</span> (BAV)</strong>: Approximately <strong>53%</strong> of cases.</li>\n<li><strong>Trileaflet <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> Deterioration</strong></li>\n<li><strong>Previous Rheumatic Fever </strong><strong>(Option C ruled out)</strong>: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> can lead to <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> and calcification.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rheumatic Heart Disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It causes <span class=\"customMeta\" data-dictid=\"935fe383981692777184d257bc8571\">commissural</span> fusion, resembling BAV, and leads to <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> narrowing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mediastinal Radiation </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cause late <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> and <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> of the aortic leaflets.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shone Complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Components include<strong> Aortic stenosis</strong><strong>, <span class=\"customMeta\" data-dictid=\"46aee94b0a16927771845967ac94d1\">Coarctation</span> of aorta, Parachute <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve, supravalvular <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> membrane</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic polymorphisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vitamin D receptor</li>\n<li>Estrogen <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> (notably in <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> women)</li>\n<li>Interleukin 10</li>\n<li>Apolipoprotein E4</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Traditional risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension, High LDL, Smoking, DM, CKD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bicuspid <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">Aortic Valve</span> Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"efba33a3fd1692777189906f884236\">heart valve</span> defect,</strong> with a male predominance <strong>(2–4:1)</strong>.</li>\n<li><strong>Inheritance</strong>: Autosomal dominant with incomplete penetrance</li>\n<li><strong>Genetic Factors</strong>: Mutations in <strong>NOTCH1 </strong><strong>(Option B ruled out)</strong>, <strong>GATA5</strong>, and <strong>GATA4</strong> have been noted</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with exertional dyspnea and a prominent heart murmur. Upon auscultation, the murmur is best heard at the right second intercostal space and radiates to the carotids. Interestingly, the murmur also becomes higher-pitched when heard at the apex. What is the most likely diagnosis associated with this auscultatory finding?", "options": [{"label": "A", "text": "Mitral regurgitation", "correct": false}, {"label": "B", "text": "Aortic stenosis", "correct": true}, {"label": "C", "text": "Tricuspid regurgitation", "correct": false}, {"label": "D", "text": "Pulmonary stenosis", "correct": false}], "correct_answer": "B. Aortic stenosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old female patient presents with exertional dyspnea and a history of rheumatic fever. An echocardiogram shows isolated mitral stenosis with a calcified valve. Which of the following is the most appropriate management strategy for her condition?", "options": [{"label": "A", "text": "Initiate warfarin therapy", "correct": false}, {"label": "B", "text": "Percutaneous mitral balloon commissurotomy (PMBC)", "correct": false}, {"label": "C", "text": "Schedule for mitral valve replacement", "correct": true}, {"label": "D", "text": "Start beta-blockers and diuretics", "correct": false}], "correct_answer": "C. Schedule for mitral valve replacement", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0bYyTaB3ZRaVSWceZKwI1744310449.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:571px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications / Requirements</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"eaa9464e821692777182d5ea19be91\">Balloon Valvuloplasty</span> (PMBC) (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Significant symptoms present</li>\n<li><strong>Isolated <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> stenosis</strong> (no or trivial <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> regurgitation)</li>\n<li>Mobile, <strong>non-calcified</strong> valve/sub <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"5a70fb96bf1692777181823f42fcf0\">apparatus</span> on echocardiogram</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> free of thrombus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Commissurotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Required if PMBC fails</li>\n<li>Involves opening <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> commissures and addressing subvalvular structures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> Replacement (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Substantial <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> regurgitation</li>\n<li>Rigid and <strong>calcified valve</strong></li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> formation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old female presents with worsening exertional dyspnea and fatigue. She has a history of rheumatic fever during her childhood. O/E, you note a diastolic murmur at the cardiac apex, along with a pronounced opening snap. Which of the following findings is least likely to be present?", "options": [{"label": "A", "text": "Left atrial enlargement", "correct": false}, {"label": "B", "text": "Reduced mitral valve area", "correct": false}, {"label": "C", "text": "Right ventricular hypertrophy", "correct": false}, {"label": "D", "text": "Mitral regurgitation", "correct": true}], "correct_answer": "D. Mitral regurgitation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BNkjqnQukNwRMJVjpW6n1744310224.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old female with a history of rheumatic heart disease comes to the OPD for a regular follow-up. Echocardiography confirmed the presence of severe mitral regurgitation (MR). When considering her treatment options, which of the following interventions should not be included in her management plan?", "options": [{"label": "A", "text": "Use of Apixaban if her CHA2DS2-VASc score ≥2", "correct": true}, {"label": "B", "text": "Cardiac resynchronization therapy, when indicated", "correct": false}, {"label": "C", "text": "Mitral valve repair if ejection fraction falls less than 60%", "correct": false}, {"label": "D", "text": "Vitamin K antagonists", "correct": false}], "correct_answer": "A. Use of Apixaban if her CHA2DS2-VASc score ≥2", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/MGEtGdWkNh45dZ0T0omx1744310097.png", "https://image.prepladder.com/notes/D1NaKwPuP4LEWDnXFVzA1744310021.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management of <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">Mitral</span> Regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>ECG</strong>\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> may be present in cases of chronic MR</li>\n<li>P-mitrale &gt; 120 seconds (enlarged left atrium)</li>\n</ul>\n</li>\n<li><strong>Echocardiogram</strong>\n<ul>\n<li>Regurgitant flow of blood from the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> to the left atrium</li>\n</ul>\n</li>\n<li><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> </strong>\n<ul>\n<li>Double atrial shadow (left <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> enlarged)</li>\n<li><strong>Walking man sign</strong> (↑ carinal angle)</li>\n<li>Signs of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema: <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and<strong> Kerley B lines.</strong></li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> due to volume overload\n\t\t\t\t\t<ul>\n<li>(MS, there is <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">compensatory</span> hypertrophy)</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Double density sign left atrium\" data-author=\"Gaillard F, Deng F, Murphy A, et al. Double density sign (left atrium). Reference article, Radiopaedia.org (Accessed on 16 Nov 2024) https://doi.org/10.53347/rID-20322\" data-hash=\"8853\" data-license=\"\" data-source=\"https://radiopaedia.org/articles/double-density-sign-left-atrium\" data-tags=\"April2025\" height=\"357\" src=\"https://image.prepladder.com/notes/MGEtGdWkNh45dZ0T0omx1744310097.png\" width=\"357\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Walking man sign chest x-ray\" data-author=\"Gaillard F, Bell D, Tatco V, et al. Walking man sign (chest x-ray). Reference article, Radiopaedia.org (Accessed on 16 Nov 2024) https://doi.org/10.53347/rID-20321\" data-hash=\"8852\" data-license=\"\" data-source=\"https://radiopaedia.org/articles/walking-man-sign-chest-x-ray\" data-tags=\"April2025\" height=\"277\" src=\"https://image.prepladder.com/notes/D1NaKwPuP4LEWDnXFVzA1744310021.png\" width=\"462\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute MR</strong> leading to <span class=\"customMeta\" data-dictid=\"da8747dcd51692777185e1ed0554cc\">decompensated</span> <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> can be treated with:\n\t\t\t\t<ul>\n<li>Loop diuretics</li>\n<li>Sodium nitroprusside</li>\n<li>Mechanical support till <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> repair</li>\n</ul>\n</li>\n<li><strong>Chronic MR</strong>\n<ul>\n<li>For secondary MR, aggressive guideline-directed therapy<strong> (GDMT) </strong>can be done using.\n\t\t\t\t\t<ul>\n<li>Beta-blockers (Atenolol and Metoprolol)</li>\n<li>ACE inhibitors (Lisinopril and Captopril)</li>\n<li>Angiotensin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockers (Telmisartan and Losartan)</li>\n<li>Cardiac <span class=\"customMeta\" data-dictid=\"175cb514a61692777197f78c0b1edf\">resynchronization</span> therapy for arrhythmias <strong>(Option B ruled out)</strong></li>\n</ul>\n</li>\n<li><strong>Warfarin or NOAC </strong>if <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> occurs\n\t\t\t\t\t<ul>\n<li><strong>NOAC should be avoided in the presence of rheumatic heart disease and mechanical <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valves</strong><strong> (Option A)</strong></li>\n<li><strong>Warfarin </strong>is preferred in RHD with valvular <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> <strong>(Option D ruled out)</strong></li>\n</ul>\n</li>\n<li><strong>Surgical repair:</strong>\n<ul>\n<li><strong>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> repair </strong>&gt; replacement</li>\n<li>Transcatheter <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> repair (Mitra clip)</li>\n</ul>\n</li>\n<li>Surgical repair in <strong>asymptomatic patients</strong> must be done when<strong> EF&lt;60% or LV ESD &gt;= 40mm.</strong> <strong>(Option C ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old female presents to the clinic with complaints of fatigue, shortness of breath on exertion, and palpitations. On physical examination, a systolic thrill is palpable at the cardiac apex. Echocardiography showed severe backflow of blood from the left ventricle to the left atrium during ventricular systole. What kind of murmur is most likely to be heard during cardiac auscultation of this patient?", "options": [{"label": "A", "text": "Continuous murmur", "correct": false}, {"label": "B", "text": "An opening snap followed by a diastolic murmur", "correct": false}, {"label": "C", "text": "Holosystolic murmur, best heard at the apex", "correct": true}, {"label": "D", "text": "Crescendo decrescendo systolic murmur best heard at the base", "correct": false}], "correct_answer": "C. Holosystolic murmur, best heard at the apex", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MITRAL REGURGITATION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical examination </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BP may be normal or ↓ ; Narrow pulse pressure.</li>\n<li>Palpable <span class=\"customMeta\" data-dictid=\"7deb9070e81692777200227c178c2f\">thrill</span> at the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> apex.</li>\n<li>Hyperdynamic and laterally displaced <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> beat.</li>\n<li>Normal or ↑ JVP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Auscultation findings </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Soft or absent S1.</li>\n<li><strong>Wide variable <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> of S2: </strong>P2 is variable, and A2 appears early as less blood flows through the aortic valve; thus, the S2 split is wide.</li>\n<li>S4 may be heard in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> severe MR.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Holosystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> in chronic MR</strong>. (High-pitched blowing murmur, radiating towards axilla)</li>\n<li><strong>A decrescendo <span class=\"customMeta\" data-dictid=\"ef42a2f795169277718653bd2c3694\">early <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> murmur</span> in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> severe MR.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mitral Regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Auscultation Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Murmur</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BP: Normal or ↓ with narrow pulse pressure</li>\n<li>Palpable <span class=\"customMeta\" data-dictid=\"7deb9070e81692777200227c178c2f\">thrill</span> at the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> apex</li>\n<li>Hyperdynamic, laterally displaced <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> beat</li>\n<li>Normal or ↑ JVP</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Soft or absent S1</li>\n<li>Wide, variable <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> of S2</li>\n<li>S4 may be heard in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> severe MR</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Holosystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> (chronic MR)</li>\n<li>Decrescendo <span class=\"customMeta\" data-dictid=\"ef42a2f795169277718653bd2c3694\">early <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> murmur</span> (acute MR)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with shortness of breath on exertion, fatigue, and palpitations. On examination, a pan systolic murmur is heard best at the apex, radiating to the axilla. Echocardiography reveals mitral valve prolapse with significant mitral regurgitation. Which of the following is NOT a typical cause of primary chronic mitral regurgitation?", "options": [{"label": "A", "text": "Ischemic cardiomyopathy", "correct": true}, {"label": "B", "text": "Rheumatic fever", "correct": false}, {"label": "C", "text": "Infective endocarditis", "correct": false}, {"label": "D", "text": "Radiation", "correct": false}], "correct_answer": "A. Ischemic cardiomyopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:655px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MITRAL <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">REGURGITATION</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n<p><strong>(Options B, C &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Etiology of &lt;span class=\" custommeta\"=\"\" data-dictid=\"d93de7238d16927771922b27cb6086\"/>Mitral <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> \" data-author=\"\" data-hash=\"8849\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"233\" src=\"https://image.prepladder.com/notes/gSmFC0gAlY0S8WIJwrTM1744309732.png\" width=\"450\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Pathophysiology of &lt;span class=\" custommeta\"=\"\" data-dictid=\"d93de7238d16927771922b27cb6086\"/>Mitral <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> \" data-author=\"\" data-hash=\"8850\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"195\" src=\"https://image.prepladder.com/notes/b3CWUiFdP7NreV9jpcCk1744309819.png\" width=\"421\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild to moderate MR is asymptomatic</li>\n<li>Severe MR\n\t\t\t\t<ul>\n<li><strong>Orthopnea </strong></li>\n<li><strong>Exertional fatigue</strong></li>\n<li><strong>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> </strong></li>\n<li><strong>Ankle oedema</strong></li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Late-onset right-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> may also occur</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old male with mitral valve prolapse, chronic atrial fibrillation (CHA2DS2-VASc score of 5), severe mitral regurgitation, and an ejection fraction of 35% presents with occasional palpitations and breathlessness. He also has a history of infective endocarditis. Which of the following statements regarding his management is not true?", "options": [{"label": "A", "text": "Anticoagulation therapy should be avoided", "correct": true}, {"label": "B", "text": "Beta-blockers should be initiated for his palpitations", "correct": false}, {"label": "C", "text": "Mitral valve repair is preferred over mitral valve replacement", "correct": false}, {"label": "D", "text": "Prophylactic antibiotics should be initiated", "correct": false}], "correct_answer": "A. Anticoagulation therapy should be avoided", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/reV0nNVBvcIWCQYVoEbx1744309554.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 34 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 2 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A man presents to the emergency department unconscious and hypotensive. His ECG reveals narrow complex tachycardia. What is the next best step in management?", "options": [{"label": "A", "text": "Synchronized DC cardioversion", "correct": true}, {"label": "B", "text": "Carotid massage", "correct": false}, {"label": "C", "text": "IV adenosine 6 mg", "correct": false}, {"label": "D", "text": "IV amiodarone", "correct": false}], "correct_answer": "A. Synchronized DC cardioversion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Synchronized DC cardiov\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man collapsed in his house and was rushed to the hospital. On arrival, his ECG tracing was as shown below. Which of the following is the best intervention for this patient?", "options": [{"label": "A", "text": "Use of automated external defibrillator", "correct": false}, {"label": "B", "text": "Injection of vasopressin 40 IU", "correct": false}, {"label": "C", "text": "Injection of Adrenaline 1mg IV", "correct": true}, {"label": "D", "text": "Injection of Atropine 0.5mg IV", "correct": false}], "correct_answer": "C. Injection of Adrenaline 1mg IV", "question_images": ["https://image.prepladder.com/content/iIWthQBAC5LFbNEqHBgL1746793257.png"], "explanation_images": ["https://image.prepladder.com/content/NlhOnVoL0Lzc33xUKrfO1746793322.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Resuscitation Steps for Asystole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1133\" src=\"https://image.prepladder.com/content/NlhOnVoL0Lzc33xUKrfO1746793322.png\" width=\"650\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 12 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 3 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A patient with diffuse severely contaminated peritonitis underwent laparotomy and was left open after surgery. Which of the following might help?", "options": [{"label": "A", "text": "VAC", "correct": true}, {"label": "B", "text": "Normal saline soaked gauze", "correct": false}, {"label": "C", "text": "Prefer closure after laparotomy", "correct": false}, {"label": "D", "text": "Antibiotic soaked gauze", "correct": false}], "correct_answer": "A. VAC", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Option</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effectiveness in Open Abdomen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Considerations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VAC Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Highly effective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces infection, removes fluids, aids healing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">Saline</span> Soaked Gauze</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary benefit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keeps wound moist but does not actively remove exudates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">Closure</span> After Laparotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not preferred in contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome &amp; infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotic-Soaked Gauze</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited benefit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not provide <span class=\"customMeta\" data-dictid=\"befa0a72121692777193663f2ca836\">negative pressure</span> drainage</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency department with confusion. On examination, he opens his eyes to pain, shows abnormal flexion to pain, and is disoriented in speech. What is his Glasgow Coma Scale (GCS) score?", "options": [{"label": "A", "text": "11", "correct": false}, {"label": "B", "text": "12", "correct": false}, {"label": "C", "text": "10", "correct": false}, {"label": "D", "text": "9", "correct": true}], "correct_answer": "D. 9", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:441px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Response Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient's Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexion withdrawal from pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total <span class=\"customMeta\" data-dictid=\"e37b435fd416927771886af66a9675\">GCS</span> Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 + 4 + 3</strong> = <strong>9</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:406px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To voice</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexion (abnormal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extension (abnormal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structures are preserved during radical neck dissection?", "options": [{"label": "A", "text": "Digastric muscle", "correct": true}, {"label": "B", "text": "Sternocleidomastoid muscle", "correct": false}, {"label": "C", "text": "Spinal accessory nerve", "correct": false}, {"label": "D", "text": "Ipsilateral cervical lymph nodes", "correct": false}], "correct_answer": "A. Digastric muscle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A.\n<table>\n<thead>\n<tr>\n<td>\n<p><strong>Type of Radical Neck Dissection</strong></p>\n</td>\n<td>\n<p><strong>Structures Removed</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Radical Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (RND)</p>\n</td>\n<td rowspan=\"4\">\n<ul>\n<li>All <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the neck</li>\n<li>Sternocleidomastoid muscle</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein</li>\n<li>Spinal <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve</li>\n<li>Submandibular <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> (optional)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td>\n<p>Modified Radical Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (MRND)</p>\n</td>\n<td>\n<ul>\n<li>Selective <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the neck</li>\n<li>Sternocleidomastoid muscle</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> (optional)</li>\n<li>Spinal <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve (preserved or partially preserved)</li>\n<li>Submandibular <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> (optional)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\">\n<p>Selective Neck Dissection</p>\n</td>\n<td>\n<p>Selective <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the neck based on the level of involvement</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Preservation of other structures based on the extent of disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 13 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 13 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "You are walking in a park when you notice a person suddenly collapse and become unresponsive. You quickly assess the situation and suspect cardiac arrest. According to Basic Cardiac Life Support (BCLS) guidelines, what is the first appropriate action you should take?", "options": [{"label": "A", "text": "Start chest compressions immediately", "correct": false}, {"label": "B", "text": "Check the scene for safety before approaching the victim", "correct": true}, {"label": "C", "text": "Call for help and get an AED before checking for responsiveness", "correct": false}, {"label": "D", "text": "Provide rescue breaths before checking for a pulse", "correct": false}], "correct_answer": "B. Check the scene for safety before approaching the victim", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ybhvfBsrtQ9GgJtaFcvG1744302116.png", "https://image.prepladder.com/notes/gUUQRdKMvIILTVkLyeXW1744302241.png", "https://image.prepladder.com/notes/C96QAOPjHWF8VCxKevo91744302344.png"], "explanation": "<p><strong>Educational Objective:</strong></p>\n<ul><li>➤ Learning Objective:</li><li>➤ Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS)</li><li>➤ Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS)</li><li>➤ Aspect Basic Life Support (BLS) Advanced Cardiovascular Life Support (ACLS) Goal Maintain brain perfusion by supporting circulation and breathing. Maintain cardiovascular function with advanced interventions, including airway management, rhythm correction, and medication administration. Primary Users First responders (e.g., EMTs, nurses, rescuers with CPR certification). Healthcare professionals (e.g., physicians, paramedics, nurses with advanced training). Airway Management Basic methods: mouth-to-mask, bag-mask ventilation. Advanced airway techniques: endotracheal intubation, supraglottic airway devices. Breathing Support Rescue breaths or bag-mask ventilation. Continuous ventilation with advanced airway in place (1 breath every 6 seconds). Use of Defibrillation AED (Automated External Defibrillator) automatically detects rhythm and advises shock if needed. A defibrillator is used, but the healthcare provider makes the decision to shock based on rhythm analysis. Differential Diagnosis of Pulselessness Focuses on performing CPR and defibrillation without diagnosing underlying causes. Includes diagnosing and treating reversible causes of pulselessness like hypovolemia, tension pneumothorax, cardiac tamponade, etc. Medication Use No medications were administered. Administers medications (e.g., epinephrine, amiodarone, atropine) Chest Compressions High-quality chest compressions (30:2 ratio for adults without advanced airway). Same chest compression techniques, with rhythm-guided interruptions for defibrillation or other interventions. Focus on Reversible Causes Not explicitly emphasized. Actively diagnoses and treats reversible causes (e.g., 5 H’s and T’s)</li><li>➤ Aspect Basic Life Support (BLS) Advanced Cardiovascular Life Support (ACLS)</li><li>➤ Basic Life Support (BLS)</li><li>➤ Basic Life Support (BLS)</li><li>➤ Basic Life Support (BLS)</li><li>➤ Advanced Cardiovascular Life Support (ACLS)</li><li>➤ Advanced Cardiovascular Life Support (ACLS)</li><li>➤ Advanced Cardiovascular Life Support (ACLS)</li><li>➤ Goal Maintain brain perfusion by supporting circulation and breathing. Maintain cardiovascular function with advanced interventions, including airway management, rhythm correction, and medication administration.</li><li>➤ Maintain brain perfusion by supporting circulation and breathing.</li><li>➤ Maintain brain perfusion by supporting circulation and breathing.</li><li>➤ Maintain cardiovascular function with advanced interventions, including airway management, rhythm correction, and medication administration.</li><li>➤ Maintain cardiovascular function with advanced interventions, including airway management, rhythm correction, and medication administration.</li><li>➤ Primary Users First responders (e.g., EMTs, nurses, rescuers with CPR certification). Healthcare professionals (e.g., physicians, paramedics, nurses with advanced training).</li><li>➤ First responders (e.g., EMTs, nurses, rescuers with CPR certification).</li><li>➤ First responders (e.g., EMTs, nurses, rescuers with CPR certification).</li><li>➤ Healthcare professionals (e.g., physicians, paramedics, nurses with advanced training).</li><li>➤ Healthcare professionals (e.g., physicians, paramedics, nurses with advanced training).</li><li>➤ Airway Management Basic methods: mouth-to-mask, bag-mask ventilation. Advanced airway techniques: endotracheal intubation, supraglottic airway devices.</li><li>➤ Airway Management</li><li>➤ Airway Management</li><li>➤ Airway Management</li><li>➤ Basic methods: mouth-to-mask, bag-mask ventilation.</li><li>➤ Basic methods: mouth-to-mask, bag-mask ventilation.</li><li>➤ Advanced airway techniques: endotracheal intubation, supraglottic airway devices.</li><li>➤ Advanced airway techniques: endotracheal intubation, supraglottic airway devices.</li><li>➤ Breathing Support Rescue breaths or bag-mask ventilation. Continuous ventilation with advanced airway in place (1 breath every 6 seconds).</li><li>➤ Breathing Support</li><li>➤ Breathing Support</li><li>➤ Breathing Support</li><li>➤ Rescue breaths or bag-mask ventilation.</li><li>➤ Rescue breaths or bag-mask ventilation.</li><li>➤ Continuous ventilation with advanced airway in place (1 breath every 6 seconds).</li><li>➤ Continuous ventilation with advanced airway in place (1 breath every 6 seconds).</li><li>➤ Use of Defibrillation AED (Automated External Defibrillator) automatically detects rhythm and advises shock if needed. A defibrillator is used, but the healthcare provider makes the decision to shock based on rhythm analysis.</li><li>➤ Use of Defibrillation</li><li>➤ Use of Defibrillation</li><li>➤ Use of Defibrillation</li><li>➤ AED (Automated External Defibrillator) automatically detects rhythm and advises shock if needed.</li><li>➤ AED (Automated External Defibrillator) automatically detects rhythm and advises shock if needed.</li><li>➤ A defibrillator is used, but the healthcare provider makes the decision to shock based on rhythm analysis.</li><li>➤ A defibrillator is used, but the healthcare provider makes the decision to shock based on rhythm analysis.</li><li>➤ Differential Diagnosis of Pulselessness Focuses on performing CPR and defibrillation without diagnosing underlying causes. Includes diagnosing and treating reversible causes of pulselessness like hypovolemia, tension pneumothorax, cardiac tamponade, etc.</li><li>➤ Differential Diagnosis of Pulselessness</li><li>➤ Differential Diagnosis of Pulselessness</li><li>➤ Differential Diagnosis of Pulselessness</li><li>➤ Focuses on performing CPR and defibrillation without diagnosing underlying causes.</li><li>➤ Focuses on performing CPR and defibrillation without diagnosing underlying causes.</li><li>➤ Includes diagnosing and treating reversible causes of pulselessness like hypovolemia, tension pneumothorax, cardiac tamponade, etc.</li><li>➤ Includes diagnosing and treating reversible causes of pulselessness like hypovolemia, tension pneumothorax, cardiac tamponade, etc.</li><li>➤ Medication Use No medications were administered. Administers medications (e.g., epinephrine, amiodarone, atropine)</li><li>➤ No medications were administered.</li><li>➤ No medications were administered.</li><li>➤ Administers medications (e.g., epinephrine, amiodarone, atropine)</li><li>➤ Administers medications (e.g., epinephrine, amiodarone, atropine)</li><li>➤ Chest Compressions High-quality chest compressions (30:2 ratio for adults without advanced airway). Same chest compression techniques, with rhythm-guided interruptions for defibrillation or other interventions.</li><li>➤ Chest Compressions</li><li>➤ Chest Compressions</li><li>➤ Chest Compressions</li><li>➤ High-quality chest compressions (30:2 ratio for adults without advanced airway).</li><li>➤ High-quality chest compressions (30:2 ratio for adults without advanced airway).</li><li>➤ Same chest compression techniques, with rhythm-guided interruptions for defibrillation or other interventions.</li><li>➤ Same chest compression techniques, with rhythm-guided interruptions for defibrillation or other interventions.</li><li>➤ Focus on Reversible Causes Not explicitly emphasized. Actively diagnoses and treats reversible causes (e.g., 5 H’s and T’s)</li><li>➤ Focus on Reversible Causes</li><li>➤ Focus on Reversible Causes</li><li>➤ Focus on Reversible Causes</li><li>➤ Not explicitly emphasized.</li><li>➤ Not explicitly emphasized.</li><li>➤ Actively diagnoses and treats reversible causes (e.g., 5 H’s and T’s)</li><li>➤ Actively diagnoses and treats reversible causes (e.g., 5 H’s and T’s)</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basic Life Support (BLS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advanced <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">Cardiovascular</span> Life Support (ACLS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintain brain <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> by supporting <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> and breathing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintain <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function with advanced interventions, including <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> management, rhythm correction, and medication administration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Users</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First responders (e.g., EMTs, nurses, rescuers with CPR certification).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Healthcare professionals (e.g., physicians, paramedics, nurses with advanced training).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Airway Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Basic methods: mouth-to-mask, bag-mask ventilation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> techniques: <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> intubation, <span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\">supraglottic</span> <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> devices.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breathing Support</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rescue breaths or bag-mask ventilation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> with advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> in place (1 breath every 6 seconds).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Use of Defibrillation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AED (Automated External Defibrillator) automatically detects rhythm and advises shock if needed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"480005d26f16927771853fd11950c7\">defibrillator</span> is used, but the healthcare provider makes the decision to shock based on rhythm analysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis of Pulselessness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focuses on performing CPR and <span class=\"customMeta\" data-dictid=\"66e0f32ec216927771851ee930e967\">defibrillation</span> without diagnosing underlying causes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes diagnosing and treating <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes of pulselessness like hypovolemia, tension pneumothorax, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medication Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No medications were administered.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administers medications (e.g., epinephrine, amiodarone, atropine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest Compressions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-quality chest compressions (30:2 ratio for adults without advanced airway).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Same chest <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> techniques, with rhythm-guided interruptions for <span class=\"customMeta\" data-dictid=\"66e0f32ec216927771851ee930e967\">defibrillation</span> or other interventions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focus on <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not explicitly emphasized.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Actively diagnoses and treats <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes (e.g., 5 H’s and T’s)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient with sepsis is admitted to the ICU. During the hospital stay, the patient suddenly becomes unresponsive, pulseless, and apneic. An immediate ECG is performed, revealing chaotic, irregular waveforms without identifiable QRS complexes or P waves. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Asystole", "correct": false}, {"label": "B", "text": "Pulseless Electrical Activity", "correct": false}, {"label": "C", "text": "Ventricular Tachycardia", "correct": false}, {"label": "D", "text": "Ventricular Fibrillation", "correct": true}], "correct_answer": "D. Ventricular Fibrillation", "question_images": ["https://image.prepladder.com/notes/UvsEFj8FghHUawIAdirz1744302492.png"], "explanation_images": ["https://image.prepladder.com/notes/UvsEFj8FghHUawIAdirz1744302492.png", "https://image.prepladder.com/notes/PP7Q3Ua61DQtXxeGIbow1744302618.png", "https://image.prepladder.com/notes/lz9zqS4AVzrs3kxG792J1744302688.png", "https://image.prepladder.com/notes/UKNfnBH9k7h4zBglbM111744302756.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular Fibrillation: </strong>is a life-threatening <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> characterized by chaotic, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> waveforms on the ECG with no identifiable QRS complexes or P waves. It results in ineffective quivering of the ventricles, leading to a complete loss of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output and immediate loss of consciousness.</p>\n<p style=\"text-align:center\"><img alt=\"ECG pattern seen in Ventricular Fibrillation\" data-author=\"\" data-hash=\"8763\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"189\" src=\"https://image.prepladder.com/notes/UvsEFj8FghHUawIAdirz1744302492.png\" width=\"795\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular Tachycardia </strong><strong>(Option C): </strong>It is characterized by a rapid heart rate originating from the ventricles, typically defined as three or more consecutive <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> beats at a rate exceeding 100 beats per minute. The ECG will show wide QRS complexes (≥0.12 seconds) that appear similar and occur regularly. In some cases, VT can still have a pulse.</p>\n<p style=\"text-align:center\"><img alt=\"ECG pattern seen in Ventricular Tachycardia\" data-author=\"\" data-hash=\"8765\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"300\" src=\"https://image.prepladder.com/notes/PP7Q3Ua61DQtXxeGIbow1744302618.png\" width=\"582\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:594px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asystole </strong><strong>(Option A): </strong>It is a state of no <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> in the heart, resulting in a flat-line ECG with no discernible waves (no P waves, QRS complexes, or T waves). It indicates a complete absence of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity.</p>\n<p style=\"text-align:center\"><img alt=\"ECG pattern seen in Asystole\" data-author=\"\" data-hash=\"8766\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/lz9zqS4AVzrs3kxG792J1744302688.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulseless <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">Electrical Activity</span> </strong><strong>(Option B): </strong>It is a condition where the ECG shows organized <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> (which may appear as normal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> rhythm or other patterns), but the heart fails to contract effectively, resulting in no <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> pulse.</p>\n<p style=\"text-align:center\"><img alt=\"ECG pattern seen in Pulseless Electrical Activity\" data-author=\"\" data-hash=\"8769\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"153\" src=\"https://image.prepladder.com/notes/UKNfnBH9k7h4zBglbM111744302756.png\" width=\"530\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basic Life Support (BLS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advanced <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">Cardiovascular</span> Life Support (ACLS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintain brain <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> by supporting <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> and breathing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintain <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function with advanced interventions, including <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> management, rhythm correction, and medication administration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Users</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First responders (e.g., EMTs, nurses, rescuers with CPR certification).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Healthcare professionals (e.g., physicians, paramedics, nurses with advanced training).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Airway Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Basic methods: mouth-to-mask, bag-mask ventilation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> techniques: <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> intubation, <span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\">supraglottic</span> <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> devices.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breathing Support</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rescue breaths or bag-mask ventilation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> with advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> in place (1 breath every 6 seconds).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Use of Defibrillation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AED (Automated External Defibrillator) automatically detects rhythm and advises shock if needed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"480005d26f16927771853fd11950c7\">defibrillator</span> is used, but the healthcare provider makes the decision to shock based on rhythm analysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis of Pulselessness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focuses on performing CPR and <span class=\"customMeta\" data-dictid=\"66e0f32ec216927771851ee930e967\">defibrillation</span> without diagnosing underlying causes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes diagnosing and treating <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes of pulselessness like hypovolemia, tension pneumothorax, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medication Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No medications were administered.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administers medications (e.g., epinephrine, amiodarone, atropine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest Compressions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-quality chest compressions (30:2 ratio for adults without advanced airway).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Same chest <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> techniques, with rhythm-guided interruptions for <span class=\"customMeta\" data-dictid=\"66e0f32ec216927771851ee930e967\">defibrillation</span> or other interventions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focus on <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not explicitly emphasized.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Actively diagnoses and treats <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes (e.g., 5 H’s and T’s)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old man is brought after collapsing at home. Upon arrival, he is found to be in cardiac arrest. The medical team begins resuscitation efforts and considers potential reversible causes. Which of the following is not considered one of the reversible causes of cardiac arrest?", "options": [{"label": "A", "text": "Hypovolemia", "correct": false}, {"label": "B", "text": "Tension pneumothorax", "correct": false}, {"label": "C", "text": "Hypertrophied ventricle", "correct": true}, {"label": "D", "text": "Hypoxia", "correct": false}], "correct_answer": "C. Hypertrophied ventricle", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:475px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>H's </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>T's </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypovolemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tension pneumothorax</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoxia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tamponade (cardiac)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydrogen <span class=\"customMeta\" data-dictid=\"4b2f2a6d0a16927771902f60fa9ff7\">ion</span> (acidosis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Toxins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypo-/Hyperkalemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thrombosis (coronary MI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypothermia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thrombosis (pulmonary embolism)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Assertion: Cardioversion is the preferred treatment for symptomatic supraventricular tachycardia (SVT). Reason: Synchronized direct current (DC) shock is administered at the peak of the R wave to effectively restore normal sinus rhythm while minimizing the risk of ventricular fibrillation.", "options": [{"label": "A", "text": "Both assertion and reason are true, and the reason is a correct explanation of the assertion.", "correct": false}, {"label": "B", "text": "Both assertion and reason are true, but the reason is not a correct explanation of the assertion.", "correct": true}, {"label": "C", "text": "The assertion is true, but the reason is false.", "correct": false}, {"label": "D", "text": "The assertion is false, but the reason is true.", "correct": false}], "correct_answer": "B. Both assertion and reason are true, but the reason is not a correct explanation of the assertion.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0rzG9Tw7NjHej0EM0fRx1744302905.png", "https://image.prepladder.com/notes/1XEnwydKEesPz1M5PjuX1744302985.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardioversion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Defibrillation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Definition</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A synchronized electrical shock to reset the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> heart rhythm.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Illustration of Cardioversion\" data-author=\"Jmarchn\" data-hash=\"8772\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Cardioversion#/media/File:Cardioversion.svg\" data-tags=\"April2025\" height=\"208\" src=\"https://image.prepladder.com/notes/0rzG9Tw7NjHej0EM0fRx1744302905.png\" width=\"247\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An unsynchronized shock to correct life-threatening arrhythmias.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"View of defibrillator electrode position and placement\" data-author=\"PhilippN\" data-hash=\"8774\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Defibrillation#/media/File:Defibrillation_Electrode_Position.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1XEnwydKEesPz1M5PjuX1744302985.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:121px\">\n<p style=\"text-align:center\"><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:259px\">\n<p>Synchronized with the R wave in the <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> (delivered at the peak of the R wave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:244px\">\n<p>Delivered irrespective of the R wave (unsynchronized)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:121px\">\n<p style=\"text-align:center\"><strong>Physiological Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:259px\">\n<p>Stops <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> contractions to allow the heart to reset, followed by the SA <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> resuming normal activity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:244px\">\n<p>Halts all <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> in the heart, hoping normal rhythm restarts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:121px\">\n<p style=\"text-align:center\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:259px\">\n<p>Performed in arrhythmias where the heart is still contracting but irregularly, such as: </p>\n<ul>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"619efd9f7b169277719928c9441919\">Supraventricular</span> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">Tachycardia</span> (PSVT)</li>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">Fibrillation</span> (AF)</li>\n<li>Atrial Flutter</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:244px\">\n<p>Performed in life-threatening arrhythmias where the heart is not pumping blood effectively, such as:</p>\n<ul>\n<li>Ventricular <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">Fibrillation</span> (VF)</li>\n<li>Pulseless <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">Tachycardia</span> (VT)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:121px\">\n<p style=\"text-align:center\"><strong>Energy Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:259px\">\n<p>Usually lower energy levels (e.g., 50-100 joules for AF)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:244px\">\n<p>Usually higher energy levels (e.g., 150-360 joules for VF)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:121px\">\n<p style=\"text-align:center\"><strong>Performed in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:259px\">\n<p>Elective procedure, typically not in emergencies.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:244px\">\n<p>Emergencies (like during a <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:121px\">\n<p style=\"text-align:center\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:259px\">\n<p>Less risk of inducing dangerous arrhythmias due to synchronization.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:244px\">\n<p>Higher risk of inducing other arrhythmias (e.g., R-on-T phenomenon) if the shock is delivered improperly.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an ICU, during cardiac resuscitation, a flat line is observed on the ECG. The attending physician instructs the team to administer adrenaline and continue CPR. What is the primary objective of administering adrenaline in this situation?", "options": [{"label": "A", "text": "To immediately restore normal sinus rhythm.", "correct": false}, {"label": "B", "text": "To convert asystole into ventricular fibrillation.", "correct": true}, {"label": "C", "text": "To increase myocardial oxygen demand.", "correct": false}, {"label": "D", "text": "To decrease preload on the heart.", "correct": false}], "correct_answer": "B. To convert asystole into ventricular fibrillation.", "question_images": ["https://image.prepladder.com/notes/lz9zqS4AVzrs3kxG792J1744302688.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Resuscitation Steps for Asystole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Identify Non-Shockable Rhythm (Asystole)</strong></p>\n<p><strong>Activate Emergency Response:</strong> Call for advanced life support.</p>\n<p>↓<br/>\n<strong>Initiate CPR</strong></p>\n<p><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue <span class=\"customMeta\" data-dictid=\"d43b4093f8169277718521f70bd37c\">CPR</span> for 2 minutes.</p>\n<p>↓<br/>\n<strong>Establish <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> lines for medication administration.</strong></p>\n<p>↓<br/>\n<strong>Administer Epinephrine</strong></p>\n<p><strong>Epinephrine 1 mg (1:10,000):</strong> Administer IV/IO after the first 2 minutes of CPR.</p>\n<p>↓</p>\n<p><strong>Identify Rhythm</strong></p>\n<ul>\n<li><strong>Non-Shockable Rhythm: </strong>Continue <span class=\"customMeta\" data-dictid=\"d43b4093f8169277718521f70bd37c\">CPR</span> and administer <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> every 3-5 minutes.</li>\n</ul>\n<p><strong>Goal: </strong>To increase the likelihood of developing a shockable rhythm, such as <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> (VF), which is necessary for effective defibrillation.</p>\n<ul>\n<li><strong>Shockable Rhythm:</strong> Administer a Non-Synchronized DC Shock to restore normal rhythm.</li>\n</ul>\n<p>↓<br/>\n<strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p><strong>Airway: </strong>Secure the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> with <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p><strong>Capnography: </strong>Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p><strong>Ventilation: </strong>Provide<strong> 1 breath every 6 seconds</strong> post-intubation for adequate oxygenation.</p>\n<p>↓<br/>\n<strong>Continue CPR</strong></p>\n<p>Resume chest compressions for 2 minutes.</p>\n<p>↓<br/>\n<strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n<p><strong>Primary Focus:</strong> Address <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes, especially hypothermia.</p>\n<p>↓<br/>\n<strong>Repeat <span class=\"customMeta\" data-dictid=\"d43b4093f8169277718521f70bd37c\">CPR</span> and Epinephrine</strong></p>\n<p><strong>Cycle: </strong>Continue repeating <span class=\"customMeta\" data-dictid=\"d43b4093f8169277718521f70bd37c\">CPR</span> and <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> administration every 3-5 minutes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male in the ICU experiences cardiac arrest, during which ventricular fibrillation is observed. Continuous cardiopulmonary resuscitation is in progress, and a defibrillator has been used multiple times, but the patient remains unresponsive. What is the next appropriate step in the management of this patient?", "options": [{"label": "A", "text": "Amiodarone", "correct": true}, {"label": "B", "text": "Administer Epinephrine", "correct": false}, {"label": "C", "text": "Perform Advanced Airway Management", "correct": false}, {"label": "D", "text": "Continue CPR with Compressions", "correct": false}], "correct_answer": "A. Amiodarone", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/UvsEFj8FghHUawIAdirz1744302492.png", "https://image.prepladder.com/notes/lz9zqS4AVzrs3kxG792J1744302688.png", "https://image.prepladder.com/notes/PP7Q3Ua61DQtXxeGIbow1744302618.png", "https://image.prepladder.com/notes/UKNfnBH9k7h4zBglbM111744302756.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shockable Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular Fibrillation</strong></p>\n<p style=\"text-align:center\"><img alt=\"ECG pattern seen in Ventricular Fibrillation\" data-author=\"\" data-hash=\"8763\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"125\" src=\"https://image.prepladder.com/notes/UvsEFj8FghHUawIAdirz1744302492.png\" width=\"525\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asystole</strong></p>\n<p style=\"text-align:center\"><img alt=\"ECG pattern seen in Asystole\" data-author=\"\" data-hash=\"8766\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/lz9zqS4AVzrs3kxG792J1744302688.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular Tachycardia </strong></p>\n<p style=\"text-align:center\"><img alt=\"ECG pattern seen in Ventricular Tachycardia\" data-author=\"\" data-hash=\"8765\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"249\" src=\"https://image.prepladder.com/notes/PP7Q3Ua61DQtXxeGIbow1744302618.png\" width=\"482\"/></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; vertical-align:top\">\n<p><strong>Pulseless Electrical Activity</strong></p>\n<p style=\"text-align:center\"><img alt=\"ECG pattern seen in Pulseless Electrical Activity\" data-author=\"\" data-hash=\"8769\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"191\" src=\"https://image.prepladder.com/notes/UKNfnBH9k7h4zBglbM111744302756.png\" width=\"662\"/></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shockable Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate Recognition</strong></p>\n<p><strong>Identify Shockable Rhythm:</strong> Recognize VF or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> VT.</p>\n<p><strong>Activate Emergency Response: </strong>Call for advanced life support.</p>\n<p>↓</p>\n<p><strong>Initiate CPR</strong></p>\n<p><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue CPR for 2 minutes.</p>\n<p>↓</p>\n<p><strong>Defibrillation</strong></p>\n<p>After 2 minutes of CPR, deliver a Non-Synchronized DC Shock to restore normal rhythm.</p>\n<p>If no change, administer a second shock immediately.</p>\n<p>↓</p>\n<p><strong>Continue CPR</strong></p>\n<p>Resume CPR for 2 Minutes</p>\n<p>Place an <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> line for drug administration.</p>\n<p>↓</p>\n<p><strong>Administer Epinephrine</strong></p>\n<p>Epinephrine 1 mg (1:10,000): Given IV/IO after 2 minutes of CPR to enhance <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> pressure.</p>\n<p>↓</p>\n<p><strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p><strong>Secure Airway: </strong>Perform <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p><strong>Capnography:</strong> Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p><strong>Ventilation:</strong> Provide 1 breath every 6 seconds post-intubation.</p>\n<p>↓</p>\n<p><strong>Further Defibrillation</strong></p>\n<p><strong>Third Shock:</strong> If VF or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> VT persists, deliver a third non-synchronized shock.</p>\n<p>Continue CPR for 2 More Minutes: Follow with additional CPR.</p>\n<p>↓</p>\n<p><strong>Administer <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">Antiarrhythmic</span> Medication</strong></p>\n<p><strong>Amiodarone 300 mg IV: </strong>Administer for shock-refractory VT to stabilize heart rhythm.</p>\n<p>↓</p>\n<p><strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate Recognition</strong></p>\n<p><strong>Identify Non-Shockable Rhythm:</strong> Recognize <span class=\"customMeta\" data-dictid=\"91769de9d4169277718220e09c463f\">asystole</span> or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> (PEA).</p>\n<p><strong>Activate Emergency Response:</strong> Call for advanced life support.</p>\n<p>↓<br/>\n<strong>Initiate CPR</strong></p>\n<p><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue CPR for 2 minutes.</p>\n<p>↓<br/>\n<strong>Establish <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> line for medication administration.</strong></p>\n<p>↓<br/>\n<strong>Administer Epinephrine</strong></p>\n<p><strong>Epinephrine 1 mg (1:10,000):</strong> Administer IV/IO after the first 2 minutes of CPR.</p>\n<p>↓</p>\n<p><strong>Identify Rhythm</strong></p>\n<ul>\n<li><strong>Non-Shockable Rhythm: </strong>Continue CPR and administer <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> every 3-5 minutes.</li>\n</ul>\n<p><strong>Goal: </strong><strong>To increase the likelihood of developing a shockable rhythm, such as <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> (VF), which is necessary for effective defibrillation</strong><strong>.</strong></p>\n<ul>\n<li><strong>Shockable Rhythm:</strong> Administer a Non-Synchronized DC Shock to restore normal rhythm.</li>\n</ul>\n<p>↓<br/>\n<strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p><strong>Airway: </strong>Secure the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> with <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p><strong>Capnography: </strong>Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p><strong>Ventilation: </strong>Provide 1 breath every 6 seconds post-intubation for adequate oxygenation.</p>\n<p>↓<br/>\n<strong>Continue CPR</strong></p>\n<p>Resume chest compressions for 2 minutes.</p>\n<p>↓<br/>\n<strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n<p><strong>Primary Focus:</strong> Address <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes, especially hypothermia.</p>\n<p>↓<br/>\n<strong>Repeat CPR and Epinephrine</strong></p>\n<p><strong>Cycle: </strong>Continue repeating CPR and <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> administration every 3-5 minutes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is on mechanical ventilation. Which of the following statements is correct regarding the management of their ventilation parameters?", "options": [{"label": "A", "text": "A tidal volume of 10 mL/kg lean body weight is recommended for ARDS patients.", "correct": false}, {"label": "B", "text": "The respiratory rate should not be increased in cases of raised intracranial pressure.", "correct": false}, {"label": "C", "text": "FiO2 was initially set at 1.0 and then reduced to maintain adequate oxygenation.", "correct": true}, {"label": "D", "text": "PEEP typically ranges from 8 to 10 cm of H2O for optimal alveolar recruitment.", "correct": false}], "correct_answer": "C. FiO2 was initially set at 1.0 and then reduced to maintain adequate oxygenation.", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male patient with chronic obstructive pulmonary disease (COPD) is admitted to the hospital and placed on mechanical ventilation. His arterial blood gas analysis shows the following values: PaO2: 86 mmHg, PaCO2: 50 mmHg and pH: 7.32. Which of the following management strategies should be prioritized for this patient?", "options": [{"label": "A", "text": "Decrease the tidal volume to improve ventilation.", "correct": false}, {"label": "B", "text": "Increase the FiO2 immediately to avoid oxygen toxicity.", "correct": false}, {"label": "C", "text": "Increase PEEP to improve oxygenation and maintain lung recruitment.", "correct": false}, {"label": "D", "text": "Increase the respiratory rate to enhance CO2 removal and improve pH.", "correct": true}], "correct_answer": "D. Increase the respiratory rate to enhance CO2 removal and improve pH.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:750px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient C</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameters </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>pH: 7.4 (Normal)</p>\n<p>pO2: 60 (Deficient)</p>\n<p>pCO2: 40 (Normal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>pH: 7.2 (Acidosis)</p>\n<p>pO2: 100 (Normal)</p>\n<p>pCO2: 60 (Increased)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>pH: 7.44 (Alkalosis)</p>\n<p>pO2: 100 (Normal)</p>\n<p>pCO2: 30 (Decreased)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoxemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Respiratory Acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Respiratory Alkalosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↑ FiO2 to improve <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> <strong>(Option B)</strong></li>\n<li>But prolonged high FiO2 can lead to oxygen toxicity</li>\n<li>Therefore maintain target PaO2 with the lowest FiO2 required.</li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"9abcb9edc11692777195dac40cd470\">PEEP</span> to keep <span class=\"customMeta\" data-dictid=\"0dd428c12116927771819285c8849c\">alveoli</span> open. <strong>(Option C)</strong></li>\n<li>Optimal <span class=\"customMeta\" data-dictid=\"9abcb9edc11692777195dac40cd470\">PEEP</span> enhances gas exchange and reduces the risk of atelectasis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↑ <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> rate to remove CO2, thus <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> PaCO2. <strong>(Option D)</strong></li>\n<li>↑ Minute volume</li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">Tidal</span> volume (Vt) also enhances CO2 removal.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↓ <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> rate to allow CO2 accumulation in alveoli, thereby increasing PaCO2</li>\n<li>↓ <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">Tidal</span> volume (Vt) can ↑ PaCO2 levels, but with caution to ensure adequate ventilation. <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A post-surgery patient is placed on mechanical ventilation, and the medical team is deciding whether to continue using Assist-Control Ventilation (ACV) or switch to Synchronized Intermittent Mandatory Ventilation (SIMV) to support the weaning process. Which of the following statements about ACV and SIMV is incorrect?", "options": [{"label": "A", "text": "ACV provides both patient-triggered and time-triggered breaths for full support.", "correct": false}, {"label": "B", "text": "SIMV allows spontaneous breaths between mandatory breaths, aiding in weaning.", "correct": false}, {"label": "C", "text": "ACV reduces the work of breathing and helps manage respiratory acidosis/alkalosis.", "correct": false}, {"label": "D", "text": "SIMV cannot adjust automatically to maintain minute ventilation", "correct": true}], "correct_answer": "D. SIMV cannot adjust automatically to maintain minute ventilation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/k0UgiOd0fDvKgQLDD0Cs1745563990.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:776px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> Mode</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Assist-Control <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (ACV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synchronized <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">Intermittent</span> Mandatory <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (SIMV) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:132px\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:345px\">\n<ul>\n<li>The mechanical <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> is set at:\n\t\t\t\t<ul>\n<li>Tidal volume (VT): 500 ml</li>\n<li>Respiratory Rate: 12/minute</li>\n<li>FiO2: 40%</li>\n</ul>\n</li>\n<li>The most commonly used mode of <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">mechanical ventilation</span> in <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">intensive</span> care units.</li>\n<li>Key feature is that it provides a supported breath for both patient-triggered or time-triggered breaths. </li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:299px\">\n<ul>\n<li>Volume control <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> mode.</li>\n<li>Delivers a set number of mandatory breaths with a preset volume while allowing <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> breaths when <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> pressure drops below end-expiratory pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:132px\">\n<p><strong>Advantages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:345px\">\n<ul>\n<li>Increases patient comfort by <strong>allowing them to trigger breaths as needed.</strong></li>\n<li>Enables easy management of CO2 levels to correct <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis/alkalosis.</li>\n<li>Reduces the patient's work of breathing.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:299px\">\n<ul>\n<li>SIMV is used to help<strong> <span class=\"customMeta\" data-dictid=\"494480c78216927772020feec30822\">wean</span> patients from the ventilator.</strong></li>\n<li>Adjusts automatically to maintain minute ventilation.</li>\n<li>Allows normal alveolar ventilation, avoiding <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> by preserving the patient's <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> drive.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:132px\">\n<p><strong>Disadvantages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:345px\">\n<ul>\n<li>Volume-cycled <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> can lead to barotrauma, especially in stiff lungs; monitoring <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> pressures is crucial.</li>\n<li>Tachypnea or insufficient <span class=\"customMeta\" data-dictid=\"b8e1ca39d61692777187254f3cc140\">exhalation</span> time can cause breath <span class=\"customMeta\" data-dictid=\"30c017afe41692777199e7a8cd6bf9\">stacking</span> and auto-PEEP, increasing <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">intrathoracic</span> pressure and leading to hypotension; disconnecting the <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> briefly allows full exhalation.</li>\n<li>Hyperventilation may occur, causing <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> alkalosis; adequate <span class=\"customMeta\" data-dictid=\"b81cee1b5f16927771987099f651a0\">sedation</span> can prevent this.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:299px\">\n<ul>\n<li>There is a potential for <span class=\"customMeta\" data-dictid=\"ed738e11d216927771826229821cad\">asynchrony</span> between patient and ventilator, where a machine-driven inspiration may <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> with the patient's <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> exhalation.</li>\n<li>This can increase the work of breathing, potentially leading to <span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\">hypoventilation</span> or pneumothorax.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Image </strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Assist-Control &lt;span class=\" custommeta\"=\"\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\"/>Ventilation \" data-author=\"\" data-hash=\"8785\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"500\" src=\"https://image.prepladder.com/notes/NGxNyAxn8CL2otx42vF41744303656.png\" width=\"500\" /&gt;</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"SIMV\" data-author=\"\" data-hash=\"11255\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"500\" src=\"https://image.prepladder.com/notes/k0UgiOd0fDvKgQLDD0Cs1745563990.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient on mechanical ventilation is being monitored using ventilator waveforms. Based on the waveform interpretations, which of the following statements is correct?", "options": [{"label": "A", "text": "The upslope of the volume vs. time scalar represents the expiratory volume.", "correct": false}, {"label": "B", "text": "A negative value on the flow vs. time scalar represents expiratory flow.", "correct": true}, {"label": "C", "text": "PEEP is indicated by the peak inspiratory pressure on the pressure vs. time scalar.", "correct": false}, {"label": "D", "text": "The middle steep part of the pressure-volume curve indicates low lung compliance.", "correct": false}], "correct_answer": "B. A negative value on the flow vs. time scalar represents expiratory flow.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/dSo8gsrcHNatFSWpsP2T1744304168.png", "https://image.prepladder.com/notes/VzDqKuR6LVJEcDuYtsE01746518505.png", "https://image.prepladder.com/notes/Cff7chP4NyQZbjadrksr1746518614.png", "https://image.prepladder.com/notes/cS3cWKF8Zdd8OScUGLty1744304571.png", "https://image.prepladder.com/notes/sC77aUDG1B2AaJWIilEv1744304645.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:744px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Volume vs. Time Scalar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flow vs. Time Scalar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure vs. Time Scalar</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Graphically represents the amount of gas delivered into the lungs over time by the ventilator.</li>\n<li><strong>Upslope:</strong> Represents the inspiratory volume. <strong>(Option A)</strong></li>\n<li><strong>Downslope: </strong>Represents the <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> volume.</li>\n<li><strong>Use: </strong>Helps to identify air leaks, air trapping, and patient’s <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> breathing efforts and is useful for evaluating changes in <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume with adjustments in <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> settings.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Represents gas flow between the patient and the ventilator.</li>\n<li><strong>Inspiratory Flow: </strong>Positive value on the graph.</li>\n<li><strong>Expiratory Flow: </strong>Negative value on the graph. <strong>(Option B)</strong></li>\n<li><strong>The area under the curve: </strong>Indicates the volume moved during breathing phases.</li>\n<li><strong>Use: </strong>To identify the mode of ventilation. It provides information about the patient's exhalation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Displays pressure in the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> as a function of time, which can be fixed or variable depending on the mode of ventilation.</li>\n<li><strong>Baseline Pressure: </strong>Indicates PEEP (Positive End-Expiratory Pressure). <strong>(Option C)</strong></li>\n<li><strong>Peak Inspiratory Pressure (PIP): </strong>Maximum pressure at the end of the curve.</li>\n<li><strong>Plateau Pressure (Pplat): </strong>Represents <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> pressure under <span class=\"customMeta\" data-dictid=\"0e0dce452a1692777198212234f2f0\">static</span> conditions (no airflow), obtained during an inspiratory hold.</li>\n<li><strong>Use:</strong> Provides valuable information about <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> compliance over time.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:763px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure-Volume Curve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flow-Volume Curve </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shows pressure (cm water) along the x-axis and volume (mL) along the y-axis.</li>\n<li>Inspiratory curve forms a sigmoidal shape:\n\t\t\t\t<ul>\n<li><strong>Initial Flat Part: </strong>Represents air movement into collapsed airways with low compliance.</li>\n<li><strong>Middle Steep Part:</strong> Indicates lung recruitment. <strong>(Option D)</strong></li>\n<li><strong>Flattening at End:</strong> Represents the end of inspiration.</li>\n</ul>\n</li>\n<li><strong>Hysteresis</strong>: Failure of the lung tissue to act the same with inspiration and expiration.</li>\n<li><strong>Expiratory curve </strong>resembles a football shape.\n\t\t\t\t<ul>\n<li><strong>Flatter Slope</strong>: Indicates decreased lung compliance.</li>\n<li><strong>Steeper Slope</strong>: Indicates increased lung compliance.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It shows volume (mL) on the x-axis and flow rate (L/min) on the y-axis.</li>\n<li><strong>Inspiratory Limb</strong>: Flow reaches <span class=\"customMeta\" data-dictid=\"116e588c7b1692777202c7f3040428\">zero</span> at the end of inspiration.</li>\n<li><strong>Expiratory Limb</strong>: Curve completes when both volume and flow return to zero, indicating the end of expiration.</li>\n<li><strong>Obstructive patterns</strong>: Show a “scooped out” appearance on the <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> limb, with <span class=\"customMeta\" data-dictid=\"5725f054721692777184f74b5fa780\">concavity</span> indicating lower flow at a given volume.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with acute respiratory distress syndrome (ARDS) is on mechanical ventilation. His healthcare team is evaluating the best ventilation mode to optimize his care. Which of the following statements regarding Pressure Control Ventilation (PCV) and Pressure Support Ventilation (PSV) is correct, particularly if the patient’s respiratory effort is minimal?", "options": [{"label": "A", "text": "PCV guarantees a specific tidal volume regardless of lung compliance.", "correct": false}, {"label": "B", "text": "In PSV, tidal volume is guaranteed and does not depend on the patient's effort.", "correct": false}, {"label": "C", "text": "PCV limits peak airway pressures, beneficial for patients at high risk of barotrauma.", "correct": true}, {"label": "D", "text": "PSV is used for heavily sedated patients with no spontaneous breathing efforts.", "correct": false}], "correct_answer": "C. PCV limits peak airway pressures, beneficial for patients at high risk of barotrauma.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ovNgilWo1iITRpmDJ7xp1744304819.png", "https://image.prepladder.com/notes/1f8JAr6oe9urF855vvDz1744304907.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure Control <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (PCV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pressure Support <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (PSV)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tidal volume in <span class=\"customMeta\" data-dictid=\"fc17bf3e0b169277719482b6add142\">PCV</span> varies depending on lung compliance. <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PSV is entirely patient-triggered and controlled.</li>\n<li>Tidal volume is not guaranteed in PSV and depends on lung compliance and the patient’s ability to sustain an inspiratory effort. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PCV is useful for limiting peak <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> and lung distending (plateau) pressures.</li>\n<li>It is often used in conditions where high pressures could cause harm, such as<strong> ARDS</strong> or after <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> surgery. <strong>(Option C)</strong></li>\n<li>Limit <span class=\"customMeta\" data-dictid=\"5b92d758801692777182d17f9d55bc\">barotrauma</span> if the patient's <strong>respiratory effort is minimal.</strong></li>\n<li>Inspiratory flow rate can vary with patient effort (improved comfort/synchrony)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patient effort is preserved and controls <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume, inspiratory flow and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate, allowing for <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> synchrony.</li>\n<li>Commonly used in patients who are<strong> less sedated</strong> and able to participate in breathing, often during weaning from <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">mechanical ventilation</span> or when the <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> is used mainly for <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> support. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PCV does not assure a specific <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume, so <strong>tidal volume and minute ventilation</strong> need to be monitored.</li>\n<li>Spontaneously breathing patients on <span class=\"customMeta\" data-dictid=\"fc17bf3e0b169277719482b6add142\">PCV</span> can generate <span class=\"customMeta\" data-dictid=\"befa0a72121692777193663f2ca836\">negative pressure</span> in the circuit, leading to increased inspiratory flow rates and <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volumes, which raises transalveolar pressure and heightens the risk of volume or barotrauma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Apnea and <span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\">hypoventilation</span> are possible</li>\n<li>Must monitor <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate, <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume and <span class=\"customMeta\" data-dictid=\"48780228371692777192344586b3b3\">minute ventilation</span> closely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Images</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Pressure Control Ventilation\" data-author=\"\" data-hash=\"8799\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ovNgilWo1iITRpmDJ7xp1744304819.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Pressure Support Ventilation\" data-author=\"\" data-hash=\"8801\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1f8JAr6oe9urF855vvDz1744304907.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with congestive heart failure presents with acute shortness of breath, orthopnea, and bilateral pulmonary crackles. ABG reveals hypoxemia. Which of the following interventions will improve both oxygenation and reduce preload and afterload in this patient?", "options": [{"label": "A", "text": "High-flow nasal oxygen", "correct": false}, {"label": "B", "text": "Continuous Positive Airway Pressure (CPAP)", "correct": true}, {"label": "C", "text": "Non-rebreather mask", "correct": false}, {"label": "D", "text": "Intubation", "correct": false}], "correct_answer": "B. Continuous Positive Airway Pressure (CPAP)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/EubYmlLTJr2dSvFhZc541744305188.png", "https://image.prepladder.com/notes/n6wxjtwuKwJgOdO3P5GO1744305260.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Continuous positive <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> pressure (</strong><strong>CPAP)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Continuous positive &lt;span class=\" custommeta\"=\"\" data-dictid=\"3b9dd3166f1692777180b697887ccb\"/>airway pressure (cpap) machine\" data-author=\"PruebasBMA\" data-hash=\"8802\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Continuous_positive_airway_pressure#/media/File:CPAP.png\" data-tags=\"April2025\" height=\"329\" src=\"https://image.prepladder.com/notes/POVEhT07doVMwVEHZzFq1744305015.png\" width=\"393\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>CPAP delivers constant <strong>positive pressure</strong> to the airways <strong>throughout the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> cycle</strong> (inspiration and expiration).</p>\n<p>It helps maintain <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> patency, improve oxygenation, reduce atelectasis, and enhance ventilation-perfusion (V/Q) matching.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Obstructive Sleep <span class=\"customMeta\" data-dictid=\"22b9ee5b2b16927771814b5d8d34ac\">Apnea</span> (OSA)</strong>: Maintains <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> in patients with conditions like obesity, hypotonia, and <span class=\"customMeta\" data-dictid=\"991529649a169277718010fa83cbbc\">adenotonsillar</span> hypertrophy.</li>\n<li><strong>Neonatal <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Distress</strong>: Used in NICU for <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">preterm</span> infants with underdeveloped lungs and <span class=\"customMeta\" data-dictid=\"e42f69176a1692777199d38657a9c3\">surfactant</span> deficiency.</li>\n<li><strong>Infant <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Conditions</strong>: Treats hypoxia, bronchiolitis, pneumonia, and <span class=\"customMeta\" data-dictid=\"7236ea594e16927772005ce989aebe\">tracheomalacia</span> by reducing the work of breathing.</li>\n<li><strong>Hypoxic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure</strong>: Improves <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output in <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> patients, promoting better V/Q matching.</li>\n<li><strong>Pre-Intubation Support</strong>: Provides <span class=\"customMeta\" data-dictid=\"f934e237e81692777196cb5efd18f0\">positive end-expiratory pressure</span> (PEEP) to enhance <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> before intubation.</li>\n<li><strong>Extubation Support</strong>: Helps extubated patients (e.g., those with <span class=\"customMeta\" data-dictid=\"1c7fb88b45169277719464b58ed4c5\">OSA</span> or heart failure) who still benefit from positive pressure.</li>\n<li><strong>Heart Failure</strong>: Reduces the need for <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <strong>cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema</strong> by decreasing <span class=\"customMeta\" data-dictid=\"628ed9c26316927771964889249b3b\">preload</span> and afterload.<strong> (Option C)</strong></li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Diseases (COPD and Asthma)</strong>: <span class=\"customMeta\" data-dictid=\"d7b3c2abeb169277718339f549aad0\">BiPAP</span> reduces the work of breathing, improves gas exchange, and prevents <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure progression.</li>\n<li><strong>Acute <span class=\"customMeta\" data-dictid=\"ce5a7a84ff16927771830347fbbbff\">Bronchitis</span> and Pneumonia</strong>: Improves <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> and reduces breathing effort, especially in patients with chronic lung disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is not recommended for patients with poor <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> drive, severe anxiety, unstable <span class=\"customMeta\" data-dictid=\"1b798ee2c21692777183440eb9102c\">cardiorespiratory</span> status, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> trauma, copious secretions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Equipment and Techniques</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CPAP machines consist of a motor, air filter, tubing, and mask <span class=\"customMeta\" data-dictid=\"ec503a687b16927771908fbd6d884c\">interface</span> (nasal, nasopharyngeal, or full-face mask). </li>\n<li>Special <span class=\"customMeta\" data-dictid=\"ae6c057fde1692777185b85f0eca18\">CPAP</span> systems like bubble <span class=\"customMeta\" data-dictid=\"ae6c057fde1692777185b85f0eca18\">CPAP</span> are used for neonates. </li>\n<li>Humidifiers and auto-titrating machines improve patient comfort and therapy effectiveness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common side effects include <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> congestion, dry mouth, bloating, and mask discomfort. </li>\n<li>Compliance is a major issue, and patient monitoring is crucial to adjust settings and address discomfort.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male with a history of COPD presents with increasing dyspnea, productive cough, and confusion. Arterial blood gas (ABG) shows pH 7.30, pCO₂ 58 mmHg, and pO₂ 55 mmHg. He is hemodynamically stable. What is the next best step in management?", "options": [{"label": "A", "text": "Immediate endotracheal intubation", "correct": false}, {"label": "B", "text": "Noninvasive positive-pressure ventilation (NIV)", "correct": true}, {"label": "C", "text": "Intravenous antibiotics only", "correct": false}, {"label": "D", "text": "High-flow nasal cannula oxygen therapy", "correct": false}], "correct_answer": "B. Noninvasive positive-pressure ventilation (NIV)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Noninvasive Positive-Pressure <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV)</strong></h3>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NIV refers to positive-pressure <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> delivered through a <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> or full-face mask, either at a continuous pressure (CPAP) or with varying inspiratory and <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> pressures (BiPAP).</p>\n<p><strong>Modes:</strong><br/>\n\t\t\tModern noninvasive ventilators can provide full support, including volume control ventilation.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure:</strong> This treatment is effective for conditions that respond quickly to treatment, reducing the need for prolonged mechanical ventilation.</li>\n<li><strong>COPD exacerbations:</strong> <span class=\"customMeta\" data-dictid=\"0e4135f3bc1692777193047657d8c5\">NIV</span> benefits moderate <span class=\"customMeta\" data-dictid=\"56e9e8596a16927771895aaa2e49e0\">hypercarbia</span> <strong>(pH 7.25-7.35),</strong> reducing the need for <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> and hospital stay. Severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> (pH &lt; 7.2) may require <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">mechanical ventilation</span> with intubation. <strong>(Option B)</strong></li>\n<li><strong>Cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema:</strong> Acts as adjunctive therapy, improving gas exchange and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"00c0f6c5371692777192d9df3f64b2\">mechanics</span> alongside <span class=\"customMeta\" data-dictid=\"09562877f516927771865e4cf1fd7e\">diuresis</span> and vasodilators.</li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure:</strong> This is useful in restrictive lung diseases (e.g., severe scoliosis, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> muscle weakness) and chronic <span class=\"customMeta\" data-dictid=\"1f0bd058f91692777189f9a7c1992e\">hypercapnia</span> in COPD, reducing hospital admissions when used nocturnally.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Advantages </strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces work of breathing</li>\n<li>Improves <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> compliance</li>\n<li>Recruits collapsed (atelectatic) alveoli</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires less <span class=\"customMeta\" data-dictid=\"b81cee1b5f16927771987099f651a0\">sedation</span> compared to <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> ventilation</li>\n<li>Shortens hospital stay</li>\n<li>Lowers <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> rates without the risks of <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> intubation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inability to protect the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> (e.g., severe encephalopathy)</li>\n<li>High <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> risk (e.g., vomiting, upper GI bleeding)</li>\n<li>Difficulty clearing <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> secretions</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Facial trauma/surgery</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> instability</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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The resuscitation team decides to use double external defibrillation. What is the correct placement for the first defibrillator, and how should the second be positioned?", "options": [{"label": "A", "text": "A) Left sternal border and left axilla; close to the first.", "correct": false}, {"label": "B", "text": "B) Right sternal border and cardiac apex; antero-posterior position.", "correct": true}, {"label": "C", "text": "C) Both pads on the same side; on the abdomen for the second.", "correct": false}, {"label": "D", "text": "D) Anteriorly on the chest; also anterior for the second with no specific placement.", "correct": false}], "correct_answer": "B. B) Right sternal border and cardiac apex; antero-posterior position.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male mountaineer plans a rapid ascent to an altitude of 4500 meters for a climbing expedition. He has a history of experiencing symptoms like fatigue, non-productive cough, and difficulty breathing during previous high-altitude trips. Based on the scenario, which of the following strategies should the mountaineer implement to effectively prevent symptoms, and what is the main treatment he should consider if symptoms develop?", "options": [{"label": "A", "text": "Maintain an average altitude gain exceeding 300 m per day, and begin immediate treatment with acetazolamide.", "correct": false}, {"label": "B", "text": "Ascend rapidly without acclimatization, and use supplemental oxygen if symptoms develop.", "correct": false}, {"label": "C", "text": "Ascend slowly with a maximum altitude gain of 300 m per day, and prioritize descent of 1000 meters if symptoms occur.", "correct": true}, {"label": "D", "text": "Use alcohol to relax during the ascent, and rely solely on portable hyperbaric chambers if symptoms arise.", "correct": false}], "correct_answer": "C. Ascend slowly with a maximum altitude gain of 300 m per day, and prioritize descent of 1000 meters if symptoms occur.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High altitude <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slow ascent is the most effective method of prevention, even for <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> individuals.</li>\n<li>Graded ascent and adequate time for acclimatization.</li>\n<li>Low sleeping altitudes.</li>\n<li>Avoidance of alcohol and sleeping pills.</li>\n<li>Avoidance of vigorous exercise, especially during the first days at altitude.</li>\n<li>Nifedipine, a <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blocker, can prevent <span class=\"customMeta\" data-dictid=\"95f872b7231692777188a3bf72e2bc\">HAPE</span> in individuals with a history of the condition. The recommended <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> is 60 mg daily of a slow-release formulation, starting during ascent and continuing until the third or fourth day after arrival at the final altitude or after <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> below 3000 m.</li>\n<li>Preliminary data suggest glucocorticoids may prevent <span class=\"customMeta\" data-dictid=\"95f872b7231692777188a3bf72e2bc\">HAPE</span> when taken one day prior to ascent and continued during ascent at high altitude.</li>\n<li>Susceptible individuals should maintain an average altitude gain not exceeding 300 m per day above 2500 m.</li>\n<li>If progressive <span class=\"customMeta\" data-dictid=\"4ceeb0cef2169277718080f29afe8d\">acclimatization</span> is not possible, <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> with <span class=\"customMeta\" data-dictid=\"7c0ddaeead1692777193d6ef9ffbf0\">nifedipine</span> or <span class=\"customMeta\" data-dictid=\"b17474135a1692777200c9c1d78997\">tadalafil</span> is recommended for long stays at high altitude, and <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> for short stays of less than 5 days.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The mainstay of treatment is to descend 1000 meters or until symptoms resolve.</li>\n<li>Minimize exertion during <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> to reduce <span class=\"customMeta\" data-dictid=\"9f81027f0116927771892823259e5d\">hypoxemia</span> and worsening condition.</li>\n<li>Oxygen therapy may help alleviate symptoms if <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> is delayed or difficult.</li>\n<li>Main treatment remains descent, regardless of oxygen availability.</li>\n<li>Supplemental oxygen via high-flow <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> and facemask should be titrated to SpO2 greater than 90%.</li>\n<li>Portable <span class=\"customMeta\" data-dictid=\"1b1cc7f2861692777189c9bd7d9b81\">hyperbaric</span> chambers can be used if <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> is not possible but require constant care.</li>\n<li>Hyperbaric chambers may be challenging for individuals with nausea, vomiting, claustrophobia, or altered mental status from AMS/HACE.</li>\n<li>There is a risk of symptom <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> after exiting the <span class=\"customMeta\" data-dictid=\"1b1cc7f2861692777189c9bd7d9b81\">hyperbaric</span> chamber.</li>\n<li>Nifedipine can improve symptoms as an <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> therapy by reducing <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vasoconstriction.</li>\n<li>Nifedipine should not be the sole therapy if <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> or oxygen is an option.</li>\n<li>Phosphodiesterase inhibitors may help decrease <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> and <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> pressure through <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> if <span class=\"customMeta\" data-dictid=\"7c0ddaeead1692777193d6ef9ffbf0\">nifedipine</span> is unavailable.</li>\n<li>There is no clinically proven role for acetazolamide, β-agonists, or diuretics in the treatment of HAPE.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male skier is found unresponsive in the snow with a core body temperature of 27°C (81°F). He exhibits severe hypothermia and requires immediate medical attention. Which of the following is NOT a treatment approach for managing his hypothermia?", "options": [{"label": "A", "text": "A) Administer warm intravenous fluids at 40-42°C.", "correct": false}, {"label": "B", "text": "B) Utilize ECMO (extracorporeal membrane oxygenation) to provide rewarming and circulatory support.", "correct": false}, {"label": "C", "text": "C) Use passive external rewarming by layering him with wet clothing.", "correct": true}, {"label": "D", "text": "D) Perform active internal rewarming using warm saline lavage of body cavities.", "correct": false}], "correct_answer": "C. C) Use passive external rewarming by layering him with wet clothing.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male fisherman is rescued after being exposed to cold water for several hours. Upon examination, his core body temperature is 29°C (84°F). He shows signs of lethargy, dilated pupils, and a slow heart rate. Which of the following statements about his condition is false?", "options": [{"label": "A", "text": "Mild hypothermia typically presents with symptoms like shivering and increased muscle tone.", "correct": false}, {"label": "B", "text": "In moderate hypothermia shivering generally stops as the body temperature approaches 30°C.", "correct": false}, {"label": "C", "text": "Severe hypothermia can lead to unresponsiveness and increased risk of cardiac dysrhythmias.", "correct": false}, {"label": "D", "text": "Osborn waves are typically absent in hypothermic patients with temperatures below 28°C.", "correct": true}], "correct_answer": "D. Osborn waves are typically absent in hypothermic patients with temperatures below 28°C.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/T85hCzwWhwqijzk2QXzT1744278031.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypothermia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypothermia is defined as a drop in core <span class=\"customMeta\" data-dictid=\"4a7581c8b01692777183819f38c633\">body temperature</span> below 35°C, resulting in the failure to maintain <span class=\"customMeta\" data-dictid=\"50796581771692777189251fbe5ef1\">homeostasis</span> and affecting all organ systems.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Primary Hypothermia</strong>: Caused by environmental cold exposure, such as cold air or water. Common in cold <span class=\"customMeta\" data-dictid=\"64f5c141d51692777188eb378afc37\">geographic</span> areas but can also occur in mild climates.</li>\n<li><strong>Secondary Hypothermia</strong>: Results from conditions that impair heat production or increase heat loss (e.g., trauma, burns, drug overdoses, <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> disorders, CNS injury, or drug effects).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild Hypothermia</strong> (32-35°C / 90-95°F)</p>\n<p><strong>(Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: Hunger, nausea, fatigue, shivering, pale/dry skin, increased muscle tone, blood pressure, heart rate, and respiration.</li>\n<li>Neurologic symptoms: Cognitive decline, memory impairment, ataxia, dysarthria.</li>\n<li>Shivering may stop if energy stores are depleted (e.g., malnutrition).</li>\n<li>Cold-induced <span class=\"customMeta\" data-dictid=\"09562877f516927771865e4cf1fd7e\">diuresis</span> due to <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> vasoconstriction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate Hypothermia</strong> (28-32°C / 82-90°F)</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cognitive decline, lethargy, CNS depression (hyporeflexia, dilated pupils).</li>\n<li>Shivering stops at 30-32°C.</li>\n<li>Paradoxical undressing may occur.</li>\n<li>Increased risk of atrial fibrillation, hypotension, bradycardia, bradypnea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe Hypothermia</strong> (&lt;28°C / &lt;82°F)</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unresponsiveness, further decline in cerebral blood flow, hypotension, bradycardia, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n<li>Risk of atrial, junctional dysrhythmias.</li>\n<li>Pulmonary congestion, oliguria, and areflexia.</li>\n<li>Potential for <span class=\"customMeta\" data-dictid=\"1b798ee2c21692777183440eb9102c\">cardiorespiratory</span> failure and death.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Findings</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Atrial Fibrillation</strong>: Most common <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> in <span class=\"customMeta\" data-dictid=\"8697d3db6716927771892e1805ab8f\">hypothermic</span> patients.</li>\n<li><strong>Bradycardia</strong>: Seen in moderate to severe hypothermia, increasing the risk of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> arrhythmias.</li>\n<li><strong>QT Interval Prolongation</strong>: Due to slowed impulse <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> through <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> channels.</li>\n<li><strong>Osborn (J) Waves</strong>: Elevated J point, visible on ECG in the precordial leads, with wave height proportional to the degree of hypothermia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male hiker ascends rapidly from sea level to an altitude of 4500 meters over 24 hours. Two days after his arrival, he begins to experience increasing fatigue, a non-productive cough, and difficulty breathing during physical activity. His oxygen saturation is 60% on examination, and he exhibits tachypnea and cyanosis. Based on the scenario, which factors do not contribute to the patient's clinical features?", "options": [{"label": "A", "text": "Low hypoxic ventilatory response (HVR)", "correct": false}, {"label": "B", "text": "Use of sleep medications during ascent", "correct": false}, {"label": "C", "text": "Recent heavy physical exertion prior to ascent", "correct": false}, {"label": "D", "text": "Extended acclimatization period before ascent", "correct": true}], "correct_answer": "D. Extended acclimatization period before ascent", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>High altitude <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HAPE is a severe, high-altitude illness, potentially fatal.</li>\n<li>It is noncardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> caused by hypoxia.</li>\n<li>It occurs above 2500 meters, and can start as low as 2000 meters.</li>\n<li>Risk factors: low hypoxic <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> response (HVR), rapid ascent, male sex, sleep medications, high salt intake, cold temperatures, and heavy exertion.</li>\n<li>Pre-existing conditions (e.g., <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension) increase risk.</li>\n<li>Faster ascent correlates with higher incidence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HAPE results from the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vasculature's response to hypoxia.</li>\n<li>Hypoxic <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> response (HVR) varies among individuals and has a genetic component.</li>\n<li>High altitude adaptations include changes in resting ventilation, HVR, oxygen saturation, and <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> concentration.</li>\n<li>Rapid ascent to altitude causes immediate increases in <span class=\"customMeta\" data-dictid=\"48780228371692777192344586b3b3\">minute ventilation</span> and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> alkalosis.</li>\n<li>Shifts in the oxygen-dissociation curve occur, initially increasing oxygen affinity, followed by a decrease as 2,3-DPG levels rise.</li>\n<li>Blunted HVR (due to genetic factors or sedatives) leads to exaggerated hypoxemic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"3f0b42b17016927772014c586d44b7\">vasoconstriction</span> (HPV).</li>\n<li>HPV increases <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> to affected alveoli, raising <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> pressures and permeability, leading to non-uniform <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> further impedes <span class=\"customMeta\" data-dictid=\"d27c5d96b416927771941e7efc4010\">oxygen transport</span> and exacerbates <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HAPE typically manifests 2 to 5 days after arriving at high altitude.</li>\n<li>Initial symptoms include non-productive cough, decreased exercise tolerance, chest pain, and exertional dyspnea.</li>\n<li>Progression can lead to <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> at rest, productive <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> with pink frothy sputum, rales, and cyanosis.</li>\n<li>Patients may exhibit <span class=\"customMeta\" data-dictid=\"28f03e93ee1692777200dd8ea97b29\">tachypnea</span> and tachycardia.</li>\n<li>SpO2 levels are often significantly lower than expected for altitude, with values typically ranging from 40% to 70%.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman, 36 weeks pregnant, is brought to the emergency department after collapsing at home. Upon arrival, she is unresponsive and in cardiac arrest. CPR is initiated immediately. The team begins advanced cardiac life support for pregnancy. Which of the following is the most appropriate next step to optimize maternal and fetal outcomes?", "options": [{"label": "A", "text": "Delay chest compressions to position the patient for cesarean section.", "correct": false}, {"label": "B", "text": "Place the patient in a left lateral decubitus position and perform left uterine displacement.", "correct": true}, {"label": "C", "text": "Administer 2 mg epinephrine IV every 5 minutes.", "correct": false}, {"label": "D", "text": "Delay defibrillation to avoid harm to the fetus.", "correct": false}], "correct_answer": "B. Place the patient in a left lateral decubitus position and perform left uterine displacement.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mnemonic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Anesthetic Complications (Aspiration, High neuraxial block, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> depression)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Accidents/ Trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bleeding (Uterine atony, <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">Placenta</span> accreta, Abruption, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> rupture)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Cardiovascular Causes (MI, Cardiomyopathy, <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> disease, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> heart disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Drug-Related Issues (Oxytocin, Opioids, Illicit drugs, Anaphylaxis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>E</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Embolic Causes (Amniotic fluid, Pulmonary, <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> air embolism)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>F</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Fever (Sepsis, Infection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>G</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>General Issues - H’s and T’s (causes of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>H</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hypertension (Preeclampsia, Eclampsia, HELLP syndrome)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old man was found unconscious at home and resuscitated after a cardiac arrest. He achieved Return of Spontaneous Circulation (ROSC) and was admitted to the ICU. By Day 3 (49-72 hours post-ROSC), the patient has been rewarmed, and sedation is being weaned off. Which of the following is an appropriate neuro-prognostic assessment to perform at this stage if the clinical condition allows it?", "options": [{"label": "A", "text": "Perform a routine EEG to assess for seizure activity", "correct": false}, {"label": "B", "text": "Perform somatosensory evoked potentials (SSEP)", "correct": true}, {"label": "C", "text": "Initiate Targeted Temperature Management (TTM)", "correct": false}, {"label": "D", "text": "Perform a neurological exam with a focus on pupillary and motor responses", "correct": false}], "correct_answer": "B. Perform somatosensory evoked potentials (SSEP)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9EaJADW4fZvHhAUvmZBC1744278002.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man experiences a sudden cardiac arrest while jogging in a park. A bystander witnesses the collapse. According to the Adult OHCA Chain of Survival, what is the correct sequence of actions performed by the emergency responders in this scenario?", "options": [{"label": "A", "text": "Early recognition and Prevention → Activation of Emergency Response → Defibrillation → High-Quality CPR → Recovery→ Post-Cardiac Arrest Care", "correct": false}, {"label": "B", "text": "Activation of Emergency Response → High-Quality CPR → Defibrillation → Advanced Resuscitation → Post-Cardiac Arrest Care → Recovery", "correct": true}, {"label": "C", "text": "High-Quality CPR → Activation of Emergency Response → Advanced Resuscitation → Defibrillation → Post-Cardiac Arrest Care → Recovery", "correct": false}, {"label": "D", "text": "High-Quality CPR → Activation of Emergency Response → Defibrillation → Advanced Resuscitation → Post-Cardiac Arrest Care → Recovery", "correct": false}], "correct_answer": "B. Activation of Emergency Response → High-Quality CPR → Defibrillation → Advanced Resuscitation → Post-Cardiac Arrest Care → Recovery", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CWT7N3KnWYCA0sKE5yDb1744278054.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child is found unresponsive at home. The parents initiate CPR, and the child is transported to the emergency department. Upon arrival, the medical team begins CPR and attaches a monitor/defibrillator. The rhythm check shows asystole. What is the next step in managing this child according to the Pediatric Cardiac Arrest Algorithm?", "options": [{"label": "A", "text": "Deliver a shock immediately", "correct": false}, {"label": "B", "text": "Administer Amiodarone IV/IO", "correct": false}, {"label": "C", "text": "Administer Epinephrine and continue CPR", "correct": true}, {"label": "D", "text": "Administer Lidocaine IV/IO", "correct": false}], "correct_answer": "C. Administer Epinephrine and continue CPR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about massive transfusion management are correct? A) PRBC should be administered first to address hypoxia and acidosis. B) Blood components should be transfused in a 1:1:1 ratio of PRBC: FFP: PRP, beginning with PRBC. C) Blood products should be warmed during transfusion to prevent hypothermia-induced coagulopathy. D) Platelets should be administered first to prevent coagulopathy. E) Components are stored at different temperatures: PRBC at 4°C, FFP at -30°C (thawed before use), and platelets at room temperature (20-24°C).", "options": [{"label": "A", "text": "A, B, and C only", "correct": false}, {"label": "B", "text": "A, B, C, and E only", "correct": true}, {"label": "C", "text": "B, C, and D only", "correct": false}, {"label": "D", "text": "B,C D, and E only", "correct": false}], "correct_answer": "B. A, B, C, and E only", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old farmer is brought to the emergency department 2 hours after being bitten by a snake on his left ankle. He presents with severe swelling of the left leg, gingival bleeding, and incoagulable blood on the 20-minute whole blood clotting time test. You decide to administer polyvalent antivenom serum (ASV). Twenty minutes after starting the ASV infusion, the patient develops urticaria, cough, and abdominal pain. His blood pressure drops to 85/50 mmHg. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Discontinue ASV infusion permanently", "correct": false}, {"label": "B", "text": "Continue ASV infusion and administer corticosteroids", "correct": false}, {"label": "C", "text": "Stop ASV infusion temporarily and treat with epinephrine", "correct": true}, {"label": "D", "text": "Administer heparin to counteract coagulopathy", "correct": false}], "correct_answer": "C. Stop ASV infusion temporarily and treat with epinephrine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Early (Anaphylactic) Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>10-180 minutes after starting ASV</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Itching, urticaria</p>\n<p>- Nausea, vomiting</p>\n<p>- Cough, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> colic</p>\n<p>- Fever, tachycardia</p>\n<p>- Hypotension</p>\n<p>- Bronchospasm</p>\n<p>- Angioedema</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>1. Stop ASV <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> immediately</p>\n<p>2. Administer <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> (adrenaline) IM or SC</p>\n<p>3. Give antihistamines and corticosteroids</p>\n<p>4. Treat shock if present</p>\n<p>5. Resume ASV at a slower rate after symptoms subside</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Pyrogenic Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>1-2 hours after treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Fever</p>\n<p>- Rigors</p>\n<p>- Hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">Symptomatic</span> treatment</p>\n<p>- Antipyretics</p>\n<p>- IV fluids if needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Late (Serum Sickness) Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>5-24 days (mean 7 days) after ASV</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Fever</p>\n<p>- Itching</p>\n<p>- Urticaria</p>\n<p>- Arthralgia</p>\n<p>- Lymphadenopathy</p>\n<p>- Proteinuria</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Antihistamines</p>\n<p>- Corticosteroids (e.g., prednisolone) for 5-7 days</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old farmer is brought to the emergency department 30 minutes after being bitten by a snake on his right leg. He presents with severe pain and swelling at the bite site, and examination reveals two puncture wounds. His blood pressure is 90/60 mmHg, and he has gingival bleeding. The 20-minute whole blood clotting time test shows that the blood is incoagulable. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Administer 50 ml of polyvalent antivenom", "correct": false}, {"label": "B", "text": "Administer 150-200 ml of polyvalent antivenom", "correct": true}, {"label": "C", "text": "Apply a tight tourniquet above the bite site", "correct": false}, {"label": "D", "text": "Administer heparin to manage coagulopathy", "correct": false}], "correct_answer": "B. Administer 150-200 ml of polyvalent antivenom", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Indications/Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>First Aid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>-Do not allow the victim to walk (Carry)</p>\n<p>-Avoid tourniquets, except in specific cases(No)</p>\n<p>- Reassure patient</p>\n<p>- <span class=\"customMeta\" data-dictid=\"87bf05a56616927771893b9550e8ad\">Immobilize</span> bitten limb</p>\n<p>- Transport to the hospital quickly</p>\n<p>- Tell the doctor about any <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Tourniquets only for severe elapid/sea snake bites with &gt;0.5h but &lt;2-3h transport time</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Check for signs of envenomation</p>\n<p>- Monitor vital signs</p>\n<p>- Perform 20-minute <span class=\"customMeta\" data-dictid=\"60d609888b169277720258496ef45a\">whole blood</span> <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> time</p>\n<p>- Check <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> profile, CPK, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Incoagulable blood indicates <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"3e641db3d416927771871043236d4b\">envenomation</span> by Viperidae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Antivenom Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- <strong>Mild: </strong>50 ml</p>\n<p>- <strong>Moderate: </strong>50-100 ml</p>\n<p>- <strong>Severe:</strong> 150-200 ml</p>\n<p>Effective against the 4 most important <span class=\"customMeta\" data-dictid=\"6ab7a16d751692777201645703100e\">venomous</span> snakes in India, namely, Cobra, Common Krait, Russell's <span class=\"customMeta\" data-dictid=\"efbb05601b1692777202641ca3e610\">viper</span> and saw-scaled viper.</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Indications:</strong></p>\n<p>- Haemostatic abnormalities</p>\n<p>- Neurotoxicity</p>\n<p>- <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">Cardiovascular</span> dysfunction</p>\n<p>- Impaired consciousness</p>\n<p>- Rhabdomyolysis</p>\n<p>- Extensive local swelling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Antivenom Administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"e63a499e5716927771860681cef17d\">Dilute</span> in 5 ml/kg body weight of <span class=\"customMeta\" data-dictid=\"28f696d61216927771904dbe51b33b\">isotonic</span> saline/5% Dextrose</p>\n<p>- Infuse over 1-2 hours</p>\n<p>- Monitor for <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reactions</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Repeat if severe signs persist after 1-2 hours or if <span class=\"customMeta\" data-dictid=\"254d99e23d1692777184c9e13d0b18\">coagulability</span> is not restored within 6 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Supportive Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"64dfe4fca51692777200a7ffbc44bb\">Tetanus</span> prophylaxis</p>\n<p>- Antibiotics (if severe local reaction)</p>\n<p>- Manage <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> paralysis</p>\n<p>- Fresh frozen plasma/cryoprecipitates for severe bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Avoid heparin, corticosteroids, and EDTA.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old farmer is brought to the emergency department after being bitten by a snake while working in his field in rural India. He presents with severe local pain, swelling, and gum bleeding. Within 2 hours, he develops diplopia, dysphagia, and progressive weakness in his limbs. Laboratory tests show prolonged prothrombin time and decreased fibrinogen levels. Which of the following snakes is most likely responsible for this envenomation?", "options": [{"label": "A", "text": "Cobra", "correct": false}, {"label": "B", "text": "Russell's viper", "correct": true}, {"label": "C", "text": "Saw-scaled viper", "correct": false}, {"label": "D", "text": "Krait", "correct": false}], "correct_answer": "B. Russell's viper", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/namPT4weS8gxCQKcOC4U1744276617.png", "https://image.prepladder.com/notes/gtYy5jkrJWT65YarQMq91744276648.png", "https://image.prepladder.com/notes/L5DhRtNZb5mMnqz59A2x1744276894.png", "https://image.prepladder.com/notes/wC2hFdI5IwgoDAWZM7kX1744276922.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:1000px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cobra </strong></p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Krait </strong></p>\n<p style=\"text-align:center\"><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Russell's <span class=\"customMeta\" data-dictid=\"efbb05601b1692777202641ca3e610\">Viper</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Saw-scaled <span class=\"customMeta\" data-dictid=\"efbb05601b1692777202641ca3e610\">Viper</span> </strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><strong>Image</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Cobra\" data-author=\"Hari Prasad\" data-hash=\"8410\" data-license=\"CC BY SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:King-Cobra.jpg\" data-tags=\"April2025\" height=\"161\" src=\"https://image.prepladder.com/notes/namPT4weS8gxCQKcOC4U1744276617.png\" width=\"160\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Krait\" data-author=\"Sp.herp\" data-hash=\"8411\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bungarus_lividus,_Lesser_Black_Krait_at_Jalpaiguri,_India.jpg\" data-tags=\"April2025\" height=\"158\" src=\"https://image.prepladder.com/notes/gtYy5jkrJWT65YarQMq91744276648.png\" width=\"214\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Russel's Viper\" data-author='\" AChawla \"' data-hash=\"8414\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Russell%27s_viper\" data-tags=\"April2025\" height=\"155\" src=\"https://image.prepladder.com/notes/L5DhRtNZb5mMnqz59A2x1744276894.png\" width=\"172\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Saw Scaled Viper\" data-author=\"Ashahar alias Krishna Khan\" data-hash=\"8416\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Saw-scaled_viper_Echis_carinatus_by_Krishna_Khan_Amravati.jpg\" data-tags=\"April2025\" height=\"99\" src=\"https://image.prepladder.com/notes/wC2hFdI5IwgoDAWZM7kX1744276922.png\" width=\"171\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Venom Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurotoxic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurotoxic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemotoxic and Neurotoxic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemotoxic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Local Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate pain and swelling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal local symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pain, swelling, and tender lymphadenopathy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pain and swelling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Neurological Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Ptosis</p>\n<p>- <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">Paralysis</span> of jaw/tongue</p>\n<p>- Pooling of secretions</p>\n<p>- <span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\">Paradoxical</span> respiration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Ptosis</p>\n<p>- <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">Paralysis</span> of jaw/tongue</p>\n<p>- Pooling of secretions</p>\n<p>- <span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\">Paradoxical</span> respiration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Diplopia</p>\n<p>- Dysphagia</p>\n<p>- Dysarthria/ dysphonia</p>\n<p>- <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> paralysis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally not present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Bleeding Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">Gum</span> bleeding</p>\n<p>- Epistaxis</p>\n<p>- Hematuria</p>\n<p>- Retro-peritoneal bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">Gum</span> bleeding</p>\n<p>- Epistaxis</p>\n<p>- Hematuria</p>\n<p>- Can persist for weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Renal Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> necrosis</p>\n<p>- <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible, but less common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Coagulation Profile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Prolonged PT/INR</p>\n<p>- Decreased fibrinogen</p>\n<p>- Thrombocytopenia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Prolonged PT/INR</p>\n<p>- Decreased fibrinogen</p>\n<p>- Thrombocytopenia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>20 WBCT Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal (solid clot)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal (solid clot)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal (rapid <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> degradation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal (rapid <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> degradation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Onset of Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid onset of neurological symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often delayed onset, may occur during sleep</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid onset of local and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid onset of local symptoms</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman is admitted to the ICU with sepsis secondary to a urinary tract infection. After 48 hours, she develops acute hypoxemic respiratory failure. Her chest X-ray shows bilateral infiltrates, and her PaO2/FiO2 ratio is 180 mmHg on PEEP of 8 cm H2O. An echocardiogram shows normal cardiac function. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Initiate high-frequency oscillatory ventilation", "correct": false}, {"label": "B", "text": "Start inhaled nitric oxide therapy", "correct": false}, {"label": "C", "text": "Begin low tidal volume ventilation with 6 mL/kg predicted body weight", "correct": true}, {"label": "D", "text": "Administer high-dose corticosteroids", "correct": false}], "correct_answer": "C. Begin low tidal volume ventilation with 6 mL/kg predicted body weight", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Diagnosis (Berlin Definition)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p>Within 1 week of known clinical <span class=\"customMeta\" data-dictid=\"c0eabf6972169277719023f6f2ca31\">insult</span> or new/worsening <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Chest Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p>Bilateral opacities not fully explained by effusions, collapse, or nodules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Origin of Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p>Respiratory failure not fully explained by <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure or fluid overload</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Oxygenation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li><strong>Mild (Grade A):</strong> 200 mmHg &lt; PaO2/FiO2 ≤ 300 mmHg (with <span class=\"customMeta\" data-dictid=\"9abcb9edc11692777195dac40cd470\">PEEP</span> or <span class=\"customMeta\" data-dictid=\"ae6c057fde1692777185b85f0eca18\">CPAP</span> ≥ 5 cm H2O)</li>\n<li><strong>Moderate (Grade B):</strong> 100 mmHg &lt; PaO2/FiO2 ≤ 200 mmHg</li>\n<li><strong>Severe (Grade C &amp; D): </strong>PaO2/FiO2 ≤ 100 mmHg</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Management Recommendations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Grade A (Mild)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Low <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> (4–8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure &lt; 30 cm H2O)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Grade B (Moderate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Minimized <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> and driving pressures</li>\n<li>High <span class=\"customMeta\" data-dictid=\"9abcb9edc11692777195dac40cd470\">PEEP</span> (35–50 cmH2O for 20–40 s)</li>\n<li>Prone positioning</li>\n<li>Recruitment maneuvers</li>\n<li>ECMO in selected patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Grade C (Severe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Neuromuscular <span class=\"customMeta\" data-dictid=\"70d039f1401692777183bb2f23a21a\">blockade</span> in early ARDS</li>\n<li>Conservative fluid management</li>\n<li>Inhaled vasodilators as rescue therapy</li>\n<li>Avoid routine use of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> catheter</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Grade D (Severe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Avoid high-frequency oscillatory ventilation</li>\n<li>Avoid β2-agonists for improving outcomes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man is admitted to the ICU with severe pneumonia. He develops worsening respiratory symptoms and bilateral infiltrates on chest X-ray within 5 days. Which of the following best describes the pathophysiological mechanism occurring in the alveoli during the early phase of this patient's condition?", "options": [{"label": "A", "text": "Increased surfactant production", "correct": false}, {"label": "B", "text": "Thickening of the alveolar basement membrane", "correct": false}, {"label": "C", "text": "Accumulation of protein-rich edema fluid", "correct": true}, {"label": "D", "text": "Fibrosis of the alveolar walls", "correct": false}], "correct_answer": "C. Accumulation of protein-rich edema fluid", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Direct Lung Injury Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Pneumonia</li>\n<li>Aspiration of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> contents</li>\n<li>Pulmonary contusion</li>\n<li>Near-drowning</li>\n<li>Toxic <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<p><strong>Indirect Lung Injury Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li>Sepsis</li>\n<li>Severe trauma</li>\n<li>Multiple bone fractures</li>\n<li>Pancreatitis</li>\n<li>Burns</li>\n<li>Multiple transfusions</li>\n<li>Drug overdose</li>\n<li>Cardiopulmonary bypass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\"><strong>Pathophysiology</strong></td>\n<td style=\"border-bottom:1px solid #030712; border-left:1px solid #030712; border-right:1px solid #030712; border-top:1px solid #030712; vertical-align:top\">\n<ul>\n<li><strong>Exudative Phase (0-7 days):</strong></li>\n</ul>\n<p>- Injury to alveolar <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> endothelial cells and <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> pneumocytes</p>\n<p>- Increased <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> permeability</p>\n<p>- Accumulation of protein-rich <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> fluid in <span class=\"customMeta\" data-dictid=\"0dd428c12116927771819285c8849c\">alveoli</span> and interstitium</p>\n<p>- Formation of <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> membranes</p>\n<p>- <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">Neutrophil</span> <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> and activation</p>\n<p>- Release of pro-inflammatory cytokines (e.g., TNF-α, IL-1, IL-8)</p>\n<p>- Impaired gas exchange and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> lung compliance</p>\n<ul>\n<li><strong>Proliferative Phase (7-21 days):</strong></li>\n</ul>\n<p>- <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">Proliferation</span> of <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">type II</span> pneumocytes</p>\n<p>- Resolution of alveolar edema</p>\n<p>- Early fibroproliferation</p>\n<ul>\n<li><strong>Fibrotic Phase (&gt;21 days):</strong></li>\n</ul>\n<p>- <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">Collagen</span> deposition and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> in some patients</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Acute &lt;span class=\" custommeta\"=\"\" data-dictid=\"cfad80a0f716927771979aae100f95\"/>Respiratory <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">Distress</span> Syndrome\" data-author=\"\"Swati Haldar Snehal Jadhav Vandana Gulati David J Beale Acharya Balkrishna Anurag Varshney Enzo Palombo Avinash Karpe Rohan Mahendra Shah \"\" data-hash=\"8405\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Figur-e-4-T-he-micr-obiome-imm-une-pr-oteins-cellular-inter-action-in-the-lungs-Cr_fig2_373601839\" data-tags=\"April2025\" height=\"502\" src=\"https://image.prepladder.com/notes/EN1m96XJNqg4rEE8VAaZ1744275953.png\" width=\"647\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male presents to the emergency department with fever, tachypnea, and altered mental status. Laboratory results show: WBC: 14,000/μL Serum lactate: 1.8 mmol/L Creatinine: 1.8 mg/dL (baseline 0.9 mg/dL) Chest X-ray reveals a right lower lobe infiltrate. The patient requires 5 L/min of oxygen to maintain SpO2 &amp;gt; 90%. According to the Sepsis-3 criteria, which of the following is the most accurate diagnosis for this patient?", "options": [{"label": "A", "text": "Systemic Inflammatory Response Syndrome (SIRS)", "correct": false}, {"label": "B", "text": "Sepsis", "correct": true}, {"label": "C", "text": "Severe sepsis", "correct": false}, {"label": "D", "text": "Septic shock", "correct": false}], "correct_answer": "B. Sepsis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male trauma patient is undergoing a massive transfusion protocol (MTP) following a severe motor vehicle accident. Two hours into the MTP, he developed acute respiratory distress. A chest X-ray reveals bilateral infiltrates. His blood pressure is within normal limits, and BNP (Brain Natriuretic Peptide) levels are not elevated. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Transfusion-associated circulatory overload (TACO)", "correct": false}, {"label": "B", "text": "Transfusion-related acute lung injury (TRALI)", "correct": true}, {"label": "C", "text": "Acute respiratory distress syndrome (ARDS)", "correct": false}, {"label": "D", "text": "Cardiogenic pulmonary edema", "correct": false}], "correct_answer": "B. Transfusion-related acute lung injury (TRALI)", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TRALI (Transfusion-Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TACO (Transfusion-Associated <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">Circulatory</span> Overload)</strong><strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> following blood transfusion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> due to <strong>volume overload</strong> from blood transfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually<strong> within 6 hours</strong> of transfusion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur during or up to 12 hours post-transfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immune-mediated injury to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> capillaries leads to fluid leakage into alveoli.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Volume <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> causes increased <span class=\"customMeta\" data-dictid=\"20b745c46c1692777189374f036950\">hydrostatic</span> pressure in the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> circulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden onset of dyspnea, hypoxemia, fever, hypotension.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dyspnea, orthopnea, rapid weight gain, <strong>hypertension</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crackles, tachypnea, no signs of fluid <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> (e.g., <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> distension).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crackles, tachypnea, signs of fluid <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> (e.g., elevated JVP, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> edema).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> Findings</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bilateral &lt;span class=\" custommeta\"=\"\" data-dictid=\"89275101301692777186567d1912a0\"/>diffuse <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infiltrates\" data-author=\"Glick Y\" data-hash=\"8403\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/transfusion-related-acute-lung-injury-trali\" data-tags=\"April2025\" height=\"297\" src=\"https://image.prepladder.com/notes/DUQdUbLnFfwyS2cHNBnG1744275407.png\" width=\"238\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Bilateral <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infiltrates (non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema).</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Cardiomegaly, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, pleural effusions (cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema).</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:150px\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:267px\">\n<p>Hypotensive or normal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:295px\">\n<p>Hypertensive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:150px\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:267px\">\n<p>Neutrophilia, leukocytosis, and <strong>anti-HLA antibodies in donor blood</strong> (in some cases).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:295px\">\n<p><strong>Elevated BNP</strong> (brain <span class=\"customMeta\" data-dictid=\"bd16654d3e169277719371077d7a8c\">natriuretic</span> peptide), no specific markers for TACO.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:150px\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:267px\">\n<p>Supportive care (oxygen, <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">mechanical ventilation</span> if necessary), no diuretics.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:295px\">\n<p>Diuretics (e.g., furosemide), oxygen, stopping or slowing the transfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:150px\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:267px\">\n<p>Use of leukocyte-reduced or HLA-matched blood products.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:295px\">\n<p>Slow <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> rate, avoid <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> volume, and monitor for fluid overload.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female presents with severe postpartum hemorrhage. Her vitals are: BP- 70/40 mmHg, HR- 135/min, RR- 28/min, Blood loss- Approximately 2L, ABC score- 3 Massive Transfusion Protocol is initiated. After round 1 of transfusion (4 units PRBC + 2 units FFP), the patient continues to bleed. Which of the following is the most appropriate next step?", "options": [{"label": "A", "text": "Administer Factor VIIa immediately", "correct": false}, {"label": "B", "text": "Give 4 units PRBC, 4 units FFP, and 1 unit SDP in Round 2", "correct": true}, {"label": "C", "text": "Only give additional PRBC to correct anemia", "correct": false}, {"label": "D", "text": "Start cryoprecipitate without checking fibrinogen levels", "correct": false}], "correct_answer": "B. Give 4 units PRBC, 4 units FFP, and 1 unit SDP in Round 2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 28 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 17 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A patient with type 2 diabetes mellitus experiences hypoglycemia and sustains a fall. Due to incoherent speech, a CT scan is performed and reveals a substantial subdural hematoma (SDH) with a volume greater than 30 cc. What should be the immediate next step in management?", "options": [{"label": "A", "text": "Administer Mannitol", "correct": false}, {"label": "B", "text": "Administer Aspirin and Clopidogrel", "correct": false}, {"label": "C", "text": "Perform a Craniotomy", "correct": true}, {"label": "D", "text": "Stabilize the patient and urgently seek a neurosurgical consultation", "correct": false}], "correct_answer": "C. Perform a Craniotomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute SDH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chronic SDH</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-72 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;3 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid deterioration</li>\n<li>Loss of consciousness</li>\n<li>Focal deficits</li>\n<li>High mortality</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gradual onset</li>\n<li>Confusion</li>\n<li>Headache</li>\n<li>Gait disturbance</li>\n<li>Better prognosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Young adults</li>\n<li>Coagulopathy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elderly</li>\n<li>Brain atrophy</li>\n<li>Anticoagulation</li>\n<li>Minor trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperdense crescent</li>\n<li>Immediate mass effect</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypodense/mixed density</li>\n<li>Bilateral in 20-30%</li>\n<li>Gradual mass effect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emergency craniotomy</li>\n<li>Reverse coagulopathy</li>\n<li>ICU care</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Burr hole drainage</li>\n<li>Hold anticoagulation</li>\n<li>May observe small ones</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old woman was brought to the casualty in an unconscious state after having suddenly collapsed. As there was no pulse, cardiopulmonary resuscitation was started and the monitor showed the following rhythm. What is the next step?", "options": [{"label": "A", "text": "Defibrillation", "correct": true}, {"label": "B", "text": "Synchronized cardioversion", "correct": false}, {"label": "C", "text": "1mg epinephrine", "correct": false}, {"label": "D", "text": "0.5mg atropine", "correct": false}], "correct_answer": "A. Defibrillation", "question_images": ["https://image.prepladder.com/content/SQVG35ZJVzgCX9F9bQKB1747046506.png"], "explanation_images": ["https://image.prepladder.com/content/s0yqR7XTt3aA63EMQiD51747046549.png", "https://image.prepladder.com/content/5kZT01pT9Y6Du480oTS31747046549.png", "https://image.prepladder.com/content/miKvyzu6nbmxnv5q2eU21747046549.png", "https://image.prepladder.com/content/QgOb89OfDwr8zGeQoCbt1747046549.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Shockable Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Fibrillation</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"448\" src=\"https://image.prepladder.com/content/s0yqR7XTt3aA63EMQiD51747046549.png\" width=\"446\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asystole</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"138\" src=\"https://image.prepladder.com/content/5kZT01pT9Y6Du480oTS31747046549.png\" width=\"447\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Tachycardia </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"230\" src=\"https://image.prepladder.com/content/miKvyzu6nbmxnv5q2eU21747046549.png\" width=\"447\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulseless Electrical Activity</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"128\" src=\"https://image.prepladder.com/content/QgOb89OfDwr8zGeQoCbt1747046549.png\" width=\"447\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Shockable Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immediate Recognition</strong></p>\n<p style=\"text-align:center\"><strong>Identify Shockable Rhythm:</strong> Recognize VF or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> VT.</p>\n<p style=\"text-align:center\"><strong>Activate Emergency Response: </strong>Call for advanced life support.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Initiate CPR</strong></p>\n<p style=\"text-align:center\"><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue CPR for 2 minutes.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Defibrillation (Option A)</strong></p>\n<p style=\"text-align:center\">After 2 minutes of CPR, deliver a Non-Synchronized DC Shock to restore normal rhythm.</p>\n<p style=\"text-align:center\">If no change, administer a second shock immediately.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Continue CPR</strong></p>\n<p style=\"text-align:center\">Resume CPR for 2 Minutes</p>\n<p style=\"text-align:center\">Place an <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> line for drug administration.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Administer Epinephrine</strong></p>\n<p style=\"text-align:center\"><strong>Epinephrine 1 mg (Option C)</strong> (1:10,000): Given IV/IO after 2 minutes of CPR to enhance <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> pressure.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p style=\"text-align:center\"><strong>Secure Airway: </strong>Perform <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p style=\"text-align:center\"><strong>Capnography:</strong> Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p style=\"text-align:center\"><strong>Ventilation:</strong> Provide 1 breath every 6 seconds post-intubation.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Further Defibrillation</strong></p>\n<p style=\"text-align:center\"><strong>Third Shock:</strong> If VF or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> VT persists, deliver a third non-synchronized shock.</p>\n<p style=\"text-align:center\">Continue CPR for 2 More Minutes: Follow with additional CPR.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Administer Antiarrhythmic Medication</strong></p>\n<p style=\"text-align:center\"><strong>Amiodarone 300 mg IV: </strong>Administer for shock-refractory VT to stabilize heart rhythm.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immediate Recognition</strong></p>\n<p style=\"text-align:center\"><strong>Identify Non-Shockable Rhythm:</strong> Recognize <span class=\"customMeta\" data-dictid=\"91769de9d4169277718220e09c463f\">asystole</span> or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> (PEA).</p>\n<p style=\"text-align:center\"><strong>Activate Emergency Response:</strong> Call for advanced life support.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Initiate CPR</strong></p>\n<p style=\"text-align:center\"><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue CPR for 2 minutes.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Establish <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> lines for medication administration.</strong></p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Administer Epinephrine</strong></p>\n<p style=\"text-align:center\"><strong>Epinephrine 1 mg (1:10,000):</strong> Administer IV/IO after the first 2 minutes of CPR.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Identify Rhythm</strong></p>\n<ul>\n<li style=\"text-align:center\"><strong>Non-Shockable Rhythm: </strong>Continue CPR and administer <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> every 3-5 minutes.</li>\n</ul>\n<p style=\"text-align:center\"><strong>Goal: </strong>To increase the likelihood of developing a shockable rhythm, such as <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> (VF), which is necessary for effective defibrillation.</p>\n<ul>\n<li style=\"text-align:center\"><strong>Shockable Rhythm:</strong> Administer a Non-Synchronized DC Shock to restore normal rhythm.</li>\n</ul>\n<p style=\"text-align:center\">↓<br/>\n<strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p style=\"text-align:center\"><strong>Airway: </strong>Secure the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> with <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p style=\"text-align:center\"><strong>Capnography: </strong>Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p style=\"text-align:center\"><strong>Ventilation: </strong>Provide 1 breath every 6 seconds post-intubation for adequate oxygenation.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Continue CPR</strong></p>\n<p style=\"text-align:center\">Resume chest compressions for 2 minutes.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n<p style=\"text-align:center\"><strong>Primary Focus:</strong> Address <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes, especially hypothermia.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Repeat CPR and Epinephrine</strong></p>\n<p style=\"text-align:center\"><strong>Cycle: </strong>Continue repeating CPR and <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> administration every 3-5 minutes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following is used in the management of breathless patients at a high altitude of 3000 mts except.", "options": [{"label": "A", "text": "Intravenous digoxin", "correct": true}, {"label": "B", "text": "Oxygen supplementation", "correct": false}, {"label": "C", "text": "Immediate descent", "correct": false}, {"label": "D", "text": "Acetazolamide", "correct": false}], "correct_answer": "A. Intravenous digoxin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The recommended temperature of a water bath for a patient with frostbite is", "options": [{"label": "A", "text": "37 degree C", "correct": true}, {"label": "B", "text": "42 degree C", "correct": false}, {"label": "C", "text": "32 degree C", "correct": false}, {"label": "D", "text": "30 degree C", "correct": false}], "correct_answer": "A. 37 degree C", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the ABCD2 scoring, which factors indicate a greater likelihood of a patient with TIA experiencing a future stroke?", "options": [{"label": "A", "text": "Age &amp;lt;60 years", "correct": false}, {"label": "B", "text": "SBP&amp;gt;140 mm Hg and DBP &amp;lt;90 mmHg", "correct": false}, {"label": "C", "text": "Duration of TIA &amp;gt;5 mins", "correct": false}, {"label": "D", "text": "Diabetes", "correct": true}], "correct_answer": "D. Diabetes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 60 years <strong>(Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BP ≥ 140/90 <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> without weakness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilateral leg weakness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 points</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10–59 minutes <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 60 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 points</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of diabetes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:409px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stroke Risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 90</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0–3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.2%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3.1%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4–5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4.1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5.9%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9.8%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6–7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8.1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>11.7%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>17.8%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a scorching summer afternoon, a man, who had been toiling in a field, unexpectedly collapsed. Upon examination, there were no apparent physical indications of dehydration, although his radial pulse was detectable. The doctor determined that the man's serum electrolyte levels were within the normal range. Shockingly, the man's body temperature measured 106 degrees Fahrenheit. Considering these circumstances, which of the following should be administered as an initial form of immediate assistance?", "options": [{"label": "A", "text": "Inject epinephrine immediately", "correct": false}, {"label": "B", "text": "Cover with hot damp sheets", "correct": false}, {"label": "C", "text": "Cover with cool damp sheets", "correct": true}, {"label": "D", "text": "Start CPR", "correct": false}], "correct_answer": "C. Cover with cool damp sheets", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Heat Exhaustion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Heat Stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged strenuous activity with inadequate water/salt <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> in a hot environment.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Failure of <span class=\"customMeta\" data-dictid=\"f36a7c49d116927772002856c83dc1\">thermoregulation</span> in extreme heat exposure (Option C ruled out).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nausea, vomiting, malaise, myalgia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden collapse and loss of consciousness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CNS symptoms: dizziness, fatigue, impaired judgment, <span class=\"customMeta\" data-dictid=\"1cb2d1482916927771964c2890313e\">psychosis</span> (severe water depletion)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin initially wet, then dry</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moist skin, increased pulse</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperventilation, tachycardia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rectal temperature &gt; 37.8°C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Core temp &gt; 40.5°C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Other symptoms such as Constricted pupils, convulsions, unconsciousness, cerebral dysfunction, high fever, absence of sweating.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding the management of frostbite is incorrect?", "options": [{"label": "A", "text": "Amputation in severe cases", "correct": false}, {"label": "B", "text": "Rewarming is done", "correct": false}, {"label": "C", "text": "Antibiotics and analgesics not used", "correct": true}, {"label": "D", "text": "The area is dried and cleaned", "correct": false}], "correct_answer": "C. Antibiotics and analgesics not used", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/OdhawU4EViEdXB5wIZdm1745327336.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exposure to extreme cold (-2.5ºC), causing tissue freezing and blood supply obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blue-black discoloration of fingers, toes, nose, ears, face.</p>\n<ul>\n<li>Mild cases: numbness, prickling.</li>\n<li>Severe cases: paresthesia, stiffness, necrosis, gangrene, edema, blisters.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rewarming:\n\t\t\t\t<ul>\n<li>For <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"9db5c32d52169277720386478c79ac\">frostbite</span> (frostnip): Firm steady pressure is applied with a warm hand (without rubbing), by placing fingers in the armpits and for the feet, by covering with dry socks</li>\n<li>For deep frostbite: Frozen <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> is immersed for several minutes in a moving water bath, heated to 40–42°C, until the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> tip of the part being thawed, flushes</li>\n</ul>\n</li>\n<li>Pressure or <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> is avoided</li>\n<li>Anti-infective measures: Tetanus <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> and antibiotics for deep infection</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was being treated in ICU for sepsis. The initial ABG shows pH= 6.9, pO 2 = 80 mm Hg. pCO 2 = 55 mmHg, HCO 3 = 10 meq/L. A repeat ABG after 2 hours shows pH=7.1, pCO 2 = 20 mmHg, pO 2 = 140 mm Hg, and HCO 3 = 10 meq/L. Which is most plausible to explain the change seen in the ABG report?", "options": [{"label": "A", "text": "Excessive air and less heparin in the ABG sample", "correct": false}, {"label": "B", "text": "Excess air and more heparin in the ABG sample", "correct": true}, {"label": "C", "text": "Less air and more heparin in the ABG sample", "correct": false}, {"label": "D", "text": "Less air and less heparin in the ABG sample", "correct": false}], "correct_answer": "B. Excess air and more heparin in the ABG sample", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What medication can be administered to a patient who experiences altered consciousness, sweating, rapid heartbeat, persistent erection, and increased saliva production, with a blood pressure reading of 150/90 mm Hg after visiting a temple with their grandmother?", "options": [{"label": "A", "text": "ASV", "correct": false}, {"label": "B", "text": "Adrenaline", "correct": false}, {"label": "C", "text": "Steroid", "correct": false}, {"label": "D", "text": "Prazosin", "correct": true}], "correct_answer": "D. Prazosin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the ER with anaphylaxis; which of the following not a part of the clinical criteria to diagnose anaphylaxis? Urticaria, edema of the lips and tongue, and rashes within 2 minutes to 2 hours of contact. Wheeze and respiratory distress Abdominal cramps and vomiting Hypertension", "options": [{"label": "A", "text": "1, 2, and 3", "correct": false}, {"label": "B", "text": "1 and 2", "correct": false}, {"label": "C", "text": "2 and 3", "correct": false}, {"label": "D", "text": "3 and 4", "correct": true}], "correct_answer": "D. 3 and 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 3 and 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a post-operative patient, after 2 hours of receiving FFP, sudden onset dyspnea, hypoxemia, tachypnea, hypotension, and bilateral pulmonary infiltrates on chest X-ray occur. What is the most likely diagnosis?", "options": [{"label": "A", "text": "TRALI", "correct": true}, {"label": "B", "text": "TACO", "correct": false}, {"label": "C", "text": "Pulmonary edema", "correct": false}, {"label": "D", "text": "ARDS", "correct": false}, {"label": "E", "text": "Sepsis", "correct": false}], "correct_answer": "A. TRALI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fb60955dfd1692777200b373fe14cc\"&gt;TRALI&lt;/span&gt; (Transfusion-related &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;acute&lt;/span&gt; lung injury)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the lifelong treatment for individuals who have received a potent prosthetic mitral valve replacement?", "options": [{"label": "A", "text": "Aspirin", "correct": false}, {"label": "B", "text": "Clopidogrel", "correct": false}, {"label": "C", "text": "Atorvastatin", "correct": false}, {"label": "D", "text": "Warfarin", "correct": true}], "correct_answer": "D. Warfarin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - W\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer has come with symptoms of pinpoint pupils, excessive salivation, and increased secretion from the body. The most probable diagnosis is", "options": [{"label": "A", "text": "Opioid overdose", "correct": false}, {"label": "B", "text": "Organophosphate poisoning", "correct": true}, {"label": "C", "text": "Stroke", "correct": false}, {"label": "D", "text": "Heat stroke", "correct": false}], "correct_answer": "B. Organophosphate poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"505a21f8451692777194a113951c68\"&gt;Organophosphate&lt;/span&gt; poisoning\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscarinic effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nicotinic effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>D</strong> – <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">Diarrhea</span> (increased GI motility, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> sounds)</li>\n<li><strong>U</strong> - Increased frequency of Urination</li>\n<li><strong>M</strong> - <span class=\"customMeta\" data-dictid=\"cacca0f20e169277719222049c80a2\">Miosis</span> pupil</li>\n<li><strong>B</strong>-Bradycardia (by <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of M2 receptors)</li>\n<li><strong>B</strong>-Bronchorrhea, Bronchospasm</li>\n<li><strong>E</strong> - Emesis</li>\n<li><strong>L</strong>-Increased Lacrimation</li>\n</ul>\n<ul>\n<li>Red <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> or <span class=\"customMeta\" data-dictid=\"99ba7175ec16927771844d79117f07\">chromodacryorrhea</span> is seen due to <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of <span class=\"customMeta\" data-dictid=\"4a759c9f1016927771964b8325ac2f\">porphyrin</span> in tears</li>\n</ul>\n<ul>\n<li><strong>L</strong> - Lethargy</li>\n<li><strong>S</strong> – Salivation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache, tremor, confusion slurred speech, coma, convulsions.</li>\n<li>Initially, it causes muscle fasciculations, areflexia.</li>\n<li>Later, muscle <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> occurs (Type-1 or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> syndrome).</li>\n<li>Death occurs due to <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> muscles (i.e <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient with necrotizing fascitis was admitted to the ER. The patient was tachycardic and hypotensive. He was treated for septic shock. Which of the following is the characteristic feature of refractory septic shock?", "options": [{"label": "A", "text": "Shock persisting &amp;gt; 1 hour after IVF administration", "correct": false}, {"label": "B", "text": "Shock persisting &amp;gt; 1 hour after IVF administration and high dose vasopressors", "correct": true}, {"label": "C", "text": "Shock that is refractory to medical treatment", "correct": false}, {"label": "D", "text": "Shock that does not improve despite treatment for 24 hours", "correct": false}], "correct_answer": "B. Shock persisting &gt; 1 hour after IVF administration and high dose vasopressors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Shock persisting &amp;gt; 1 hour after &lt;span class=\"customMeta\" data-dictid=\"cf23a56e0916927771903ba7e75f72\"&gt;IVF&lt;/span&gt; administration and high-dose v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which test is the most sensitive for diagnosing Organophosphate poisoning among the following options?", "options": [{"label": "A", "text": "Plasma acetylcholinesterase", "correct": true}, {"label": "B", "text": "Organophosphate level in blood", "correct": false}, {"label": "C", "text": "Organophosphate level in plasma", "correct": false}, {"label": "D", "text": "RBC transaminase levels", "correct": false}], "correct_answer": "A. Plasma acetylcholinesterase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\"&gt;Plasma&lt;/span&gt; acetylcholinesterase: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly diabetic and hypertensive patient was carried to the emergency room in a comatose state. On examination, the blood pressure was 170/100 mmHg and pulse rate was &amp;gt;100/min. Plantar reflex was bilateral extensor. What is the next step to do?", "options": [{"label": "A", "text": "Check blood sugar level", "correct": true}, {"label": "B", "text": "Give antihypertensive", "correct": false}, {"label": "C", "text": "IV mannitol", "correct": false}, {"label": "D", "text": "CT brain", "correct": false}], "correct_answer": "A. Check blood sugar level", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Check &lt;span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\"&gt;blood sugar&lt;/span&gt; lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not done before drawing blood for arterial blood gas analysis?", "options": [{"label": "A", "text": "Allen's test", "correct": false}, {"label": "B", "text": "Rinse the syringe with heparin", "correct": false}, {"label": "C", "text": "Flexion of wrist", "correct": true}, {"label": "D", "text": "Placing needle at 45 degree angle", "correct": false}], "correct_answer": "C. Flexion of wrist", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\"&gt;Flexion&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 27 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 18 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old man comes with recurrent episodes of loss of consciousness, tremors, excessive sweating, and confusion. A tumour of the pancreas is suspected, and the serum proinsulin level (on a 72-hour fasting test) is raised. Which of the following investigations would be most preferred?", "options": [{"label": "A", "text": "Computed tomography", "correct": false}, {"label": "B", "text": "MRI", "correct": false}, {"label": "C", "text": "Manual Palpation and Intraoperative Ultrasound", "correct": false}, {"label": "D", "text": "Endoscopic Ultrasound (EUS)", "correct": true}], "correct_answer": "D. Endoscopic Ultrasound (EUS)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Techniques for <span class=\"customMeta\" data-dictid=\"43b7327590169277719092c556b0b6\">Insulinoma</span> Localization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Invasive <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Modalities for Insulinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transabdominal ultrasonography</li>\n<li>CT<strong> </strong><strong>(Option A)</strong></li>\n<li>MRI <strong>(Option B)</strong></li>\n<li>Somatostatin scintigraphy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> (EUS)\n\t\t\t\t<ul>\n<li>Considered the <strong>primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tool</strong>.</li>\n</ul>\n</li>\n<li>EUS-guided Fine-Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> (FNA)</li>\n<li>Angiography with Arterial <span class=\"customMeta\" data-dictid=\"15d33997ac1692777198ec0c954aa3\">Secretagogue</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">Sampling</span> (ASVS)</li>\n<li>Manual <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">Palpation</span> and <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">Intraoperative</span> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old woman presents with recurrent episodes of diarrhoea, weight loss, and intermittent abdominal pain over the past 6 months. She also reports occasional flushing and has developed diabetes despite having no previous history of it. On examination, she is noted to have steatorrhea and a mild skin rash. Blood tests reveal elevated fasting plasma glucose levels. Which of the following diagnostic methods is not used in the diagnosis of this patient’s condition?", "options": [{"label": "A", "text": "Elevated fasting plasma somatostatin levels", "correct": false}, {"label": "B", "text": "Secretin stimulation test", "correct": false}, {"label": "C", "text": "Somatostatin receptor imaging", "correct": true}, {"label": "D", "text": "Biopsy and immunohistochemistry for somatostatin", "correct": false}], "correct_answer": "C. Somatostatin receptor imaging", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Assertion : In diabetic ketoacidosis (DKA), potassium levels can appear normal or even elevated initially despite a total body potassium deficiency. Reason : Potassium shifts from the intracellular to the extracellular space due to insulin deficiency and acidosis, temporarily raising serum potassium levels.", "options": [{"label": "A", "text": "Both assertion and reason are correct, and the reason correctly explains the assertion.", "correct": true}, {"label": "B", "text": "Both assertion and reason are correct, but the reason does not correctly explain the assertion.", "correct": false}, {"label": "C", "text": "The assertion is correct, but the reason is incorrect.", "correct": false}, {"label": "D", "text": "The assertion is incorrect, but the reason is correct.", "correct": false}], "correct_answer": "A. Both assertion and reason are correct, and the reason correctly explains the assertion.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with type 1 diabetes presents with increased thirst, frequent urination, nausea, vomiting, and abdominal pain. On examination, he has dry mucous membranes, tachypnea, and a fruity odour to his breath. His blood pressure is 90/60 mmHg. Labs show blood glucose of 450 mg/dL, bicarbonate of 18 mEq/L, and pH of 7.28. Which of the following statements is FALSE?", "options": [{"label": "A", "text": "Kussmaul breathing is deep, laboured, and rapid.", "correct": false}, {"label": "B", "text": "Fruity odour on the breath is caused by acetone.", "correct": false}, {"label": "C", "text": "Dehydration in DKA is associated with dry mucous membranes and poor capillary refill.", "correct": false}, {"label": "D", "text": "Fever is always present in DKA and indicates infection.", "correct": true}], "correct_answer": "D. Fever is always present in DKA and indicates infection.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old male with Type 1 Diabetes Mellitus presents to the emergency department with nausea, vomiting, and abdominal pain. He reports that he has not taken his insulin for the past two days. On examination, he appears dehydrated, with deep and rapid breathing. Laboratory tests reveal high blood glucose, ketonemia, and metabolic acidosis. Which of the following statements about the pathophysiology of the patient’s condition is TRUE?", "options": [{"label": "A", "text": "Insulin deficiency leads to increased glucose utilization by the cells.", "correct": false}, {"label": "B", "text": "Elevated counterregulatory hormones increase glycogen synthesis, reducing blood glucose levels.", "correct": false}, {"label": "C", "text": "Lipolysis increases free fatty acids (FFA) in the liver, leading to ketogenesis.", "correct": true}, {"label": "D", "text": "Increased glucose utilization prevents hyperglycemia and osmotic diuresis.", "correct": false}], "correct_answer": "C. Lipolysis increases free fatty acids (FFA) in the liver, leading to ketogenesis.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/aIHTt0qiqsRDqpI8saH51744296690.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient presents to the clinic with persistent diarrhoea, which has led to significant dehydration. After evaluation, it is determined that the diarrhoea is secretory. The patient has a history of diabetes, which is uncontrolled. Which of the following statements best describes the management and mechanisms associated with secretory diarrhoea in this patient?", "options": [{"label": "A", "text": "Secretory diarrhoea primarily results from the malabsorption of nutrients", "correct": false}, {"label": "B", "text": "The main goal of management is reducing intestinal secretion", "correct": false}, {"label": "C", "text": "Antisecretory agents like Racecadotril and Crofelemer may help reduce fluid loss", "correct": true}, {"label": "D", "text": "Secretory diarrhoea shows a high osmotic gap that is not related to food intake", "correct": false}], "correct_answer": "C. Antisecretory agents like Racecadotril and Crofelemer may help reduce fluid loss", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:478px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of <span class=\"customMeta\" data-dictid=\"9e7aec9ff416927771984a1e3100b7\">secretory</span> diarrhoea </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Overuse of laxatives</li>\n<li>Chronic alcoholism</li>\n<li>Drugs and toxins</li>\n<li>Bile acid diarrhoea</li>\n<li>Bacterial infections:\n\t\t\t\t<ul>\n<li>Cholera, pancreatic cholera</li>\n</ul>\n</li>\n<li>Bowel resection, disease, or fistula</li>\n<li>Partial <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or impaction</li>\n<li>Hormone-producing tumors:\n\t\t\t\t<ul>\n<li>Carcinoid syndrome</li>\n<li>VIPnoma</li>\n<li>Medullary cancer Thyroid</li>\n<li>Mastocytosis</li>\n<li>Gastrinoma</li>\n<li>Colorectal <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> adenoma</li>\n</ul>\n</li>\n<li>Addison’s disease</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> defects</li>\n<li>Diabetes mellitus:\n\t\t\t\t<ul>\n<li>Idiopathic diarrhoea with associated <span class=\"customMeta\" data-dictid=\"0e5348eb421692777199f7a9fc4b0c\">steatorrhea</span> is seen in uncontrolled insulin-dependent diabetes</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following toxin-producing bacteria does a VIPoma mimic?", "options": [{"label": "A", "text": "Shigella dysenteriae", "correct": false}, {"label": "B", "text": "Vibrio cholerae", "correct": true}, {"label": "C", "text": "Corynebacterium diphtheriae", "correct": false}, {"label": "D", "text": "Bordetella pertussis", "correct": false}], "correct_answer": "B. Vibrio cholerae", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the true statement about the condition where the patient presents with high plasma somatostatin levels, steatorrhea, hypochlorhydria, and diabetes mellitus due to a tumour.", "options": [{"label": "A", "text": "The tumour primarily occurs in the stomach", "correct": false}, {"label": "B", "text": "This is usually a small tumour that often goes unnoticed", "correct": false}, {"label": "C", "text": "This is rarely associated with MEN 1 syndrome", "correct": true}, {"label": "D", "text": "Metastasis is rare and is treated using chemotherapy for localized disease", "correct": false}], "correct_answer": "C. This is rarely associated with MEN 1 syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old female presents with significant weight loss and a characteristic rash as in the image. Blood tests reveal elevated plasma glucagon levels exceeding 1000 pg/mL. A CT scan shows a large mass in the tail of the pancreas. Which of the following statements regarding her condition is correct?", "options": [{"label": "A", "text": "The mass is commonly found in the head of the pancreas", "correct": false}, {"label": "B", "text": "The initial treatment includes antibiotics and steroids", "correct": false}, {"label": "C", "text": "The rash seen is necrolytic migratory erythema", "correct": true}, {"label": "D", "text": "Surgical resection is the treatment option for this condition", "correct": false}], "correct_answer": "C. The rash seen is necrolytic migratory erythema", "question_images": ["https://image.prepladder.com/notes/3iLCKAfBgqy3KvigZ5cX1744296765.png"], "explanation_images": ["https://image.prepladder.com/notes/QTyaR0uMehgTQlw3RfsT1744296817.png", "https://image.prepladder.com/notes/Yx8widlsPesr1cB4kVl31744296851.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glucagonoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Insulinoma </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Over 50% are metastatic.</li>\n<li>Typically large at diagnosis.</li>\n<li>Located in the tail and body of the pancreas.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More commonly benign.</li>\n<li>Small (&lt;2cm) at diagnosis.</li>\n<li>Equally present in all parts of the pancreas.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acanthosis nigricans</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Necrobiosis lipoidica</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Necrolytic <span class=\"customMeta\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\">migratory</span> erythema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is seen in <span class=\"customMeta\" data-dictid=\"b6a934c67b16927771868fca92baf9\">diabetes mellitus</span> and other endocrinopathies.</li>\n<li>Presents as <span class=\"customMeta\" data-dictid=\"30261213bf16927771898b5d2f245d\">hyperpigmentation</span> &amp; thick velvety patch on the back of the neck, axilla, or groin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is a chronic <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> disease that is rare and seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</li>\n<li>Presents as well-rounded erythematous papules.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Found in patients with glucagonoma.</li>\n<li>Presents as <span class=\"customMeta\" data-dictid=\"fc2efe08081692777183a5a07d6101\">bullae</span> and vesicles with a <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> over the abdomen, groin, genitals, or buttocks.</li>\n<li>Also seen as <span class=\"customMeta\" data-dictid=\"9058ad97cc16927771840ca5446e4e\">cheilitis</span> or glossitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Acanthosis Nigricans\" data-author=\"Viner, Russell &amp; White, Billy &amp; Barrett, Timothy &amp; Candy, David &amp; Gibson, Penny &amp; Gregory, John &amp; Matyka, Krystyna &amp; Ong, Kenneth &amp; Roche, Edna &amp; Rudolf, Mary &amp; Shaikh, Guftar &amp; Shield, Julian &amp; Wales, Jerry.\" data-hash=\"8651\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Acanthosis-nigricans_fig2_225050496\" data-tags=\"April2025\" height=\"213\" src=\"https://image.prepladder.com/notes/QTyaR0uMehgTQlw3RfsT1744296817.png\" width=\"317\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Necrobiosis Lipoidica\" data-author=\"Warfieldian\" data-hash=\"8653\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Necrobiosis_lipoidica\" data-tags=\"April2025\" height=\"309\" src=\"https://image.prepladder.com/notes/Yx8widlsPesr1cB4kVl31744296851.png\" width=\"237\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Necrolytic &lt;span class=\" custommeta\"=\"\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\"/>Migratory Erythema\" data-author=\"Sheng-li Wu, Ji-gang Bai, Jun Xu, Qing-yong Ma &amp; Zheng Wu\" data-hash=\"8649\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Necrolytic_migratory_erythema#/media/File:Necrolytic_migratory_erythema.tif\" data-tags=\"April2025\" height=\"204\" src=\"https://image.prepladder.com/notes/hb3XjznFbrqwALz2Dnjd1744296788.png\" width=\"273\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old female with type 2 diabetes on SGLT2 inhibitors is brought to the emergency department unconscious. Lab results show pH 7.2, HCO3¯ 15 meq/L, RBS 210 mg/dL, and plasma beta-hydroxybutyrate 2.8 mmol/L with normal lactate. Urine analysis reveals the presence of ketones. What condition is most consistent with these findings?", "options": [{"label": "A", "text": "Lactic Acidosis", "correct": false}, {"label": "B", "text": "Diabetic Ketoacidosis", "correct": false}, {"label": "C", "text": "Euglycemic Diabetic Ketoacidosis", "correct": true}, {"label": "D", "text": "Hyperglycemic Hyperosmolar State", "correct": false}], "correct_answer": "C. Euglycemic Diabetic Ketoacidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:735px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Parameters </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diabetic <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">Ketoacidosis</span> (DKA) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lactic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hyperglycemic Hyperosmolar <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> (HHS) (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Euglycemic <span class=\"customMeta\" data-dictid=\"3232faac091692777186b1c8320945\">DKA</span> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>pH </strong>(7.35-7.45)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6.8 - 7.3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≤7.35</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;7.3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6.8 - 7.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HCO3¯ </strong>(22 to 26 meq/L)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;18</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;18</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;18</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;18</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ketostix</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>++++</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+/-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>++++</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma beta-hydroxybutyrate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;2.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;2.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBS (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>250 - 600</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;250</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>600 - 1200</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;200 - 250</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">Osmolality</span> </strong>(275 to 295 mOsm/kg)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300 - 320</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>330 - 380</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~300</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male comes to the clinic with recurrent episodes of hypoglycemia and loss of consciousness. On further evaluation, he is found to have a tumour on the pancreas. Which of the following is not a component of Whipple’s triad to suspect insulinoma?", "options": [{"label": "A", "text": "Symptoms of hypoglycemia", "correct": false}, {"label": "B", "text": "Low plasma glucose concentration", "correct": false}, {"label": "C", "text": "Subsequent improvement of symptoms with the use of glucose treatment", "correct": false}, {"label": "D", "text": "Elevated fasting insulin levels", "correct": true}], "correct_answer": "D. Elevated fasting insulin levels", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old diabetic woman is brought to the emergency department with complaints of confusion, fatigue, and dizziness. On examination, she has palpitations, sweating, and tremors. Her blood glucose concentration is found to be 48mg/dl. Which of the following is not a common cause of hypoglycemia in this patient?", "options": [{"label": "A", "text": "Insulin", "correct": false}, {"label": "B", "text": "Sulfonylureas", "correct": false}, {"label": "C", "text": "Metformin", "correct": true}, {"label": "D", "text": "Meglitinides", "correct": false}], "correct_answer": "C. Metformin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Manifestations of Hypoglycemia</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neuroglycopenic symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These symptoms result from insufficient <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> supply to the central nervous system.</li>\n<li>They are:\n\t\t\t\t<ul>\n<li>Behavioural changes</li>\n<li>Confusion</li>\n<li>Fatigue</li>\n<li>Seizures</li>\n<li>Loss of consciousness</li>\n<li>Cardiac arrhythmias</li>\n<li>Severe cases may lead to death</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neurogenic (Autonomic) symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These are caused by the body's <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> response to hypoglycemia.</li>\n<li>They are of two types as follows:</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adrenergic symptoms (due to <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> and possibly epinephrine)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cholinergic symptoms (due to acetylcholine)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Palpitations</li>\n<li>Tremors</li>\n<li>Anxiety</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sweating</li>\n<li>Hunger</li>\n<li>Paresthesias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These symptoms are <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">nonspecific</span> and require confirmation of low <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels for attribution to hypoglycemia.</li>\n<li>Symptoms should resolve upon raising <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels (Whipple’s triad).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common signs:</strong></p>\n<ul>\n<li>Diaphoresis (sweating)</li>\n<li>Pallor (pale skin)</li>\n<li>Increased heart rate and <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> blood pressure, though, may not be evident in individuals with frequent <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">hypoglycemic</span> episodes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological effects:</strong></p>\n<ul>\n<li>Neuroglycopenic symptoms are often noticeable.</li>\n<li>Transient <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits can occur but permanent deficits are rare.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypoglycemia levels</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level 1 (Mild)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> is &lt;70 mg/dL but 54 mg/dL or higher.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level 2 (Moderate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> is &lt;54 mg/dL.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level 3 (Severe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The individual is unable to function due to mental or physical changes caused by low blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and requires assistance from another person.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with persistent abdominal pain and unintentional weight loss over the past 3 months. He reports no significant past medical history and denies any changes in bowel habits. A CT scan of the abdomen reveals a well-circumscribed mass in the pancreas. Laboratory tests show elevated serum glucose levels but normal levels of other pancreatic hormones. Which of the following is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Insulinoma", "correct": false}, {"label": "B", "text": "Gastrinoma", "correct": false}, {"label": "C", "text": "Non-functioning pancreatic NET", "correct": true}, {"label": "D", "text": "Glucagonoma", "correct": false}], "correct_answer": "C. Non-functioning pancreatic NET", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Functioning PNET</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-functioning <span class=\"customMeta\" data-dictid=\"cde2dcfb251692777195bb7a41d550\">PNET</span> </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with symptoms due to <strong>hormone secretion</strong>.</li>\n<li>The most common are<strong> insulinomas</strong>.</li>\n</ul>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>No hormone</strong> secretion.</li>\n<li>The majority of pancreatic NETs (about 80%) are nonfunctional.</li>\n<li>Often clinically silent until they cause <strong>anatomic symptoms</strong>.</li>\n<li>Typically diagnosed incidentally or when symptoms like <strong>abdominal pain</strong> or <strong>weight loss occur</strong>.</li>\n<li>Usually more advanced when found <strong>(metastasized)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Functional pancreatic <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms/signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulinoma </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insulin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoglycemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrinoma </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glucagon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peptic ulcer, diarrhoea, GERD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Somatostatinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Somatostatin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhea, diabetes, hypochlorhydria, cholelithiasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucagonoma (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glucagon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Necrolytic <span class=\"customMeta\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\">migratory</span> erythema, diabetes, depression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VIPoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasoactive intestinal peptide</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Watery diarrhoea, hypokalemia, achlorhydria.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man with poorly controlled type 2 diabetes presents to the emergency department with confusion and increased thirst over the past week. On examination, he has dry mucous membranes, a weak pulse, and a blood pressure of 85/50 mmHg. Laboratory tests show: (Plasma glucose: 1000 mg/dL, Serum osmolality: 360 mOsm/kg, Serum sodium: 130 mEq/L, Arterial blood gas: pH 7.38, bicarbonate 18 mEq/L). Which of the following is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Administer IV Ringer Lactate", "correct": false}, {"label": "B", "text": "Administer IV 0.9% normal saline", "correct": true}, {"label": "C", "text": "Start IV insulin bolus of 1 unit/kg with IV Potassium", "correct": false}, {"label": "D", "text": "Administer oral hypoglycemic agents", "correct": false}], "correct_answer": "B. Administer IV 0.9% normal saline", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Laboratory Abnormalities and Diagnosis of HHS</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Key Laboratory Features</strong>:\n\t\t\t\t<ul>\n<li>Marked <span class=\"customMeta\" data-dictid=\"c52b35ebb01692777189131c97fbba\">hyperglycemia</span> (plasma <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> may exceed 55.5 mmol/L [1000 mg/dL])</li>\n<li>Hyperosmolality (&gt;350 mOsm/L)</li>\n<li>Prerenal azotemia</li>\n</ul>\n</li>\n<li><strong>Sodium Levels</strong>:\n\t\t\t\t<ul>\n<li>Measured <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> sodium may be normal or slightly low despite hyperglycemia.</li>\n<li>Corrected <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> sodium usually increases (add 1.6 <span class=\"customMeta\" data-dictid=\"9e8f51ce00169277719221e130a188\">mEq</span> to measured sodium for each 5.6 mmol/L [100 mg/dL] rise in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> glucose).</li>\n</ul>\n</li>\n<li><strong>Acidosis</strong>: In contrast to DKA, <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> and <span class=\"customMeta\" data-dictid=\"8041c08b7f16927771907f50bddcd3\">ketonemia</span> are typically<strong> absent</strong> or mild; small anion-gap <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> may occur due to increased <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid.</li>\n<li><strong>Ketonuria</strong>: Moderate ketonuria, if present, is usually due to starvation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of <span class=\"customMeta\" data-dictid=\"36a802ceb516927771893371227fb8\">Hyperglycemic</span> Hyperosmolar State (HHS)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Fluid Replacement</strong></h4>\n<ul>\n<li><strong>Initial Stabilization</strong>: Start with<strong> 1–3 litres of 0.9% <span class=\"customMeta\" data-dictid=\"ab6984f43316927771937ff19f3807\">normal saline</span> </strong>over the first 2–3 hours to stabilize <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> status. <strong>(Option B)</strong></li>\n<li><strong>Considerations</strong>:\n\t\t\t\t<ul>\n<li>HHS involves more significant fluid loss over days to weeks, so the <span class=\"customMeta\" data-dictid=\"82343f61171692777197b4a08bc719\">reversal</span> of <span class=\"customMeta\" data-dictid=\"898fc91fcf1692777189b0a95a850c\">hyperosmolarity</span> must balance <span class=\"customMeta\" data-dictid=\"5ca36f9c45169277720309b0504fed\">free water</span> <span class=\"customMeta\" data-dictid=\"1432e265321692777197c37bee1a8f\">repletion</span> and the risk of neurological complications.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> sodium is &gt;150 mmol/L, use 0.45% saline.</li>\n</ul>\n</li>\n<li><strong>Ongoing Fluid Administration</strong>: After achieving <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> stability, continue with <span class=\"customMeta\" data-dictid=\"6c1412e72916927771893d06180642\">hypotonic</span> fluids (0.45% <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> initially, followed by 5% <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">dextrose</span> in water [D5W]) to correct the <span class=\"customMeta\" data-dictid=\"5ca36f9c45169277720309b0504fed\">free water</span> deficit, which can be as much as 9–10 litres.\n\t\t\t\t<ul>\n<li>Administer at a rate of 200–300 mL/hour over 1–2 days.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Electrolyte Management</strong></h4>\n<ul>\n<li><strong>Potassium Repletion</strong>: Necessary and guided by <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> measurements. <strong>(Option C ruled out)</strong></li>\n<li><strong>Consider Diuretics</strong>: Patients on diuretics may have significant <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> and <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> deficits.</li>\n<li><strong>Address Hypophosphatemia</strong>: Can occur during therapy; treated with <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> (KPO4) and nutritional support.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Insulin Therapy</strong></h4>\n<ul>\n<li><strong>Initial <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Regimen</strong>:\n\n\t\t\t\t<ul>\n<li>Start with an <strong>IV <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> bolus</strong> of<strong> 0.1 unit/kg</strong>, followed by a continuous<strong> infusion</strong> at <strong>0.1 unit/kg/hour</strong>. <strong>(Option C ruled out)</strong></li>\n<li>If <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> does not decrease, double the <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> rate.</li>\n</ul>\n</li>\n<li><strong>Glucose Monitoring</strong>: When <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> falls to 11.1-13.9 mmol/L <strong>(200–250 mg/dL)</strong>, add <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> to IV fluids and decrease <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> to 0.02-0.1 unit/kg/hour.</li>\n<li><strong>Continuation of Therapy</strong>: <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> should continue until the patient resumes oral <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> and can transition to <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> insulin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-Hospitalization</strong>: Patients should be discharged on insulin, with some able to transition to oral glucose-lowering agents <strong>(Option D)</strong> later.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:791px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>DKA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HSS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Very common.</li>\n<li>Often younger.</li>\n<li>Common in <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> DM.</li>\n<li>Fewer comorbidities are present.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Relatively rare.</li>\n<li>Often older.</li>\n<li>Common in <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">Type 2</span> DM.</li>\n<li>More comorbidities are present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Time to Develop</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Several hours to days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Several days to weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe (absolute) <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> leads to unrestrained ketogenesis.</li>\n<li>Poor <span class=\"customMeta\" data-dictid=\"296c955ad216927771900bf1905f13\">ketone</span> tolerance leads to early symptom development.</li>\n<li>A shorter <span class=\"customMeta\" data-dictid=\"c52b35ebb01692777189131c97fbba\">hyperglycemia</span> duration causes less severe volume <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> and no significant hypernatremia.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Moderate (relative) <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> prevents ketogenesis.</li>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"c52b35ebb01692777189131c97fbba\">hyperglycemia</span> causes osmotic diuresis, severe hypovolemia, and hypernatremia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"e6a317ff3c16927771956fee0e76ed\">Physiologic</span> Abnormality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ketoacidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertonicity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Core Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> ketones.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap.</li>\n<li>Elevated blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe hyperglycemia.</li>\n<li>Altered mental status.</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> (&gt;320 mOsm)</li>\n<li>Severe volume depletion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Factor for Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum osmolality</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old woman with type 2 diabetes is admitted for confusion and severe dehydration. Her blood glucose is 900 mg/dL, and serum osmolality is elevated. Arterial blood gas reveals a normal pH and bicarbonate. Which of the following clinical signs would NOT be expected in this patient?", "options": [{"label": "A", "text": "Hypotension", "correct": false}, {"label": "B", "text": "Tachycardia", "correct": false}, {"label": "C", "text": "Kussmaul breathing", "correct": true}, {"label": "D", "text": "Fever", "correct": false}], "correct_answer": "C. Kussmaul breathing", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Clinical Features</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically seen in elderly individuals with <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes mellitus.</p>\n<ul>\n<li><strong>Symptoms</strong>: Characterized by a several-week history of:\n\n\t\t\t\t<ul>\n<li>Polyuria</li>\n<li>Weight loss</li>\n<li>Diminished oral intake</li>\n</ul>\n</li>\n<li><strong>Acute Presentation</strong>: May culminate in:\n\t\t\t\t<ul>\n<li>Mental confusion</li>\n<li>Lethargy</li>\n<li>Coma</li>\n</ul>\n</li>\n<li><strong>Physical Exam Findings</strong>:\n\t\t\t\t<ul>\n<li>Profound <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">dehydration</span> and hyperosmolality</li>\n<li>Hypotension and <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> <strong>(Option A &amp; B)</strong></li>\n<li>Altered mental status</li>\n</ul>\n</li>\n</ul>\n<p>Nausea, vomiting, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, and <strong>Kussmaul respirations</strong> <strong>(Option C)</strong> are<strong> absent</strong> (typical in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> ketoacidosis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Precipitating Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myocardial infarction</li>\n<li>Stroke</li>\n<li>Sepsis and pneumonia</li>\n<li>Other serious infections <strong>(Option D)</strong></li>\n</ul>\n<p>Prior debilitating conditions (e.g., stroke, dementia) or social situations leading to compromised water intake.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Pathophysiology</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Underlying Causes</strong>: Relative<strong> <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong>and<strong> inadequate fluid intake</strong>.</li>\n<li><strong>Mechanisms</strong>:\n\t\t\t\t<ul>\n<li>Insulin <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> leads to:\n\t\t\t\t\t<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> production (<strong>glycogenolysis </strong>and <strong>gluconeogenesis</strong>)</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"6aee31718c16927772019237286270\">utilization</span> in skeletal muscle.</li>\n</ul>\n</li>\n<li>Resulting <span class=\"customMeta\" data-dictid=\"c52b35ebb01692777189131c97fbba\">hyperglycemia</span> causes osmotic diuresis, leading to <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> volume depletion, worsened by inadequate fluid replacement.</li>\n</ul>\n</li>\n<li><strong>Absence of Ketosis</strong> possibly due to:\n\t\t\t\t<ul>\n<li>Less severe <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> compared to DKA.</li>\n<li>Lower levels of counterregulatory hormones and free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids.</li>\n<li>Reduced liver capability for <span class=\"customMeta\" data-dictid=\"296c955ad216927771900bf1905f13\">ketone</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> or an insulin/glucagon ratio unfavourable for ketogenesis.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female with type 1 diabetes presents to the emergency department with increased thirst, frequent urination, nausea, abdominal pain, and signs of dehydration, including dry mucous membranes, tachycardia, and hypotension (BP: 98/60 mmHg). On examination, her vital signs include a heart rate of 110 bpm, respiratory rate of 22 breaths/min, and a blood pressure of 98/60 mmHg. Laboratory results show a blood glucose level of 350 mg/dL, serum bicarbonate of 18 mEq/L, and a pH of 7.30. What is the next step in management based on the ISPAD 2022 guidelines?", "options": [{"label": "A", "text": "Start intravenous fluids and initiate insulin therapy", "correct": true}, {"label": "B", "text": "Administer subcutaneous insulin and monitor glucose", "correct": false}, {"label": "C", "text": "Provide oral hydration and adjust the diet accordingly", "correct": false}, {"label": "D", "text": "Ensure airway patency and consider nasogastric tube insertion", "correct": false}], "correct_answer": "A. Start intravenous fluids and initiate insulin therapy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/v4XeLq3p1nLj2tf6Voln1744296722.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male presents with tachycardia, hypotension, and drowsiness. He has a sweet smell of acetone on his breath. Laboratory results show a random blood sugar of 400 mg/dL, serum bicarbonate level of 12 mEq/L, arterial pH of 7.1, and serum β-hydroxybutyrate level of 6 mmol/L. What diagnosis is most consistent with this patient's condition?", "options": [{"label": "A", "text": "Mild Diabetic Ketoacidosis", "correct": false}, {"label": "B", "text": "Moderate Diabetic Ketoacidosis", "correct": true}, {"label": "C", "text": "Severe Diabetic Ketoacidosis", "correct": false}, {"label": "D", "text": "Hyperglycemic Hyperosmolar State", "correct": false}], "correct_answer": "B. Moderate Diabetic Ketoacidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Severity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mild <span class=\"customMeta\" data-dictid=\"3232faac091692777186b1c8320945\">DKA</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Moderate DKA</strong><strong> (Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Severe <span class=\"customMeta\" data-dictid=\"3232faac091692777186b1c8320945\">DKA</span> </strong><strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum ß-hydroxybutyrate (mmol/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;8</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7.25-7.3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7.0-7.24</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;7.0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">Bicarbonate</span> (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-18</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anion Gap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;12</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mental Status </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alert</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alert/drowsy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stupor/coma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male with poorly controlled type 1 diabetes presents with vomiting and shortness of breath. He appears dehydrated and tachycardic, with a fruity odour on his breath. His lab results show elevated blood glucose and ketones. Which of the following is not a risk factor for his condition?", "options": [{"label": "A", "text": "Infection", "correct": false}, {"label": "B", "text": "Pancreatitis", "correct": false}, {"label": "C", "text": "Hypothyroidism", "correct": true}, {"label": "D", "text": "Inadequate insulin administration", "correct": false}], "correct_answer": "C. Hypothyroidism", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/aIHTt0qiqsRDqpI8saH51744296690.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:513px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Signs </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nausea, vomiting</li>\n<li>Abdominal pain</li>\n<li>Shortness of breath</li>\n<li>Thirst, polyuria</li>\n<li>Weight loss</li>\n<li>Weakness</li>\n<li>Leg cramps</li>\n<li>Blurred vision</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tachycardia</li>\n<li>Dehydration</li>\n<li>Hypotension (postural or supine)</li>\n<li>Tachypnea</li>\n<li>Kussmaul respirations (air hunger)</li>\n<li>Smell of acetone</li>\n<li>Respiratory distress</li>\n<li>Hypothermia</li>\n<li>Cold extremities/peripheral cyanosis</li>\n<li>Abdominal <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> (may resemble <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> abdomen)</li>\n<li>Lethargy/obtundation/cerebral oedema/possibly coma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 28 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 19 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 50-year-old woman visits her physician for a routine check-up. Her laboratory results reveal a fasting plasma glucose level of 104 mg/dL (5.8 mmol/L) and an HbA1c level of 44 mmol/mol (6.2%). Which of the following statements about her condition is correct?", "options": [{"label": "A", "text": "She is diagnosed with type 2 diabetes mellitus.", "correct": false}, {"label": "B", "text": "She meets the criteria for pre-diabetes based on her fasting plasma glucose level.", "correct": true}, {"label": "C", "text": "Her HbA1c level indicates normal glucose metabolism.", "correct": false}, {"label": "D", "text": "She requires immediate insulin therapy.", "correct": false}], "correct_answer": "B. She meets the criteria for pre-diabetes based on her fasting plasma glucose level.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Difference between IFG and IGT</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impaired <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">Fasting</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> (IFG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impaired <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> Tolerance (IGT)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indicates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> regulation after fasting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity or inadequate <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> production after sugar intake</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IFG suggests early <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance or beta-cell dysfunction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IGT indicates a more pronounced <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> impairment.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Criterion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impaired <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">Fasting</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> (IFG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose: ≥ 6.1 mmol/L (110 mg/dL) &lt; 7.0 mmol/L (126 mg/dL) <strong>(Option A ruled out)</strong></li>\n<li><strong>The American Diabetes Association suggests a lower limit of ≥ 100 mg/dL (5.6 mmol/L)</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impaired <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> Tolerance (IGT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose: &lt; 126 mg/dL (7.0 mmol/L)</li>\n<li>2-hour <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> after 75 g oral <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> drink: 140–200 mg/dL (7.8–11.1 mmol/L).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HbA1c Criteria</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NICE guidelines: <strong>6.0% to 6.4%</strong> (42–47 mmol/mol)</li>\n<li>American Diabetes Association: <strong>5.7% to 6.4%</strong> (39–47 mmol/mol)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle Modifications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Weight Management</strong>: Healthy weight through diet and exercise.</li>\n<li><strong>Healthy Eating</strong>: <span class=\"customMeta\" data-dictid=\"3ab0d6410a1692777182a1727e39c0\">Balanced diet</span> low in <span class=\"customMeta\" data-dictid=\"bd2ac838bb16927771983dd9afc74c\">saturated</span> fat, cholesterol, and sugars; high in fiber, fruits, and vegetables.</li>\n<li><strong>Physical Activity</strong>: At least 150 minutes of moderate-intensity <span class=\"customMeta\" data-dictid=\"789c9dd31a16927771801dd2426384\">aerobic</span> exercise weekly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular Risk Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aggressive management of <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and <span class=\"customMeta\" data-dictid=\"95da2a74fd16927771868f3b14d351\">dyslipidemia</span> to reduce <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consider metformin to delay <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes, if necessary.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is most characteristic of Type 3 Diabetes (T3DM)?", "options": [{"label": "A", "text": "Insulin resistance affecting the muscles and fat tissue", "correct": false}, {"label": "B", "text": "Primarily affects cognitive functions like memory due to insulin resistance in the brain", "correct": true}, {"label": "C", "text": "No connection to Alzheimer's disease", "correct": false}, {"label": "D", "text": "Treated solely through oral hypoglycemic agents", "correct": false}], "correct_answer": "B. Primarily affects cognitive functions like memory due to insulin resistance in the brain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Insulin Resistance in Brain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurons cannot effectively respond to insulin, impairing cognitive functions like memory.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Connection to AD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AD is associated with impaired <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> signalling, leading some to label it as \"diabetes of the brain.\"</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> signalling leads to amyloid-beta plaques, <span class=\"customMeta\" data-dictid=\"349c5a4f5d169277720062d348498a\">tau</span> tangles, <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress, and neuroinflammation, contributing to <span class=\"customMeta\" data-dictid=\"88a68ed2991692777193a28c3c0047\">neurodegeneration</span> and cognitive decline.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Approach</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Insulin Sensitizers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medications improving <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity could have neuroprotective effects.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lifestyle Interventions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diet and exercise <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> health may slow AD <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> and benefit cognition.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is most characteristic of Latent Autoimmune Diabetes in Adulthood (LADA)?", "options": [{"label": "A", "text": "Rapid β-cell destruction similar to type 1 diabetes", "correct": false}, {"label": "B", "text": "Absence of islet autoantibodies", "correct": false}, {"label": "C", "text": "Gradual β-cell destruction and eventual insulin requirement", "correct": true}, {"label": "D", "text": "Complete management through lifestyle modifications and oral antidiabetic agents", "correct": false}], "correct_answer": "C. Gradual β-cell destruction and eventual insulin requirement", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autoimmune Basis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> autoantibodies (e.g., <span class=\"customMeta\" data-dictid=\"ef6f26536a16927771877f4b494a87\">GAD</span> antibodies) indicating <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> β-cell destruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Slower Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual β-cell destruction; patients may not initially require <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> but will eventually need it.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnostic Challenge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often confused with <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes; <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> autoantibodies help in distinguishing it.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Consideration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Early Identification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Timely recognition is essential for preserving β-cell function with early <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> initiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment Strategies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initially managed like <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes (lifestyle changes, oral medications); <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> therapy needed later.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Monitoring and Education</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular monitoring (glucose, HbA1c, <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> autoantibodies) and patient education on self-management are crucial.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is required to diagnose complete remission of Type 2 Diabetes Mellitus (T2DM)?", "options": [{"label": "A", "text": "HbA1c below 6.5% and fasting glucose between 100 and 124 mg/dL without treatment", "correct": false}, {"label": "B", "text": "HbA1c below 6.0% and fasting glucose below 100 mg/dL sustained without treatment", "correct": true}, {"label": "C", "text": "HbA1c below 7.0% and fasting glucose below 110 mg/dL with lifestyle modifications", "correct": false}, {"label": "D", "text": "HbA1c below 6.5% for at least six months without medication", "correct": false}], "correct_answer": "B. HbA1c below 6.0% and fasting glucose below 100 mg/dL sustained without treatment", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male with thalassemia major presents to the clinic with increased fatigue, joint pain, and symptoms of hyperglycemia. On examination, he has a discoloration of the skin as shown. His medical history includes multiple blood transfusions over the years. Which of the following is the most appropriate initial step in managing his condition?", "options": [{"label": "A", "text": "Initiate a low-carbohydrate diet", "correct": false}, {"label": "B", "text": "Start iron chelation therapy", "correct": false}, {"label": "C", "text": "Begin insulin therapy", "correct": true}, {"label": "D", "text": "Schedule a follow-up for skin assessment", "correct": false}], "correct_answer": "C. Begin insulin therapy", "question_images": ["https://image.prepladder.com/notes/g1X6wvoZx5dfd3cCOo3o1744283402.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">thalassemia</span> major</li>\n<li>Regular blood transfusions cause pancreatic iron overload, impairing <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> secretion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typical diabetes symptoms (hyperglycemia)</li>\n<li>Joint pain and fatigue</li>\n<li>Skin changes less prominent in darker complexions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often after <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> ketoacidosis</li>\n<li>Elevated blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"91d0e4c6fa16927772025f96b44b27\">ferritin</span> indicating iron overload</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Insulin Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Many patients require <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> for effective blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> management.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Iron <span class=\"customMeta\" data-dictid=\"11199cbd1816927771841f1eb35b86\">Chelation</span> Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps reduce body iron levels, mitigating complications from iron overload.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Regular Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous assessment of blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"91d0e4c6fa16927772025f96b44b27\">ferritin</span> is crucial to prevent complications.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following genetic factors is most strongly associated with an increased risk of developing Type 1 Diabetes Mellitus (T1DM) in Caucasians?", "options": [{"label": "A", "text": "HLA-B27", "correct": false}, {"label": "B", "text": "HLA-DR3/DR4", "correct": true}, {"label": "C", "text": "CD25 gene mutations", "correct": false}, {"label": "D", "text": "SH2B3 gene polymorphisms", "correct": false}], "correct_answer": "B. HLA-DR3/DR4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Viral Infections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mumps, Coxsackie B4, <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">Rubella</span> (in utero), Cytomegalovirus, Epstein–Barr</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chemicals/Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nitrosamines (from smoked meats), coffee, <span class=\"customMeta\" data-dictid=\"270c00aff316927771839a8749b963\">BSA</span> (bovine <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> albumin) in cow’s milk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Dietary Hypotheses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hygiene hypothesis (reduced exposure to microorganisms in early childhood might increase <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disease susceptibility.)</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> levels</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old man with a family history of diabetes presents with a diagnosis of MODY confirmed by genetic testing. He exhibits stable mild hyperglycemia and has normal renal function. Which of the following subtypes of MODY is most likely responsible for his condition?", "options": [{"label": "A", "text": "MODY1", "correct": false}, {"label": "B", "text": "MODY2", "correct": true}, {"label": "C", "text": "MODY3", "correct": false}, {"label": "D", "text": "MODY5", "correct": false}], "correct_answer": "B. MODY2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:567px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gene Mutated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β-cell <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> Sensing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MODY2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GCK</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mutations lead to altered <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> sensing.</li>\n<li>Results in mild, stable hyperglycemia.</li>\n<li>High <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">fasting</span> glucose; normal <span class=\"customMeta\" data-dictid=\"5e98c7ac6916927771967b424f152e\">postprandial</span> response.</li>\n<li>Rarely requires treatment; low risk of complications.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β-cell Transcriptional Regulation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MODY1 </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HNF4α</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves mutations affecting β-cell function.</li>\n<li>Progressive diabetes requiring treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MODY3 </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HNF1α</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Similar to MODY1 in progressive nature.</li>\n<li>Responds well to sulfonylureas.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MODY5 </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HNF1β</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> abnormalities (e.g., <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> disease).</li>\n<li>May cause <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> malformations.</li>\n<li>Approximately 50% develop diabetes early in life.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male with type 2 diabetes presents for a routine check-up. His medical history includes hypertension and smoking. Laboratory results show elevated LDL cholesterol levels. He is concerned about long-term complications of diabetes. Which of the following is the most important strategy to reduce his risk of macrovascular complications?", "options": [{"label": "A", "text": "Tight glycaemic control only", "correct": false}, {"label": "B", "text": "Smoking cessation and statin therapy", "correct": true}, {"label": "C", "text": "Use of oral antihypertensives", "correct": false}, {"label": "D", "text": "Initiating low-dose aspirin therapy", "correct": false}], "correct_answer": "B. Smoking cessation and statin therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:583px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased Rate in Diabetics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Cardiovascular death</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.7 times higher</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Myocardial infarction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.8 times greater</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Stroke hospitalisation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5 times higher</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Non-traumatic amputations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60% occur in diabetics</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>First <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> event (type 1)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 times higher in women, 2.3 times higher in men</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient with poorly controlled diabetes mellitus presents with various complications. Which of the following conditions is not classified as a microvascular complication of diabetes mellitus?", "options": [{"label": "A", "text": "Thickening of capillary basement membranes", "correct": false}, {"label": "B", "text": "Increased vascular permeability", "correct": false}, {"label": "C", "text": "Development of diabetic foot ulcers", "correct": true}, {"label": "D", "text": "Retinal ischemia develops over time leading to neovascularization", "correct": false}], "correct_answer": "C. Development of diabetic foot ulcers", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology and Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Strategies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetic Retinopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Prolonged hyperglycemia</strong> causes biochemical changes that <strong>damage <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> blood vessels.</strong></li>\n<li><strong>Thickening of the <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> basement membrane</strong> occurs.</li>\n<li><strong>Increased <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> permeability</strong> causing microaneurysms.</li>\n<li><strong>Retinal ischemia</strong> develops over time, contributing to neovascularization. <strong>(Option D ruled out)</strong></li>\n<li><strong>Inflammatory mediators and <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Regular eye examination, laser therapy, and additional treatments as needed.</li>\n<li>Initial screening:\n\t\t\t\t<ul>\n<li>Type I DM - 3 to 5 years after diagnosis</li>\n<li>Type II DM - at the time of diagnosis</li>\n</ul>\n</li>\n<li>Screening is conducted annually, and if the results remain normal over time, it can be done once every two years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetic Nephropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early stages</strong>: hyperfiltration</li>\n<li><strong>Later stages:</strong> sustained proteinuria, nephrotic-range proteinuria, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n<li><strong>Microalbuminuria</strong> predicts <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> in type 1, less reliable in type 2.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aggressive <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> control (ACE inhibitors or ARBs),</li>\n<li>Lifestyle changes (diet, exercise),</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> replacement therapy in later stages</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetic Neuropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Axonal degeneration, schwann cell thickening, demyelination.</li>\n<li>Classifications include <strong>symmetrical <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> polyneuropathy, asymmetrical motor <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> neuropathy, mononeuropathy, and <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> neuropathy.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain management (anticonvulsants, antidepressants, <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> agents) and lifestyle modifications (glycemic control, exercise) to manage symptoms and slow progression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetic Foot Ulcers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Trauma</strong>: Minor injuries can lead to ulceration</li>\n<li><strong>Neuropathy</strong>: Loss of sensation causes unawareness of injuries.</li>\n<li><strong>Structural foot changes</strong>, increasing pressure points and <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation.</li>\n<li><strong>Charcot neuroarthropathy: </strong>deformities in foot bones and joints.</li>\n<li><strong>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Disease: </strong>Impaired <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> hampers wound <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> and raises infection and <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> risk. <strong>(macrovascular complication)</strong></li>\n<li><strong>Callus Formation</strong>: Thickened skin areas can lead to <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> beneath, resulting in ulceration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Patient Education:</strong> Educate patients on daily foot inspections, proper hygiene, appropriate footwear, and prompt care for minor injuries.</li>\n<li><strong>Multidisciplinary Team Approach</strong>: Refer patients to a team including diabetes specialists, podiatrists, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> surgeons, and orthotists for comprehensive care.</li>\n<li><strong>Debridement and Infection Control:</strong> Remove necrotic tissue and administer timely <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy to manage infections.</li>\n<li><strong>Pressure Relief Strategies</strong>: Utilize custom insoles, orthotic footwear, total contact casts, or aircast boots to alleviate pressure on the ulcer.</li>\n<li><strong>Revascularization and Amputation:</strong> Consider <span class=\"customMeta\" data-dictid=\"7f442dd07516927771814b59deffff\">angioplasty</span> or surgery for neuro-ischemic ulcers; perform amputations if severe infection or <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> is present.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man had an HbA1c of 6.1% during a routine check-up. He asks his physician about the best management strategy to prevent future progression of the disease. Which of the following is the most effective approach?", "options": [{"label": "A", "text": "Starting medication immediately to control blood sugar levels", "correct": false}, {"label": "B", "text": "Undergoing bariatric surgery for weight loss", "correct": false}, {"label": "C", "text": "Implementing lifestyle modifications, including diet and exercise", "correct": true}, {"label": "D", "text": "Monitoring blood glucose levels without any other changes", "correct": false}], "correct_answer": "C. Implementing lifestyle modifications, including diet and exercise", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Healthy Eating</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Focus on a balanced diet, limiting total and <span class=\"customMeta\" data-dictid=\"bd2ac838bb16927771983dd9afc74c\">saturated</span> fats.</li>\n<li>Moderate carbohydrate <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> (≤ 50% of daily calories) with &lt; 11% from added sugars.</li>\n<li>Consider low <span class=\"customMeta\" data-dictid=\"b5f500def916927771888b49285ac6\">glycemic</span> index (GI) foods (e.g., whole grains, legumes).</li>\n<li>Aim for at least five servings of fruits and vegetables daily.</li>\n<li>Consult a registered <span class=\"customMeta\" data-dictid=\"15975912521692777186d6b980aa96\">dietitian</span> for personalized advice.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weight Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight loss is crucial for overweight/obese individuals to improve <span class=\"customMeta\" data-dictid=\"b5f500def916927771888b49285ac6\">glycemic</span> control.</li>\n<li>Calorie restriction is essential for achieving weight loss.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular Physical Activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise weekly.</li>\n<li>Include muscle-strengthening exercises twice a week.</li>\n<li>Minimize <span class=\"customMeta\" data-dictid=\"484e72500916927771982789485f51\">sedentary</span> time (&gt;90 minutes of inactivity).</li>\n<li>Seek guidance for managing exercise-related hypoglycemia, especially in individuals with <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> diabetes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alcohol Moderation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Follow recommended alcohol <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> guidelines to avoid hypoglycemia.</li>\n<li>Consume alcohol with food to <span class=\"customMeta\" data-dictid=\"a3b8e7d7ec1692777192646b2c8f69\">mitigate</span> risks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Smoking Cessation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Quit smoking to lower the risk of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease and other health issues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Schedule regular checkups to monitor <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels, blood pressure, and <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> profiles.</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risk factors aggressively.</li>\n<li>Consider early intervention with medications like metformin if necessary.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old girl presents with increased thirst, frequent urination, and fatigue over the past few weeks. Her parents mention that she has lost weight despite having a normal appetite. On examination, she appears dehydrated and has a fruity-smelling breath. Blood tests reveal a plasma glucose level of 350 mg/dL and a positive urine ketone test. Which of the following is true for this condition?", "options": [{"label": "A", "text": "Auto-antibody present is anti-ICA", "correct": true}, {"label": "B", "text": "Increased fasting insulin levels", "correct": false}, {"label": "C", "text": "Polygenic cause", "correct": false}, {"label": "D", "text": "Due to recent hormonal changes", "correct": false}], "correct_answer": "A. Auto-antibody present is anti-ICA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type of DM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 1 DM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Pediatric onset</li>\n<li>Autoimmune destruction of &gt;80% <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells due to <span class=\"customMeta\" data-dictid=\"b1debe2a7c16927771890479332d98\">HLA</span> association</li>\n<li>Leads to insulinopenia</li>\n<li><strong>Auto-antibody: anti-ICA</strong></li>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> (utilizes <span class=\"customMeta\" data-dictid=\"296c955ad216927771900bf1905f13\">ketone</span> bodies for energy)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 2 DM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Relative <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">fasting</span> <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> levels (radioimmune <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> levels) <strong>(Option B)</strong></li>\n<li>Polygenic cause <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>MODY (Maturity Onset Diabetes of the Young)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Monogenic form</li>\n<li>Autosomal <span class=\"customMeta\" data-dictid=\"18e7ddb7841692777186f7e78b2206\">dominant inheritance</span> pattern</li>\n<li>Expressed in every generation</li>\n<li>At least 2 consecutive generations with DM history</li>\n<li>It resembles <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">Type 2</span> diabetes but usually occurs in younger individuals.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gestational <span class=\"customMeta\" data-dictid=\"b6a934c67b16927771868fca92baf9\">Diabetes Mellitus</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Defined as:</p>\n<p>1. <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &gt; 140 mg/dL after 75g of <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> (WHO criteria)</p>\n<p>2. After 100g <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> (Carpenter/Coustan <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> criteria - <span class=\"customMeta\" data-dictid=\"7cdf82ff98169277718029b0e108aa\">ADA</span> criteria):</p>\n<ul>\n<li>1 hr later, <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> ≥ 180 mg/dL</li>\n<li>2 hr later, <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> ≥ 155 mg/dL</li>\n<li>3 hr later, <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> ≥ 140 mg/dL</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presents for a routine check-up. She is overweight but has no family history of diabetes or hypertension. According to the American Diabetes Association (ADA) guidelines, what is the most appropriate screening recommendation for her?", "options": [{"label": "A", "text": "No screening is necessary until age 60.", "correct": false}, {"label": "B", "text": "Screen now and re-screen every 3 years if normal.", "correct": true}, {"label": "C", "text": "Screen every year regardless of results.", "correct": false}, {"label": "D", "text": "Screen only if symptoms of diabetes appear.", "correct": false}], "correct_answer": "B. Screen now and re-screen every 3 years if normal.", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:565px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Population</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First Screening Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rescreening Frequency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>45 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 3 years if normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overweight/Obese Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on individual risk factors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Individuals with Prediabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N/A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Annually</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Risk Ethnic Groups</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;45 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 3 years if normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnant Women</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>During pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>As needed based on risk factors</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A glucagon-stimulated C-peptide test is performed on a patient receiving exogenous insulin therapy. Which of the following findings is most likely in a patient with long-standing type 1 diabetes?", "options": [{"label": "A", "text": "Elevated serum C-peptide levels after glucagon stimulation", "correct": false}, {"label": "B", "text": "Decreased or absent serum C-peptide levels", "correct": true}, {"label": "C", "text": "Normal C-peptide levels but reduced blood glucose response", "correct": false}, {"label": "D", "text": "Elevated C-peptide levels with low insulin resistance", "correct": false}], "correct_answer": "B. Decreased or absent serum C-peptide levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:609px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Baseline sample</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Draw blood to measure the initial C-peptide level.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucagon injection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inject <span class=\"customMeta\" data-dictid=\"c4d90ebfde1692777188e3689c1753\">glucagon</span> to stimulate <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> production.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follow-up samples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Take blood samples at intervals (e.g., 30 &amp; 60 minutes) post-injection.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old male with type 2 diabetes presents for a follow-up after recent medication changes. His physician wants to assess how well his blood glucose levels have been controlled over the past few weeks. Which of the following tests is the most appropriate for short-term monitoring of his glycemic control?", "options": [{"label": "A", "text": "HbA1c", "correct": false}, {"label": "B", "text": "Fructosamine", "correct": true}, {"label": "C", "text": "Fasting Blood Glucose", "correct": false}, {"label": "D", "text": "Oral Glucose Tolerance Test (OGTT)", "correct": false}], "correct_answer": "B. Fructosamine", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference Ranges</li><li>↳ Population Fructosamine Levels (µmol/L) Non-diabetic 200–285 Diabetic (poor control) Elevated above 285</li><li>↳ Population Fructosamine Levels (µmol/L)</li><li>↳ Population</li><li>↳ Population</li><li>↳ Population</li><li>↳ Fructosamine Levels (µmol/L)</li><li>↳ Fructosamine Levels (µmol/L)</li><li>↳ Fructosamine Levels (µmol/L)</li><li>↳ Non-diabetic 200–285</li><li>↳ Non-diabetic</li><li>↳ Non-diabetic</li><li>↳ 200–285</li><li>↳ 200–285</li><li>↳ Diabetic (poor control) Elevated above 285</li><li>↳ Diabetic (poor control)</li><li>↳ Diabetic (poor control)</li><li>↳ Elevated above 285</li><li>↳ Elevated above 285</li><li>↳ Comparison to HbA1c : HbA1c reflects glucose over 2-3 months . (Option A ruled out) Comparison to Fasting, Postprandial Plasma Glucose and OGTT: Provide only single-time-point results. (Options C &amp; D ruled out)</li><li>↳ Comparison to HbA1c : HbA1c reflects glucose over 2-3 months . (Option A ruled out)</li><li>↳ Comparison to HbA1c</li><li>↳ 2-3 months</li><li>↳ (Option A ruled out)</li><li>↳ Comparison to Fasting, Postprandial Plasma Glucose and OGTT: Provide only single-time-point results. (Options C &amp; D ruled out)</li><li>↳ Comparison to Fasting, Postprandial Plasma Glucose and OGTT:</li><li>↳ single-time-point results.</li><li>↳ (Options C &amp; D ruled out)</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:385px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Population</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fructosamine Levels (µmol/L)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-diabetic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>200–285</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diabetic (poor control)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated above 285</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old obese woman with no acute symptoms presents for routine screening. Given her family history of diabetes, which diagnostic test would provide the most reliable indication of her glycemic status and aid in the early detection of diabetes?", "options": [{"label": "A", "text": "Fasting Plasma Glucose (FPG)", "correct": false}, {"label": "B", "text": "Oral Glucose Tolerance Test (OGTT)", "correct": false}, {"label": "C", "text": "Random Plasma Glucose (RPG)", "correct": false}, {"label": "D", "text": "Glycated Hemoglobin (HbA1c)", "correct": true}], "correct_answer": "D. Glycated Hemoglobin (HbA1c)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a history of hypertension presents for a routine check-up. He has no symptoms but is concerned about his blood sugar levels. His lab results show: Fasting plasma glucose: 128 mg/dL (7.1 mmol/L) HbA1c: 6.7% What is the next best step?", "options": [{"label": "A", "text": "Repeat fasting plasma glucose for confirmation", "correct": true}, {"label": "B", "text": "Perform an oral glucose tolerance test (OGTT)", "correct": false}, {"label": "C", "text": "Start lifestyle modifications and monitor for pre-diabetes", "correct": false}, {"label": "D", "text": "Diagnose diabetes mellitus and initiate treatment", "correct": false}], "correct_answer": "A. Repeat fasting plasma glucose for confirmation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Threshold for Diabetes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Random <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 200 mg/dL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 126 mg/dL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tolerance test (OGTT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 200 mg/dL after 2 hours with 75 g glucose.</p>\n<p>OGTT is not necessary if <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">fasting</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> is already in the <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> range. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glycated <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> (HbA1c)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 5.7% : Normal</p>\n<p>5.7% - 6.5% : Pre-diabetic</p>\n<p>&gt; 6.5% : Diabetic</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> Range</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impaired <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">fasting</span> glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>110–125 mg/dL (6.1–6.9 mmol/L) <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impaired <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tolerance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fasting &lt; 126 mg/dL + 2-hour OGTT: 140–200 mg/dL (7.8–11.1 mmol/L).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Islet Autoantibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> diabetes (autoimmune destruction).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C-peptide Measurement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Differentiates <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> (low C-peptide) vs. severe <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance (high C-peptide).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Protein Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"b7fa8406071692777192aecab2b359\">microalbuminuria</span> for <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> and <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lipid Profile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifies dyslipidemia, a common <span class=\"customMeta\" data-dictid=\"2b6f1f59f91692777184d312ca7e13\">comorbidity</span> in diabetes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver and <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects abnormalities related to diabetes complications.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is most likely to cause drug-induced diabetes by impairing insulin secretion from the pancreas?", "options": [{"label": "A", "text": "Glucocorticoids", "correct": false}, {"label": "B", "text": "Thiazide diuretics", "correct": true}, {"label": "C", "text": "Phenytoin", "correct": false}, {"label": "D", "text": "β-lactam antibiotics", "correct": false}], "correct_answer": "B. Thiazide diuretics", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Note</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can cause temporary or <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thiazide diuretics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impair <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to treat hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phenytoin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible liver-related mechanism <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anticonvulsant medication</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:423px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β-lactam antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Interfere with <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tests <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Levodopa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May cause <span class=\"customMeta\" data-dictid=\"b0151941a0169277720265b58da84e\">false-positive</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> results</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salicylates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affect <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> measurements in urine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with complaints of progressive changes in his appearance over the past few years. He notes that his shoes no longer fit, and his wedding ring feels tight on his finger. His wife has remarked that he seems to have developed more pronounced facial features. He also reports excessive sweating and occasional headaches. On examination, there is noticeable frontal bossing. Which of the following complications is most likely associated with his condition?", "options": [{"label": "A", "text": "Microglossia", "correct": false}, {"label": "B", "text": "Hypotension", "correct": false}, {"label": "C", "text": "Diabetes mellitus", "correct": true}, {"label": "D", "text": "High-pitched voice", "correct": false}], "correct_answer": "C. Diabetes mellitus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes of Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pancreatic Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Damage to the <span class=\"customMeta\" data-dictid=\"938890efd616927771870f4a611546\">exocrine</span> component of the pancreas</li>\n<li>Cystic fibrosis: common cause</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Causes <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> and <span class=\"customMeta\" data-dictid=\"0e5348eb421692777199f7a9fc4b0c\">steatorrhea</span> due to <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">malabsorption</span> and DM manifestations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic pancreatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Insulinopenia occurs due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cell mass.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lack of <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> leads to elevated blood sugar</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Endocrinopathies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acromegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Increased growth hormone (GH) levels lead to <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pheochromocytoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> or <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> levels cause elevated blood sugar, palpitations, and sweating.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Cushing's Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Grossly elevated <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels lead to <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance and DM.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Medications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Steroids</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Long-term use can induce <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Immunomodulators</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>mTOR inhibitors and <span class=\"customMeta\" data-dictid=\"746f157681169277718323a004b1d4\">calcineurin</span> inhibitors can affect <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> metabolism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Thiazides</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hydrochlorothiazide may cause elevated HbA1c values, leading to impaired <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tolerance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Propranolol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>It can affect <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> metabolism, and it is used for <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> and anxiety management.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Antipsychotics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Some <span class=\"customMeta\" data-dictid=\"4123308aeb1692777181e8820312dd\">antipsychotic</span> medications can lead to weight gain and <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Type 1.5 Diabetes Mellitus is incorrect?", "options": [{"label": "A", "text": "Characterized by autoimmune destruction of beta cells", "correct": false}, {"label": "B", "text": "Patients are typically diagnosed in childhood", "correct": true}, {"label": "C", "text": "It is often misdiagnosed as Type 2 DM", "correct": false}, {"label": "D", "text": "C-peptide levels decline more slowly compared to Type 1 DM", "correct": false}], "correct_answer": "B. Patients are typically diagnosed in childhood", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 29 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 19 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 60-year-old male with type 2 diabetes comes with symptoms such as flushing, nausea, and palpitations after consuming alcohol. What is the mechanism of action of the drug likely causing these symptoms?", "options": [{"label": "A", "text": "Inhibits hepatic gluconeogenesis", "correct": false}, {"label": "B", "text": "Inhibits the breakdown of GLP-1", "correct": false}, {"label": "C", "text": "Blocks the reabsorption of glucose in PCT", "correct": false}, {"label": "D", "text": "Closes ATP-sensitive potassium channels of the pancreas", "correct": true}], "correct_answer": "D. Closes ATP-sensitive potassium channels of the pancreas", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sulfonylureas</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>First Generation: Chlorpropamide, Tolbutamide</li>\n<li>Second Generation: Glipizide, Glyburide, Glimepiride</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism of Action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acts on ATP-sensitive <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> channels:</strong></p>\n<p>Closes K+ channels in pancreatic <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cell <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> → cell depolarizes → <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> release via increased Ca2+ influx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Drug of choice for patients where metformin is contraindicated</li>\n<li>It can be added in combination with other <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">hypoglycemic</span> drugs or insulin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hypoglycemia</li>\n<li>Weight gain</li>\n<li>Disulfiram-like reaction (first-generation sulfonylureas only)</li>\n<li>Longer-acting</li>\n</ul>\n<p><strong>Side effects of 1st generation <span class=\"customMeta\" data-dictid=\"552023be76169277719976e36a990e\">sulfonylurea</span> (Chlorpropamide):</strong> cholestatic jaundice, SIADH, and disulfiram-like reaction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Avoid in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> porphyria</li>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Hepatic dysfunction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman with poorly controlled diabetes mellitus presents to the emergency department with fever, facial pain, and a black necrotic eschar on her nasal turbinates. A CT scan shows sinus involvement and possible extension to the brain. What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Oral antifungal therapy", "correct": false}, {"label": "B", "text": "Immediate surgical debridement and intravenous amphotericin B", "correct": true}, {"label": "C", "text": "Intravenous antibiotics only", "correct": false}, {"label": "D", "text": "Observation and supportive care", "correct": false}], "correct_answer": "B. Immediate surgical debridement and intravenous amphotericin B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe fungal infection affecting <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages, sinuses, and brain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily caused by <em>Rhizopus oryzae</em>, associated with uncontrolled DM and <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> (DKA).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Begins in <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> turbinates; progresses rapidly due to <span class=\"customMeta\" data-dictid=\"c5ef9f5e371692777181b43f888174\">angioinvasive</span> nature, causing tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> pain, swelling, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge, necrotic eschar.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imaging studies and histopathological examination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate <span class=\"customMeta\" data-dictid=\"c929a2b71516927771812a8b7b7ec3\">antifungal</span> therapy (e.g., amphotericin B) and aggressive <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> debridement.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> with gas formation in the wall; more common in diabetics.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gas-forming bacteria cause <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> wall necrosis; <span class=\"customMeta\" data-dictid=\"c52b35ebb01692777189131c97fbba\">hyperglycemia</span> exacerbates infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal pain, fever, signs of sepsis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imaging (ultrasound/CT) showing gas in the <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> wall.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical intervention (cholecystectomy) and <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kidney infection is often caused by uropathogenic bacteria, a significant risk for diabetics.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> to <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs) leading to <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> pyelonephritis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flank pain, fever, chills, dysuria.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinalysis and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies if complications arise.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibiotics based on culture and sensitivity; <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> may be necessary for severe cases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman with a 10-year history of type 2 diabetes presents for a routine eye examination. On examination, she is found to have microaneurysms, retinal haemorrhages, and cotton wool spots. What is the most effective management option for her symptomatic foveal oedema?", "options": [{"label": "A", "text": "Pan-retinal laser photocoagulation", "correct": false}, {"label": "B", "text": "Intravitreal anti-VEGF injections", "correct": true}, {"label": "C", "text": "Corticosteroid injections", "correct": false}, {"label": "D", "text": "Routine observation and follow-up", "correct": false}], "correct_answer": "B. Intravitreal anti-VEGF injections", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Capillary <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> visible only on <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> angiography.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microaneurysms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Form on occluded capillaries, leaking fluid and blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oedema and Haemorrhages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by leakage; lipids <span class=\"customMeta\" data-dictid=\"eba5ba77ec169277719688fab52fb0\">precipitate</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> exudate.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Capillary Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occluded capillaries turn white and disappear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retinal Ischaemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larger patches <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> as more capillaries occlude.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>New Vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grow at the border of diseased and non-diseased <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> due to increased <span class=\"customMeta\" data-dictid=\"acec296d051692777201ef9eae77fa\">VEGF</span> from ischaemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraretinal <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">Microvascular</span> Abnormalities (IRMAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Form from partially perfused capillaries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous Beading</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Develops in <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> veins (multiple <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> swellings).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flame Haemorrhages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Horizontal streaky haemorrhages in the <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> nerve-fibre layer.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cotton <span class=\"customMeta\" data-dictid=\"eaae57387d1692777202060f299953\">Wool</span> Spots</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Located in the nerve-fibre layer, usually found <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> to the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male with a 15-year history of type 2 diabetes presents for routine evaluation. He has poorly controlled blood sugar levels, and reports increased urination. Urinalysis reveals microalbuminuria. Which of the following management strategies is most crucial in slowing the progression of diabetic nephropathy in this patient?", "options": [{"label": "A", "text": "Strict glycemic control using insulin therapy", "correct": false}, {"label": "B", "text": "Aggressive blood pressure control using ACE inhibitors", "correct": true}, {"label": "C", "text": "Dietary modification to reduce protein intake", "correct": false}, {"label": "D", "text": "Initiation of statin therapy regardless of cholesterol levels", "correct": false}], "correct_answer": "B. Aggressive blood pressure control using ACE inhibitors", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serious <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> and <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes; leads to <span class=\"customMeta\" data-dictid=\"c1698e06b516927771872ba662218d\">end-stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</span> in 20-50% of patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Damage to small blood vessels (diabetic microangiopathy); characterized by <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> thickening, increased permeability, and <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> accumulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperglycemia activates the renin-angiotensin system.</p>\n<p>Prolonged <span class=\"customMeta\" data-dictid=\"c52b35ebb01692777189131c97fbba\">hyperglycemia</span> causes <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fibrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early <span class=\"customMeta\" data-dictid=\"344f1a5f1d1692777189baf272aa1b\">hyperfiltration</span> declines over ~10 years; <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> develops, reaching <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">nephrotic</span> range by ~14 years.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor <span class=\"customMeta\" data-dictid=\"b5f500def916927771888b49285ac6\">glycemic</span> control, long diabetes duration, other <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> complications, ethnicity (Asians, <span class=\"customMeta\" data-dictid=\"ff75d4a77416927771953b13bd97f8\">Pima</span> Indians), pre-existing hypertension, family history.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microalbuminuria detected via albumin-to-creatinine ratio; overt <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> diagnosed with macroalbuminuria (&gt;300 mg/24 hrs).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Goals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slow <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage progression; manage <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Strategies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood pressure control: <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors or ARBs.</p>\n<p>Glycemic control: strict management.</p>\n<p>Cardiovascular risk management: address smoking, hypertension, and consider <span class=\"customMeta\" data-dictid=\"389305b4521692777198497cf9c88b\">statin</span> therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular monitoring of electrolytes and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function when using <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors/ARBs; alternatives for those intolerant.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a 15-year history of diabetes presents with numbness and tingling in his feet. On examination, he shows diminished vibration sensation in a \"glove and stocking\" distribution and has absent ankle reflexes. Which of the following features is most characteristic of diabetic neuropathy?", "options": [{"label": "A", "text": "Distal muscle weakness with atrophy of the interosseous muscles", "correct": false}, {"label": "B", "text": "Thickening of the Schwann cell basal lamina", "correct": true}, {"label": "C", "text": "Acute onset of unilateral symptoms", "correct": false}, {"label": "D", "text": "Presence of significant sensory loss in the hands", "correct": false}], "correct_answer": "B. Thickening of the Schwann cell basal lamina", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>50–90% of people with diabetes; 15–30% develop painful neuropathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Axonal <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> (myelinated/unmyelinated fibers)</li>\n<li>Thickened Schwann cell <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> lamina</li>\n<li>Patchy demyelination</li>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"b8876b135a1692777190bc28bb3e7f\">intraneural</span> capillaries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Somatic</strong>: <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">Symmetrical</span> <span class=\"customMeta\" data-dictid=\"04863b50b516927771967b59757561\">polyneuropathy</span> (sensory, distal), Asymmetrical <span class=\"customMeta\" data-dictid=\"04863b50b516927771967b59757561\">polyneuropathy</span> (motor, proximal), Mononeuropathy</li>\n<li><strong>Visceral</strong>: <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">Autonomic</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (various systems)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Symmetrical <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> Polyneuropathy</strong>: Paresthesia, pain, burning sensations, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> gait</li>\n<li><strong>Asymmetrical Motor Neuropathy</strong>: Muscle weakness, pain, weight loss, absent reflexes</li>\n<li><strong>Autonomic Neuropathy</strong>: Affects visceral systems</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastroparesis Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic nausea, <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> of undigested food, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, early satiety</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glycemic control (intensive <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> therapy)</li>\n<li>Anticonvulsants (gabapentin, pregabalin)</li>\n<li>Tricyclic antidepressants (amitriptyline, imipramine)</li>\n<li>Other antidepressants (duloxetine)</li>\n<li>Topical treatments (capsaicin)</li>\n<li>Opiates (tramadol, oxycodone)</li>\n<li>Membrane stabilizers (mexiletine)</li>\n<li>Antioxidants (alpha-lipoic acid)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetic Foot Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk of ulcers from neuropathy/peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease; management includes preventative care and treatment tailored to ulcers</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following mechanisms best explains the development of insulin resistance in individuals with obesity and type 2 diabetes?", "options": [{"label": "A", "text": "Increased glucose uptake in peripheral tissues", "correct": false}, {"label": "B", "text": "Reduced gluconeogenesis in the liver", "correct": false}, {"label": "C", "text": "Free fatty acid competition with glucose for oxidation in muscle", "correct": true}, {"label": "D", "text": "Increased release of insulin-sensitive kinases", "correct": false}], "correct_answer": "C. Free fatty acid competition with glucose for oxidation in muscle", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obesity &amp; Central Adiposity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visceral fat releases free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids (FFAs) that interfere with <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> metabolism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adipokines from <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">Adipose</span> Tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hormones released by fat cells alter <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visceral Fat &amp; Liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Portal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> from visceral fat impacts liver <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity and gluconeogenesis.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Guidelines for <span class=\"customMeta\" data-dictid=\"389305b4521692777198497cf9c88b\">Statin</span> Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recommendation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>10-year <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risk ≥ 20%</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Start <span class=\"customMeta\" data-dictid=\"389305b4521692777198497cf9c88b\">statin</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>All patients with DM aged &gt;40 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Statins recommended regardless of cholesterol levels</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes the mechanism of action of Acarbose?", "options": [{"label": "A", "text": "Increases insulin secretion from pancreatic beta cells", "correct": false}, {"label": "B", "text": "Inhibits alpha-glucosidase enzymes, delaying carbohydrate absorption", "correct": true}, {"label": "C", "text": "Stimulates glucose uptake in peripheral tissues", "correct": false}, {"label": "D", "text": "Enhances insulin sensitivity in the liver and muscles", "correct": false}], "correct_answer": "B. Inhibits alpha-glucosidase enzymes, delaying carbohydrate absorption", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old female with a long-standing history of type 2 diabetes mellitus presents to her physician for a routine follow-up. During the visit, she reported recurrent urinary tract infections and has experienced difficulty controlling her blood glucose levels. Which medication is contraindicated in this patient?", "options": [{"label": "A", "text": "Metformin", "correct": false}, {"label": "B", "text": "Canagliflozin", "correct": true}, {"label": "C", "text": "Liraglutide", "correct": false}, {"label": "D", "text": "Glipizide", "correct": false}], "correct_answer": "B. Canagliflozin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sodium-glucose co-transporter 2 (SGLT2) Inhibitors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Canagliflozin</li>\n<li>Dapagliflozin</li>\n<li>Empagliflozin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism of Action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule, promoting the <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of sodium and <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> in urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Reduce <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD)</li>\n<li>Diuretic effect, leading to sodium loss</li>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> (SBP) by 3-6 mmHg</li>\n<li>Cardiorenal advantage</li>\n<li>CHF to decrease mortality with or without DM</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs)</li>\n<li>Glucosuria (leading to UTIs and <span class=\"customMeta\" data-dictid=\"b0b814e5441692777202c969196f0e\">vulvovaginal</span> candidiasis)</li>\n<li>Dehydration (orthostatic hypotension)</li>\n<li>Weight loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Not recommended if estimated <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> rate (eGFR) &lt; 45 ml/min</li>\n<li>Use with caution in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> (decreased <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> with decreased GFR)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old woman with a history of type 2 diabetes comes for a follow-up on her blood sugar management. She reports that her current regimen is not helping to control her levels. She has a medical history of osteoporosis for which she takes calcium and vitamin D supplements and has well-controlled hypertension. Which of the following medications is contraindicated for her?", "options": [{"label": "A", "text": "Metformin", "correct": false}, {"label": "B", "text": "Pioglitazone", "correct": true}, {"label": "C", "text": "Sitagliptin", "correct": false}, {"label": "D", "text": "Glipizide", "correct": false}], "correct_answer": "B. Pioglitazone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Thiazolidinediones (TZDs)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Pioglitazone</li>\n<li>Rosiglitazone</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism of Action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Decrease <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance by binding to peroxisomal proliferator-activated <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"49be0416121692777188dc8944b7bc\">gamma</span> (PPAR-γ)</li>\n<li>Increases <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity and levels of adiponectin; regulates <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> and <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid storage</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Type 2 <span class=\"customMeta\" data-dictid=\"b6a934c67b16927771868fca92baf9\">Diabetes Mellitus</span> (T2DM)</li>\n<li>Polycystic <span class=\"customMeta\" data-dictid=\"7b1a7ff355169277719401475de6fb\">Ovary</span> Syndrome (PCOS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Weight gain</li>\n<li>Edema</li>\n<li>Heart failure</li>\n<li>Increased risk of fractures</li>\n<li>Pioglitazone: Increased risk of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> cancer</li>\n<li>Rosiglitazone: Increased risk of myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (MI) and <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> death</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hepatic failure</li>\n<li>Congestive <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> (NYHA <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">Grade</span> III/IV)</li>\n<li>Worsening of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> edema</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> risk in <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> women</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman with type 2 diabetes is being educated about her new medication, a meglitinide, to help manage her blood sugar levels. The doctor discusses the characteristics of this class of medications. Which of the following statements is incorrect regarding this drug class?", "options": [{"label": "A", "text": "They are weight neutral", "correct": true}, {"label": "B", "text": "Acts on ATP-sensitive potassium channels", "correct": false}, {"label": "C", "text": "Hypoglycemia is a potential side effect", "correct": false}, {"label": "D", "text": "They are secretagogues", "correct": false}], "correct_answer": "A. They are weight neutral", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:528px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Meglitinides</li>\n<li>They are Secretagogues but not sulphonylureas <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Repaglinide</li>\n<li>Nateglinide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism of Action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Same as sulphonylureas</li>\n<li>Acts on ATP-sensitive <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> channels <strong>(Option B)</strong></li>\n<li>Promotes <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> release (shorter acting)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hypoglycemia <strong>(Option C)</strong></li>\n<li>Weight gain</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male with type 1 diabetes presents with consistently elevated blood glucose levels in the early morning. He denies any nocturnal hypoglycemia. His current insulin regimen includes twice-daily intermediate-acting insulin. Which of the following is the most likely explanation for his fasting hyperglycaemia?", "options": [{"label": "A", "text": "Nocturnal hypoglycemia followed by rebound hyperglycemia", "correct": false}, {"label": "B", "text": "Increased insulin sensitivity between midnight and 2 am", "correct": false}, {"label": "C", "text": "Increased secretion of cortisol and growth hormone during the night", "correct": true}, {"label": "D", "text": "Insufficient insulin administration at bedtime", "correct": false}], "correct_answer": "C. Increased secretion of cortisol and growth hormone during the night", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/A53iKYcUQSecxbHHsw801744283799.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dawn Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Somogyi Phenomenon</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fasting hyperglycaemia in the early morning due to natural <span class=\"customMeta\" data-dictid=\"6d2d14b32a1692777184597558c86a\">circadian</span> hormone release.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rebound <span class=\"customMeta\" data-dictid=\"c52b35ebb01692777189131c97fbba\">hyperglycemia</span> after <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> due to counterregulatory hormone release. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased release of growth hormone and <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> in the late night hours.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Body's response to late-night hypoglycaemia by releasing adrenaline, glucagon, and cortisol.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hormonal Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hormones oppose insulin, leading to higher <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels without prior hypoglycaemia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Counterregulatory hormones stimulate <span class=\"customMeta\" data-dictid=\"724a9faafe1692777188ca8840ec5c\">gluconeogenesis</span> and glycogenolysis, raising blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> after hypoglycemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Happens between 5 am - 7 am due to <span class=\"customMeta\" data-dictid=\"6d2d14b32a1692777184597558c86a\">circadian</span> rhythms and insufficient insulin.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs after midnight, following hypoglycaemia, leading to elevated morning blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires adjusting <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> doses and timing to prevent early morning hyperglycemia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early morning <span class=\"customMeta\" data-dictid=\"c52b35ebb01692777189131c97fbba\">hyperglycemia</span> was once thought to be due to prior hypoglycaemia, but new research questions this theory.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with a history of type 2 diabetes mellitus presents with a sore throat, nasal congestion, and a persistent cough. What is the drug's mechanism of action responsible for this patient's symptoms?", "options": [{"label": "A", "text": "Inhibits the breakdown of GLP-1", "correct": true}, {"label": "B", "text": "Blocks reabsorption of glucose in the PCT", "correct": false}, {"label": "C", "text": "Activates PPAR-γ to improve insulin sensitivity", "correct": false}, {"label": "D", "text": "Inhibits intestinal alpha-glucosidases", "correct": false}], "correct_answer": "A. Inhibits the breakdown of GLP-1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:584px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>DPP-4 Inhibitors (“-glips”)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Sitagliptin</li>\n<li>Saxagliptin</li>\n<li>Linagliptin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism of Action (MOA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Inhibits DPP-4 → decreases <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> of native GLP-1</p>\n<p>→ decreases <span class=\"customMeta\" data-dictid=\"c4d90ebfde1692777188e3689c1753\">glucagon</span> release</p>\n<p>→ decreases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</p>\n<p>→ increases glucose-dependent <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> release</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lower rates of hypoglycemia</li>\n<li>Weight neutral</li>\n<li>Safe in <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> insufficiency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Respiratory infections (Nasopharyngitis)</li>\n<li>Urinary infections</li>\n<li>Weight neutral</li>\n<li>Increases <span class=\"customMeta\" data-dictid=\"2e2efa1007169277719844bd43f5aa\">satiety</span> (often desired)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Renal failure (except Linagliptin)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male with a history of type 2 diabetes presents with severe abdominal pain radiating to his back, nausea, and vomiting. His labs show elevated amylase levels. What is the drug's mechanism of action that may have contributed to this patient's condition?", "options": [{"label": "A", "text": "Inhibits hepatic gluconeogenesis", "correct": false}, {"label": "B", "text": "Blocks reabsorption of glucose in PCT", "correct": false}, {"label": "C", "text": "Increases glucose-dependent insulin secretion", "correct": true}, {"label": "D", "text": "Activates PPAR-γ to improve insulin sensitivity", "correct": false}], "correct_answer": "C. Increases glucose-dependent insulin secretion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>GLP-1 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Agonists (GLP1RAs)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Exenatide</li>\n<li>Liraglutide</li>\n<li>Lixisenatide</li>\n<li>Semaglutide (available as a once-weekly <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> and oral preparation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism of Action (MOA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Decreases <span class=\"customMeta\" data-dictid=\"c4d90ebfde1692777188e3689c1753\">glucagon</span> release</li>\n<li>Decreases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</li>\n<li>Increases glucose-dependent <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> release</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying, induces <span class=\"customMeta\" data-dictid=\"7217cb63b21692777186f86aa217e3\">early satiety</span> (weight loss)</li>\n<li>Stabilizes atherosclerotic <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> (reduction in <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> mortality)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Nausea</li>\n<li>Vomiting</li>\n<li>Pancreatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>FDA Black Box Warning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Increased risk of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> C-cell tumors in rats</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> of the thyroid</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> neoplasias (MEN)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female with Type 2 diabetes has struggled with uncontrolled blood sugar levels for several years and has been reluctant to start medications. However, during her recent visit, she expresses a desire to begin medications. On further evaluation, her lab results are as follows: eGFR: 25 mL/min Random Plasma Glucose: 286 mg/dl HbA1c: 11.2 % Urine glucose ++ She is currently managing her diabetes through dietary changes and lifestyle modifications. What is the most appropriate course of action regarding the initiation of metformin in this patient?", "options": [{"label": "A", "text": "Initiate metformin at a reduced dose", "correct": false}, {"label": "B", "text": "Metformin is contraindicated in this patient", "correct": true}, {"label": "C", "text": "Start metformin with close monitoring of renal function", "correct": false}, {"label": "D", "text": "Initiate metformin at a high dose as HbA1c is very high", "correct": false}], "correct_answer": "B. Metformin is contraindicated in this patient", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biguanides</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↓ <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> production</li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Example</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Metformin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reduction in HBA1C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>1–2 %</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Weight neutral</strong></li>\n<li>No risk of hypoglycemia</li>\n<li>Inexpensive</li>\n<li>Decreases <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> events</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diarrhea</strong></li>\n<li>Nausea</li>\n<li>Lactic acidosis</li>\n<li>Vitamin B12 deficiency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Renal <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> (GFR &lt; 30 mL/min)</li>\n<li>Congestive heart failure</li>\n<li>Radiographic contrast studies</li>\n<li>Hospitalized patients (nil per mouth)</li>\n<li>Acidosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man with Type 1 diabetes is currently using NPH insulin for his basal needs but struggles with hypoglycemia during the night. After a review of his regimen, the physician suggests switching to a peakless long-acting insulin. Which insulin would be most appropriate for him?", "options": [{"label": "A", "text": "Insulin glulisine", "correct": false}, {"label": "B", "text": "Insulin glargine", "correct": true}, {"label": "C", "text": "Insulin aspart", "correct": false}, {"label": "D", "text": "Inhaled human insulin", "correct": false}], "correct_answer": "B. Insulin glargine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:497px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Properties of <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Preparations</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preparation</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Time of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset, h</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peak, h</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effective Duration, h</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long-acting</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Degludec</strong> (peakless longest acting)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-9</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>42</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Detemir</strong> (peakless insulin)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-24</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glargine</strong> (peakless insulin) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-24</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NPH</strong> (Intermediate-acting)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-16</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Short-acting</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspart</strong> (rapid) <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.25</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5-1.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glulisine</strong> (rapid) <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.25</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5-1.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lispro</strong> (rapid)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.25</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5-1.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5-1.0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-8</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inhaled human <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> </strong>(rapid) (Afrezza) <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old female patient with Type 2 diabetes has been on a basal-bolus insulin regimen consisting of glargine and aspart for the past six months. She reports in her follow-up that her fasting blood glucose levels are around 110 mg/dL, and her postprandial levels are above 200 mg/dL for the past 2 weeks. Which of the following adjustments would be most appropriate for her management?", "options": [{"label": "A", "text": "Reduce the aspart dose and maintain the glargine dose", "correct": false}, {"label": "B", "text": "Increase the dosage of glargine with meals", "correct": false}, {"label": "C", "text": "Increase the aspart dose with meals", "correct": true}, {"label": "D", "text": "No changes needed in the dosage", "correct": false}], "correct_answer": "C. Increase the aspart dose with meals", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man with T2DM is brought to the emergency department by his family after being found confused and lethargic. He is unable to take oral glucose. His blood glucose is 40 mg/dL. The medical team administers IV glucose, but his glucose levels drop again despite repeated boluses. He is on sulfonylurea medication for diabetes. Which of the following is the next best step in management?", "options": [{"label": "A", "text": "Administer subcutaneous glucagon", "correct": false}, {"label": "B", "text": "Start a continuous glucose infusion", "correct": false}, {"label": "C", "text": "Administer oral glucose", "correct": false}, {"label": "D", "text": "Administer octreotide", "correct": true}], "correct_answer": "D. Administer octreotide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Continuous Glucose Monitoring (CGM) was recently initiated in a 28-year-old woman with longstanding T1DM. During her follow-up appointment, she inquired about estimating her HbA1c from the CGM system. Which CGM metric provides an estimate of her average glucose level and correlates with her A1C?", "options": [{"label": "A", "text": "Time in Range (TIR)", "correct": false}, {"label": "B", "text": "Hypoglycemia time", "correct": false}, {"label": "C", "text": "Glucose Management Indicator (GMI)", "correct": true}, {"label": "D", "text": "Ambulatory Glucose Profile (AGP)", "correct": false}], "correct_answer": "C. Glucose Management Indicator (GMI)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old girl with T1DM is transitioning to an insulin pump. Her doctor explains that the pump delivers continuous insulin to meet basal needs. What type of insulin is typically used for basal delivery in insulin pump therapy?", "options": [{"label": "A", "text": "Long-acting insulin", "correct": false}, {"label": "B", "text": "Intermediate-acting insulin", "correct": false}, {"label": "C", "text": "Rapid-acting insulin", "correct": true}, {"label": "D", "text": "Both A and C", "correct": false}], "correct_answer": "C. Rapid-acting insulin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1DM management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle modifications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physical activity</li>\n<li>Carbohydrate <span class=\"customMeta\" data-dictid=\"e58c34390016927771859e87c91ed7\">counting</span> helps with accurate <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> dosing before meals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glucose meters: Patients should check <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> at least 4 times daily (before meals and at bedtime)</li>\n<li>Continuous <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> Monitors (CGMs): Provide <span class=\"customMeta\" data-dictid=\"9ddd195e9a1692777197bb3f135c2e\">real-time</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> readings and alerts for hypoglycemia/hyperglycemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetes Self-Management Education and Support (DSMES) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Improve the patient’s knowledge, skills, and abilities necessary for diabetes self-care</li>\n<li>Addressing <span class=\"customMeta\" data-dictid=\"64ad0f11b81692777196734937bde1\">psychosocial</span> issues and emotional well-being</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifelong <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Replacement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multiple Daily Injections (MDI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Combines <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <strong>(long-acting</strong>, once or twice daily) and <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> (<strong>rapid-acting before meals).</strong><strong> (Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continuous <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">Subcutaneous</span> <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">Infusion</span> (CSII) / <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Pump</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Delivers<strong> continuous rapid-acting insulin</strong> for <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> needs with boluses for meals via a pump. <strong>(Option C)</strong></li>\n<li>Some pumps connect to Continuous <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> Monitors (CGMs) and automatically adjust <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> based on <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> levels (hybrid closed-loop systems).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 29 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 3-year-old boy is evaluated for short stature. Examination reveals the following findings. Laboratory results indicate low levels of cortisol and ACTH. Genetic testing reveals a mutation in a transcription factor vital for the development of corticotrophs. Which transcription factor mutation is most likely responsible?", "options": [{"label": "A", "text": "Prop1", "correct": false}, {"label": "B", "text": "LHX3", "correct": false}, {"label": "C", "text": "T-PIT", "correct": true}, {"label": "D", "text": "PIT1", "correct": false}], "correct_answer": "C. T-PIT", "question_images": ["https://image.prepladder.com/notes/Cp8m10Fd4GsSnt0h9eeh1744284781.png"], "explanation_images": ["https://image.prepladder.com/notes/Cp8m10Fd4GsSnt0h9eeh1744284781.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:753px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of Congenital <span class=\"customMeta\" data-dictid=\"e0a48202721692777189b0bac4612e\">Hypopituitarism</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Developmental causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pituitary <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> </strong><strong>(Most Common)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal development of the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland, which can be <span class=\"customMeta\" data-dictid=\"1ea06afcbd1692777181199bfa3300\">aplastic</span> (absent), hypoplastic (underdeveloped), or <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> (misplaced).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transcription factor defects:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pit-1 </strong><strong>(Option D ruled out)</strong>: Determines cell-specific expression of growth hormone (GH), <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> (PRL), and thyroid-stimulating hormone (TSH) in <strong>somatotrophs</strong>, <strong>lactotrophs</strong>, and <strong>thyrotrophs</strong> respectively.</p>\n\t\t\t \n\n\t\t\t<p><strong>Prop-1 (Option A ruled out)</strong>: Induces development of <strong>somatotropes</strong>, <strong>lactotrope</strong>, <strong>thyrotrope</strong> and <strong>gonadotropes</strong>.</p>\n\t\t\t \n\n\t\t\t<p><strong>T-Pit</strong>: Development of<strong> <span class=\"customMeta\" data-dictid=\"f2c4d4843f1692777185ca24fa3131\">Corticotrope</span> cells.</strong> Cause ACTH <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> and hypocortisolism</p>\n\t\t\t \n\n\t\t\t<p><strong>HESX1: </strong>Septo-optic <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> with combined <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormone deficiency</p>\n\t\t\t \n\n\t\t\t<p><strong>LHX3 (Option B ruled out)</strong>: Combined <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormone <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> with <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine rigidity.</p>\n\t\t\t \n\n\t\t\t<p><strong>PAX6 &amp; SOX2.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GH deficiency</strong></p>\n<ul>\n<li>Poor growth and <span class=\"customMeta\" data-dictid=\"89170298ec1692777198eac32ce789\">short stature</span> in children (Height below the 3rd <span class=\"customMeta\" data-dictid=\"8b22fa5ed1169277719587132297ce\">percentile</span> for age.)</li>\n<li><strong>Midline Craniofacial Disorders:</strong> Abnormalities in midline structures (like the eyes and <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> callosum) can be associated with <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> due to the developmental pathways shared during embryogenesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LH/FSH <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong></p>\n<ul>\n<li>Children - delayed puberty/sexual development</li>\n<li>External <span class=\"customMeta\" data-dictid=\"a6a00bd30e169277718892b3a6076c\">genitalia</span> is undeveloped - microphallus, small <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> and scrotum</li>\n<li>Lack of body and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> hair</li>\n<li>If <span class=\"customMeta\" data-dictid=\"e0a48202721692777189b0bac4612e\">hypopituitarism</span> occurs post puberty\n\t\t\t\t<ul>\n<li>Scrotum, <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> and penile length is normal or it may slightly regress</li>\n<li>Gradual loss of body and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> hair occurs.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACTH <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong></p>\n<ul>\n<li>Hypotension, hypoglycemia, stress intolerance</li>\n<li><strong>Doll-like <span class=\"customMeta\" data-dictid=\"c7a0bca80a16927772029b84f18755\">facies</span> </strong>(plump, rounded face with chubby cheeks and a smooth, pale complexion).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Congenital Hypopituitarism\" data-author=\"Ramesh Vidavalur,Srisatish Devapatla\" data-hash=\"8487\" data-license=\"NA\" data-source=\"https://www.indianpediatrics.net/aug2018/aug-705-706.htm\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Cp8m10Fd4GsSnt0h9eeh1744284781.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old boy is brought to the pediatric clinic due to concerns about his growth and appearance. His height is below the 3rd percentile for his age, and the clinician suspects congenital hypopituitarism. Which syndromes are least likely to be associated with his condition?", "options": [{"label": "A", "text": "Kallmann Syndrome", "correct": false}, {"label": "B", "text": "Bardet-Biedl Syndrome", "correct": false}, {"label": "C", "text": "Prader-Willi Syndrome", "correct": false}, {"label": "D", "text": "Laron Syndrome", "correct": true}], "correct_answer": "D. Laron Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:701px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Syndromes associated with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> hypopituitarism:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kallmann Syndrome (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by the <strong>absence</strong> of gonadotropin-releasing hormone (<strong>GnRH</strong>) and often associated with <strong>anosmia</strong> (loss of smell).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prader-Willi Syndrome (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves <strong>hypogonadotropic hypogonadism</strong>, <strong>obesity</strong>, and <strong>developmental delays</strong> due to <strong>microdeletions</strong> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>15.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bardet-Biedl Syndrome </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rare genetic disorder involving <strong>obesity</strong>, <strong>intellectual</strong> <strong>disability</strong>, and <strong>renal</strong> abnormalities, along with potential <strong>GnRH deficiency.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leptin and Leptin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Mutations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Result in <strong>obesity</strong> and <strong>central hypogonadism</strong> due to impaired GnRH production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Septo-optic dysplasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital disorder involving <strong>underdevelopment</strong> of the <strong>optic</strong> <strong>nerves</strong> and <strong>midline</strong> <strong>brain</strong> <strong>structures</strong>.</p>\n<p>It is often associated with<strong> hypopituitarism, <span class=\"customMeta\" data-dictid=\"7ebd2292161692777189789e01e88d\">hypogonadism</span> </strong>and <strong>HESX1 mutations.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old female presents with fatigue, abdominal obesity , dry skin, decreased libido, and irregular menstrual cycles. Laboratory tests reveal low cortisol (3 µg/dL) and low ACTH levels. To confirm ACTH deficiency and to assess growth hormone reserve, which investigation is most appropriate?", "options": [{"label": "A", "text": "Insulin Tolerance Test", "correct": true}, {"label": "B", "text": "Short ACTH Stimulation Test", "correct": false}, {"label": "C", "text": "Low-dose dexamethasone suppression test", "correct": false}, {"label": "D", "text": "Saline Infusion Test", "correct": false}], "correct_answer": "A. Insulin Tolerance Test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:777px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigation of patients with <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">Pituitary</span> disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACTH Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Short <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> Test</strong>: <strong>Initial test</strong> for <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> function.</li>\n<li><strong>Insulin Tolerance Test</strong>: <strong>The gold standard </strong>for diagnosing <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> deficiency, as it<strong> effectively assesses both <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> and growth hormone responses</strong>.\n\t\t\t\t<ul>\n<li>It can lead to severe <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> and should be performed under close medical supervision.</li>\n<li>In situations where <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> poses a risk, the rapid <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> test is often preferred.</li>\n<li>It is <strong>contraindicated in Ischemic heart disease &amp; Epilepsy</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LH/FSH Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Men</strong>: Measure random <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> testosterone, LH, and FSH.</li>\n<li><strong>Pre-menopausal Women</strong>: Assess <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> regularity.</li>\n<li><strong>Post-menopausal Women</strong>: Measure random <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> LH and <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> (expected <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> &gt; 30 IU/L, LH &gt; 20 IU/L).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TSH Deficiency</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum T4 levels; <span class=\"customMeta\" data-dictid=\"e33d6cd73e1692777200667a6d2703\">TSH</span> often detectable in secondary hypothyroidism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth hormone deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Investigate only if considering GH replacement therapy.</li>\n</ul>\n<p><strong>Stimulation tests for GH:</strong></p>\n<ul>\n<li><strong>Insulin-Induced Hypoglycemia</strong></li>\n<li>Arginine (may combine with GHRH)</li>\n<li>Glucagon</li>\n<li>Clonidine (in children)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Among <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones GH &amp; <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> requires <span class=\"customMeta\" data-dictid=\"7c0ffbec4f1692777196fdd5849d71\">provocative</span> tests others are assessed by <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> function tests</strong></p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disorders </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acromegaly </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tolerance test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conn syndrome </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plasma <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> to <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> ratio<strong> (Screening test)</strong></p>\n<p>Saline <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">Infusion</span> Test / Salt <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">Loading</span> Test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Addison disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Morning <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> and <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> <strong>(Screening test)</strong></p>\n<p>ACTH stimulation/cosyntropin test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetes insipidus </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Water <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">deprivation</span> test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SIADH </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum and <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> <strong>(Screening)</strong></p>\n<p>Water <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypopituitarism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insulin tolerance test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cushing's disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-dose <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pheochromocytoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plasma-free <span class=\"customMeta\" data-dictid=\"2c5c3653a61692777192b615303944\">metanephrine</span> test</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with enlarged hands, facial changes, and spacing between his lower teeth. Lab results show elevated growth hormone and IGF-1 levels. What is the most common cause of his condition?", "options": [{"label": "A", "text": "Mixed tumors secreting GH", "correct": false}, {"label": "B", "text": "Growth hormone-secreting Pituitary adenoma", "correct": true}, {"label": "C", "text": "Ectopic GH secretion", "correct": false}, {"label": "D", "text": "GHRH-producing Carcinoid tumor", "correct": false}], "correct_answer": "B. Growth hormone-secreting Pituitary adenoma", "question_images": ["https://image.prepladder.com/notes/EGqmUgNGFbYHDA6o9qWQ1744284802.png"], "explanation_images": ["https://image.prepladder.com/notes/xIju7dzoBu37tuxDcIKm1744284830.png", "https://image.prepladder.com/notes/sig0mVpYl5WSx2gxsr4Y1744284868.png", "https://image.prepladder.com/notes/Uq7oAQZASSMuEuI7fiaW1744284906.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:745px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acromegaly</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>GH-secreting <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> adenomas (&gt;1cm-macroadenoma)</strong><strong> (Most Common)</strong></li>\n<li><strong>Mixed <span class=\"customMeta\" data-dictid=\"a9db0ca5e216927771916a3955d39b\">mammosomatotroph</span> tumors</strong><strong> (25%) </strong><strong>(Option A ruled out)</strong></li>\n<li><strong>Acidophilic stem cell adenomas</strong>, which also <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> (PRL), lead to symptoms such as <span class=\"customMeta\" data-dictid=\"7ebd2292161692777189789e01e88d\">hypogonadism</span> and galactorrhea.</li>\n<li><strong>Carcinoid tumor</strong>: <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">Excess</span> GNRH production <strong>(Option D ruled out)</strong></li>\n<li><strong>Tumors in the pancreas, ovaries, and lungs: </strong>Ectopic GH <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acral bony overgrowth</strong>\n<ul>\n<li>Frontal bossing</li>\n<li>Enlarged hands and feet</li>\n<li>Mandibular <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> with prognathism</li>\n<li>Widened spaces between lower <span class=\"customMeta\" data-dictid=\"92fa9c0ee51692777190e380261b4a\">incisor</span> teeth.</li>\n</ul>\n</li>\n<li><strong>Soft tissue swelling</strong>:\n\t\t\t\t<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"0f66ada5d616927771898f530a8510\">heel pad</span> <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> (&gt;25mm)</li>\n<li>Larger shoe and glove sizes</li>\n<li>Ring tightening</li>\n<li>Coarse <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> features</li>\n<li>Macroglossia</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Acral Bony Overgrowth\" data-author=\"Jones J, Walizai T, Campos A,\" data-hash=\"8489\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/acromegaly\" data-tags=\"April2025\" height=\"295\" src=\"https://image.prepladder.com/notes/xIju7dzoBu37tuxDcIKm1744284830.png\" width=\"269\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Visceromegaly</strong>: <strong>particularly <span class=\"customMeta\" data-dictid=\"5098fe73d116927771838b3dad7c36\">cardiomegaly</span> and <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> enlargement</strong></li>\n<li><strong>Other symptoms</strong>\n<ul>\n<li>Hyperhidrosis and oily skin</li>\n<li>Deep voice,</li>\n<li>Arthropathy, <span class=\"customMeta\" data-dictid=\"67deccee6a16927771911e0dcd1c3c\">kyphosis</span> and <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel syndrome,</li>\n<li>Muscle weakness and atrophy</li>\n<li>Acanthosis <span class=\"customMeta\" data-dictid=\"50255f706b169277719388336f0dd4\">nigricans</span> and skin tags.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Facial Deformities in Acromegaly\" data-author=\"Chanson, Philippe &amp; Salenave, Sylvie\" data-hash=\"8490\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Facial-aspect-of-a-patient-with-acromegaly-The-nose-is-widened-and-thickened-the_fig2_5277075\" data-tags=\"April2025\" height=\"283\" src=\"https://image.prepladder.com/notes/sig0mVpYl5WSx2gxsr4Y1744284868.png\" width=\"445\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<figure class=\"caption_element\"><img alt=\"Acromegaly\" data-author=\"NA\" data-hash=\"8491\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Uq7oAQZASSMuEuI7fiaW1744284906.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cardiomyopathy</strong>: Characterized by arrhythmias, left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy, decreased diastolic function, and hypertension.</li>\n<li><strong>Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction</strong>: Sleep apnea, caused by laryngeal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and central sleep dysfunction, affects over 60% of patients.</li>\n<li><strong>Diabetes mellitus</strong>: Approximately 25% of patients develop diabetes, as GH antagonizes <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> action.</li>\n<li><strong>Hypertension</strong></li>\n<li><strong>Arthritis</strong></li>\n<li><strong>Obstructive</strong> <strong>sleep <span class=\"customMeta\" data-dictid=\"22b9ee5b2b16927771814b5d8d34ac\">apnea</span> </strong></li>\n<li><strong>Colon polyps and malignancy</strong>, with up to one-third of patients at risk</li>\n<li><strong>Mass effect </strong>by the adenoma, including visual disturbances.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presents with symptoms suggestive of acromegaly, including enlarged hands and facial changes. To confirm the diagnosis, which of the following tests is most appropriate to demonstrate the presence of the condition?", "options": [{"label": "A", "text": "Serum IGF-1 levels", "correct": false}, {"label": "B", "text": "Random serum growth hormone levels", "correct": false}, {"label": "C", "text": "Oral glucose tolerance test", "correct": true}, {"label": "D", "text": "MRI Head", "correct": false}], "correct_answer": "C. Oral glucose tolerance test", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with enlarged hands and feet, visual field defects, facial changes, and headaches. MRI reveals findings as shown in the image. Which of the following is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Initiate treatment with oral cabergoline", "correct": false}, {"label": "B", "text": "Start long-acting Octreotide", "correct": false}, {"label": "C", "text": "Perform transsphenoidal surgical resection", "correct": true}, {"label": "D", "text": "Initiate external beam radiation therapy", "correct": false}], "correct_answer": "C. Perform transsphenoidal surgical resection", "question_images": ["https://image.prepladder.com/notes/7Rno4H7CbG1W1k1Tth2T1744284938.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:767px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of Acromegaly</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transsphenoidal <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection</strong> is the<strong> preferred treatment,</strong> especially for those with GH-secreting adenomas.</p>\n\t\t\t \n\n\t\t\t<p><strong>Post-Surgery:</strong></p>\n<ul>\n<li>Improvement in soft tissue <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and <span class=\"customMeta\" data-dictid=\"eb61b60d6c1692777193b647e170f8\">normalization</span> of GH levels typically occur shortly after surgery</li>\n<li>IGF-1 levels normalize within 3-4 days.</li>\n<li>There is a 10% <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate of <span class=\"customMeta\" data-dictid=\"01f4c8035316927771800b6c1238b0\">acromegaly</span> years later, and up to 15% of patients may develop hypopituitarism.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred in medical therapy if <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> surgery is not feasible or if GH fails to decrease post resection</p>\n<ul>\n<li><strong>Somatostatin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Ligands (SRLs): <strong> </strong>(Option B ruled out)</strong>\n<ul>\n<li>Long-acting <span class=\"customMeta\" data-dictid=\"c3d7276c3e1692777190b4b6762dd0\">injectable</span> forms <strong>(octreotide, lanreotide)</strong>.</li>\n<li>Normalizes GH and IGF-1 levels in about 50% of patients.</li>\n<li><strong>Side Effects</strong>: GI disturbances, <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> nausea, and <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> issues.</li>\n</ul>\n</li>\n<li><strong>GH <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist:</strong>\n<ul>\n<li><strong>Pegvisomant</strong> blocks <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> GH receptors, normalizing IGF-1 levels in about 70% of patients, though GH levels remain elevated. It is administered through daily <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> injections and is used for recurrences or poor responses to SRLs.</li>\n</ul>\n</li>\n<li><strong>Dopamine Agonists: <strong> </strong>(Option A ruled out)</strong>\n<ul>\n<li>High doses of <span class=\"customMeta\" data-dictid=\"c0cb3cd6081692777183c51f11e182\">cabergoline</span> can provide modest GH suppression.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiation Therapy</strong><strong> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>External beam radiation therapy</strong> or <span class=\"customMeta\" data-dictid=\"f3333542581692777199584fa789d9\">stereotactic</span> techniques are considered for patients not achieving biochemical control through surgery or medical therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman experiences severe postpartum hemorrhage during delivery, requiring a blood transfusion. Two weeks later, she reports fatigue, weight loss, and inability to breastfeed. Which of the following is the most likely underlying cause of her symptoms?", "options": [{"label": "A", "text": "Pituitary adenoma", "correct": false}, {"label": "B", "text": "Sheehan syndrome", "correct": true}, {"label": "C", "text": "Preeclampsia", "correct": false}, {"label": "D", "text": "Simmond’s disease", "correct": false}], "correct_answer": "B. Sheehan syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:768px\">\n<thead>\n<tr>\n<th colspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Sheehan Syndrome</strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Pathology</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decrease in <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones </strong>due to<strong> ischemic damage</strong> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> pituitary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classic early sign is <strong>failed lactation</strong> following delivery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Varied Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on the severity of <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> damage</p>\n<ul>\n<li><strong>Severe Hypopituitarism</strong>:\n\n\t\t\t\t<ul>\n<li><strong>Early symptoms</strong> :lethargy, anorexia, and weight loss soon after delivery.</li>\n<li><strong>Delayed Symptoms</strong>: Secondary amenorrhea, loss of sexual hair, and fatigue may develop weeks to months later.</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Growth Hormone (GH) deficiency</strong>: Often the first hormone to be lost, leading to <strong>Hypoglycemia</strong>, muscle <strong>weakness</strong>, and <strong>mood swings</strong>.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Signs of <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">Premature</span> aging: </strong>Wrinkling of face</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>ACTH Deficiency: </strong>Can cause<strong> postural hypotension</strong> &amp; worsen <strong>hypoglycemia</strong>.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Thyroid-stimulating hormone (TSH) Deficiency</strong>: Results in secondary <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> . Unlike primary hypothyroidism, frank myxoedema is rare.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Approximately ⅓ rd may present with <strong>hyponatremia</strong>, while <strong>Central</strong> <strong>diabetes insipidus</strong> is rarely observed.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:759px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sheehan syndrome </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simmonds disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cause</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ischemic damage to the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> due to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> infarction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> or destruction of the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> due to <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> / SCD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Failure to lactate, lethargy, anorexia, and weight loss shortly after delivery</p>\n\t\t\t \n\n\t\t\t<p>Secondary amenorrhea, loss of sexual hair, fatigue, and wrinkling of the face (premature ageing) can occur as delayed symptoms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual weakness, weight loss, and signs of <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormone deficiency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most appropriate initial management for a patient with Sheehan syndrome?", "options": [{"label": "A", "text": "Immediate thyroid hormone replacement", "correct": false}, {"label": "B", "text": "Hydrocortisone administration", "correct": true}, {"label": "C", "text": "Fludrocortisone administration", "correct": false}, {"label": "D", "text": "GH administration", "correct": false}], "correct_answer": "B. Hydrocortisone administration", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Q0gH0ZXuo4drLUMHpAys1744348856.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sheehan syndrome </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brain MRI/CECT </strong></p>\n<ul>\n<li>A <strong>secondary</strong> partial or complete empty sella<strong> </strong></li>\n</ul>\n<p><strong>(Primary <span class=\"customMeta\" data-dictid=\"acbb5e285c16927771871b81d146e7\">empty sella</span> syndrome, or arachnoidocele, </strong>is a radiologic finding where the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica appears empty due to <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> from the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space, compressing and <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> within it<strong>.).</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Sheehan Syndrome\" data-author=\"Zain, Ahmer &amp; Sivakumar, Ashwin &amp; Akah, Ozo &amp; Shiza, Saher &amp; Mahadevaiah, Ashwini &amp; Khan, Aadil.\" data-hash=\"9108\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/MRI-of-the-mid-sagittal-section-of-the-brain-showing-partially-empty-sella-turcica-with-a_fig2_360080965\" data-tags=\"April2025\" height=\"297\" src=\"https://image.prepladder.com/notes/Q0gH0ZXuo4drLUMHpAys1744348856.png\" width=\"529\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Serum findings </strong>\n<ul>\n<li>Growth hormone, Prolactin, ACTH, TSH, LH and <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> ↓.</li>\n<li>ADH is normal as the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> is typically not affected.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone Replacement Therapies:</strong></p>\n<ul>\n<li><strong>Cortisol Replacement:</strong>\n<ul>\n<li><strong>Administer <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> </strong><strong>(Initial treatment)</strong> if there is <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> deficiency.</li>\n<li>Mineralocorticoid is not typically recommended. <strong>(Option C)</strong></li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Thyroid Hormone Replacement:</strong>\n<ul>\n<li><strong>Indication</strong>: Levothyroxine (50–150 μg) should be given once daily.</li>\n<li>Aim to maintain <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> T4 in the upper range of normal.</li>\n<li>Thyroid hormone <strong>(Option A)</strong> should not be administered without <span class=\"customMeta\" data-dictid=\"6045a2ba311692777188aaeacafe4f\">glucocorticoid</span> therapy in cases of <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, as this can lead to an <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> crisis.</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Sex Hormone Replacement: </strong>Recommended for women under 50 years with <span class=\"customMeta\" data-dictid=\"514d28a1c21692777188703b64cfde\">gonadotropin</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> and for <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> to restore sexual function and prevent osteoporosis.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Growth Hormone Replacement:</strong>\n<ul>\n<li>Growth hormone (GH) is given via daily <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> injections for children and adolescents with GH <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> <strong>(Option D)</strong></li>\n<li><strong>Side Effects</strong>: The primary <span class=\"customMeta\" data-dictid=\"79506a117416927771988bbe7a8302\">side effect</span> is sodium retention, which may present as <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> oedema or <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel syndrome</li>\n<li>GH replacement should start at a low dose, with regular monitoring of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> IGF-1 to assess response.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents to her primary care physician with complaints of irregular menstrual cycles, galactorrhea, and difficulty conceiving. Laboratory tests reveal elevated serum prolactin levels. MRI of the patient is given below. Which of the following statements about the given condition is not true?", "options": [{"label": "A", "text": "Female-to-Male ratio is approximately 20:1 for microadenomas", "correct": false}, {"label": "B", "text": "Men generally present with symptoms earlier than women", "correct": true}, {"label": "C", "text": "Macroadenoma may cause bitemporal hemianopia", "correct": false}, {"label": "D", "text": "Prolactin levels correlate with the size of the tumor", "correct": false}], "correct_answer": "B. Men generally present with symptoms earlier than women", "question_images": ["https://image.prepladder.com/notes/VqToOTxQ4VIhg4BDuEtY1744284969.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"16419575ae1692777188cc04f2ca40\">galactorrhea</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physiological </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathological </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pregnancy</li>\n<li>Sleep associated</li>\n<li>Sexual stimulation</li>\n<li>Stress</li>\n<li>Trauma</li>\n<li>Hypoglycemia</li>\n<li>High protein diet</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolactinoma</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD)</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> (Increased TRH)</li>\n<li>Acromegaly (Shared <span class=\"customMeta\" data-dictid=\"e129d23033169277719185ba334bac\">lineage</span> of GH &amp; PRL)</li>\n<li>Antipsychotic drugs &amp; <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">Dopamine</span> antagonists</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with erectile dysfunction and galactorrhea. Blood tests confirm elevated prolactin levels and an MRI reveals a macroadenoma. Which of the following management strategies is most appropriate for this patient?", "options": [{"label": "A", "text": "Immediate surgical resection of the tumor", "correct": false}, {"label": "B", "text": "Initiation of cabergoline therapy", "correct": true}, {"label": "C", "text": "Observation &amp;amp; regular follow-up with MRI", "correct": false}, {"label": "D", "text": "Start bromocriptine therapy, followed by regular imaging", "correct": false}], "correct_answer": "B. Initiation of cabergoline therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:784px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical treatment </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dopamine Agonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-line treatment option</strong></p>\n<ul>\n<li><strong>Cabergoline</strong> - long action and better tolerance <strong> (Option B)</strong>\n<ul>\n<li>Galactorrhea improves in 90% of patients</li>\n<li>PRL levels are normal in 80% of patients with microadenomas and 70% with macroprolactinomas.</li>\n</ul>\n</li>\n<li><strong>Bromocriptine </strong><strong>(Option D ruled out)</strong>\n<ul>\n<li>Shorter action - preferable in women wishing to <strong>conceive</strong></li>\n</ul>\n</li>\n</ul>\n<p>Side effects may include nausea, mental fogging, nightmares, insomnia, <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> and postural hypotension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgery </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n<ul>\n<li>Tumor causing <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> apoplexy</li>\n<li>Cases resistant to medical therapy</li>\n<li>Invasive macroadenomas affecting vision</li>\n<li>Pregnant woman with clinical features of tumor</li>\n<li>Mass effect of tumor persisting &gt; 1 month with medical therapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reserved for aggressive tumors that do not respond to <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> agonists or surgery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 year old nulliparous woman comes to the OB-GYN department for investigation of infertility. She also complains of occasional headaches and galactorrhoea. Lab tests and imaging lead to a diagnosis of prolactinoma. If we want to restore fertility in this patient, which of the following is the treatment of choice in this patient?", "options": [{"label": "A", "text": "Cabergoline therapy till pregnancy is confirmed", "correct": false}, {"label": "B", "text": "Bromocriptine therapy till pregnancy is confirmed", "correct": true}, {"label": "C", "text": "Radiotherapy for mass reduction of tumor", "correct": false}, {"label": "D", "text": "Transsphenoidal resection of the mass", "correct": false}], "correct_answer": "B. Bromocriptine therapy till pregnancy is confirmed", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of <span class=\"customMeta\" data-dictid=\"795cb0cee2169277719625a59d84b0\">prolactinoma</span> in pregnancy </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Desire for <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong> - <strong>Bromocriptine</strong></p>\n<ul>\n<li>Bromocriptine therapy is initiated to restore fertility</li>\n<li>It is short-acting and has low <span class=\"customMeta\" data-dictid=\"8e016cf2891692777200f428d4b4db\">teratogenic</span> effects</li>\n<li>Mechanical <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> should be practiced for the first 3 <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycles after <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of therapy to allow for conception timing</li>\n<li>After pregnancy is confirmed - the drug is discontinued, and <span class=\"customMeta\" data-dictid=\"b02f35d9471692777198bf98bee1f7\">serial</span> monitoring of <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> levels</li>\n<li>Drug may be reintroduced if tumor growth is apparent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual field <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If the tumor is very large and threatens the vision,<strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> decompression</strong> may be done</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not true regarding the stalk effect of the pituitary?", "options": [{"label": "A", "text": "Hyperprolactinemia occurs due to a hypersecreting macroadenoma", "correct": true}, {"label": "B", "text": "There is reduced secretion of dopamine in the pituitary stalk", "correct": false}, {"label": "C", "text": "Significant deficiencies in other pituitary hormones are not present", "correct": false}, {"label": "D", "text": "Prolactin level is usually less than 200 ng/ml", "correct": false}], "correct_answer": "A. Hyperprolactinemia occurs due to a hypersecreting macroadenoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/DQ3OMvYzhQkpXsCSKLqL1744284990.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following pituitary gland disorders with their respective serum hormone levels. Pituitary gland disorder Serum hormone levels 1. Hypopituitarism a) Severe ↓ ACTH and GH, other hormones maybe ↓ or normal 2. Sheehan syndrome b) GH, ACTH, TSH, LH, FSH, prolactin, ADH ↓ 3. Pituitary apoplexy c) GH, ACTH, TSH, LH, FSH normal or ↓; prolactin ↑ 4. Stalk effect d) GH, ACTH, TSH, LH, FSH, prolactin ↓ and ADH normal", "options": [{"label": "A", "text": "1-c, 2-b, 3-d, 4-a", "correct": false}, {"label": "B", "text": "1-b, 2-d, 3-a , 4-c", "correct": true}, {"label": "C", "text": "1-d, 2-a, 3-c, 4-b", "correct": false}, {"label": "D", "text": "1-a, 2-c, 3-b, 4-d", "correct": false}], "correct_answer": "B. 1-b, 2-d, 3-a , 4-c", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:749px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pituitary hormone levels in different <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> disorders</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypopituitarism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It occurs due to damage in the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> caused by tumors, surgery, trauma, or genetic conditions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GH, ACTH, TSH, LH, FSH, prolactin, <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> ↓ </strong>(deficiency varies based on which cells are affected).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sheehan syndrome </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Postpartum <span class=\"customMeta\" data-dictid=\"e0a48202721692777189b0bac4612e\">hypopituitarism</span> caused by <span class=\"customMeta\" data-dictid=\"567171ee391692777190bfb8dbeb3e\">ischemic necrosis</span> of the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> following severe blood loss during childbirth.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GH, ACTH, TSH, LH, FSH, <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> ↓ and <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> norma</strong>l</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pituitary <span class=\"customMeta\" data-dictid=\"ceceecabdc16927771816d3965c74f\">apoplexy</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A medical emergency involving sudden <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> or <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe ↓ <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> and GH, other hormones may be ↓ or normal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stalk effect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression or <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"f437283a89169277719967a6bb3283\">stalk</span> causing a reduction in hypothalamic <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of prolactin, resulting in elevated <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> levels without other <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormone abnormalities.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GH, ACTH, TSH, LH, <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> normal or ↓, <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> ↑</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a history of pituitary adenoma presents with sudden-onset severe headache, palpitations, excessive sweating, and hypotension. Lab results show severe hypoglycemia, and imaging reveals hemorrhage within the pituitary and deviation of the pituitary stalk. What is the initial management for this patient?", "options": [{"label": "A", "text": "Urgent surgical decompression", "correct": false}, {"label": "B", "text": "High dose IV glucocorticoid", "correct": true}, {"label": "C", "text": "IV dextrose administration", "correct": false}, {"label": "D", "text": "Oral hydrocortisone", "correct": false}], "correct_answer": "B. High dose IV glucocorticoid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pituitary <span class=\"customMeta\" data-dictid=\"ceceecabdc16927771816d3965c74f\">apoplexy</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute intra-pituitary <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> resulting in an <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> emergency</li>\n<li>It may arise spontaneously in preexisting adenomas, occur <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> or be associated with conditions like diabetes, hypertension, sickle cell anemia, or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> shock.</li>\n<li><strong>Severe ↓ <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> and GH, other hormones maybe ↓ or normal</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe headache</li>\n<li>Central nervous system (CNS) hemorrhage</li>\n<li>Signs of meningeal irritation</li>\n<li>Loss of consciousness</li>\n<li>Bilateral visual changes</li>\n<li>Ophthalmoplegia (eye muscle paralysis)</li>\n<li>Hypoglycemia</li>\n<li>Hypotension</li>\n<li>Shock</li>\n<li>Cardiovascular collapse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>High-dose glucocorticoids</strong> is the first line of treatment to correct <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, stabilize blood pressure, and correct hypoglycemia.</li>\n<li>Patients without evident visual loss or impaired consciousness can be managed conservatively with high-dose glucocorticoids.</li>\n<li><strong>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> decompression: </strong>Required for patients with significant or progressive visual loss, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsy, or loss of consciousness.</li>\n<li><strong>Monitoring: </strong>Visual recovery is inversely correlated with the duration of time after the <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> event, so timely intervention is crucial.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diseases is mismatched with its hormonal profile and management", "options": [{"label": "A", "text": "Lymphocytic hypophysitis - variable deficiency in pituitary hormone Sheehan syndrome - treated with hormone replacement therapy Langerhans cell histiocytosis of pituitary - ADH deficiency present", "correct": false}, {"label": "B", "text": "Lymphocytic hypophysitis - Glucocorticoid to reduce inflammation Sheehan syndrome - Panhypopituitarism Langerhans cell histiocytosis of pituitary - surgical excision of the lesion", "correct": false}, {"label": "C", "text": "Lymphocytic hypophysitis - Glucocorticoid to reduce inflammation Sheehan syndrome - ADH deficiency present Langerhans cell histiocytosis of pituitary-thyroid hormone replacement is essential.", "correct": true}, {"label": "D", "text": "Lymphocytic hypophysitis - Surgical excision if vision is affected Sheehan syndrome - Thyroid hormone replacement after Corticosteroids are stabilized Langerhans cell histiocytosis of pituitary - Chemotherapy is systemic involvement present", "correct": false}], "correct_answer": "C. Lymphocytic hypophysitis - Glucocorticoid to reduce inflammation Sheehan syndrome - ADH deficiency present Langerhans cell histiocytosis of pituitary-thyroid hormone replacement is essential.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:764px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sheehan syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphocytic <span class=\"customMeta\" data-dictid=\"7c5a78f2c61692777189c490d9646e\">hypophysitis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LCH of <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs due to <strong>postpartum <span class=\"customMeta\" data-dictid=\"567171ee391692777190bfb8dbeb3e\">ischemic necrosis</span> </strong>of the pituitary, commonly presenting with panhypopituitarism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <strong>autoimmune</strong> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the pituitary, causing variable hormone deficiencies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infiltration of the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> by <strong>Langerhans cells</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone profile </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Panhypopituitarism,</strong> except for ADH</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable deficiencies</strong>: often low ACTH, TSH, LH, FSH, PRL,</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ADH deficiency</strong> presenting as central diabetes insipidus</p>\n\t\t\t \n\n\t\t\t<p>May have low or normal <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones depending on the degree of infiltration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hormone replacement</p>\n<ul>\n<li><strong>Glucocorticoid </strong>replacement to manage <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency.</li>\n<li><strong>Thyroid hormone </strong>replacement after corticosteroids are stabilized.</li>\n<li><strong>Gonadal hormone</strong> replacement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticosteroids</strong> to manage inflammation</p>\n\t\t\t \n\n\t\t\t<p>Hormone replacement as needed for any deficiencies.</p>\n\t\t\t \n\n\t\t\t<p>Surgery only if <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> compromise or other complications arise.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical resection</strong> of affected mass</p>\n\t\t\t \n\n\t\t\t<p><strong>Chemotherapy</strong> may be needed if <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> involvement present</p>\n<ul>\n<li>Vinblastine</li>\n<li>Methotrexate-containing regimens</li>\n<li>Cytarabine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the sequence of hormonal supplementation in a patient of Panhypopituitarism", "options": [{"label": "A", "text": "Glucocorticoids → Thyroid hormones → Growth hormone → Sex hormones", "correct": false}, {"label": "B", "text": "Glucocorticoid → thyroid hormone → Sex hormones → Growth hormone", "correct": true}, {"label": "C", "text": "Thyroid hormones → Sex hormones → Glucocorticoids → Growth hormone", "correct": false}, {"label": "D", "text": "Sex hormones → Growth hormone → Glucocorticoids → Thyroid hormones", "correct": false}], "correct_answer": "B. Glucocorticoid → thyroid hormone → Sex hormones → Growth hormone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:734px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hormonal therapy for <span class=\"customMeta\" data-dictid=\"2524db68b316927771942ba959920b\">Panhypopituitarism</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone deficient </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone replacement </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACTH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Corticosteroid replacement should be started first to reduce the risk of triggering an <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> crisis.</p>\n<ul>\n<li>Hydrocortisone 10-20 mg/day in divided doses</li>\n<li>Cortisone <span class=\"customMeta\" data-dictid=\"47765053a81692777180738f50cd4e\">acetate</span> 15-25 mg/day in divided doses</li>\n<li>Prednisolone 5 mg/day</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TSH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thyroid hormone replacement is then added for hypothyroidism</p>\n<ul>\n<li>L-thyroxine 0.0075 - 0.15 mg/day</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FSH/LH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>After <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone replacement - sex hormone replacement is initiated</p>\n<ul>\n<li>Males - testosterone</li>\n<li>Females - <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> / <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">progesterone</span> / gonadotropins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adults - <span class=\"customMeta\" data-dictid=\"87e5322fd71692777198bf4f2eef18\">Somatotropin</span> (0.1 - 1.25 mg SC QID)</li>\n<li>Children - <span class=\"customMeta\" data-dictid=\"87e5322fd71692777198bf4f2eef18\">Somatotropin</span> (0.02 - 0.05 mg/kg/day)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vasopressin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intranasal desmopressin (5–20 g BID/day)</li>\n<li>Oral 300–600 μg QID</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old woman presents with hyperthermia, tachycardia, and altered mental status following an abrupt discontinuation of her antithyroid medication. Upon examination, she is diaphoretic, has a goitre, and exhibits hand tremors. Which of the following is the DOC for managing her condition?", "options": [{"label": "A", "text": "Administer Iodine solution", "correct": false}, {"label": "B", "text": "Administer a large dose of Propylthiouracil", "correct": true}, {"label": "C", "text": "Administer cholestyramine.", "correct": false}, {"label": "D", "text": "Administer Propranolol.", "correct": false}], "correct_answer": "B. Administer a large dose of Propylthiouracil", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyroid Storm</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fever </strong>with diaphoresis.</li>\n<li><strong>Cardiovascular Involvement:</strong> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">Tachycardia</span> (&gt;140 bpm), heart failure, arrhythmias, hypotension, and risk of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</li>\n<li><strong>CNS Manifestations:</strong> Agitation, delirium, anxiety, psychosis, or coma.</li>\n<li><strong>Gastrointestinal Symptoms:</strong> Nausea, vomiting, diarrhoea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, intestinal obstruction, and <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Initial Supportive Measures:</strong> IV fluids, oxygen, <span class=\"customMeta\" data-dictid=\"579dcf5fc51692777185eef17a83c6\">cooling</span> blankets, and acetaminophen.</li>\n<li><strong>Beta-blocker Therapy:</strong> Start with <span class=\"customMeta\" data-dictid=\"082f7143eb1692777196df69a3b6cb\">propranolol</span> immediately (40-80 mg every 4-6 hours) to control <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> tone.</li>\n<li><strong>DOC:</strong> Administer <span class=\"customMeta\" data-dictid=\"34735bff271692777196f13335f804\">propylthiouracil</span> (500-1000 mg loading, then 250 mg every 4 hours) or <span class=\"customMeta\" data-dictid=\"5bd74cc52b1692777192ca3ad5ee2a\">methimazole</span> (20 mg every 4-6 hours). </li>\n<li><strong>Iodine Solution:</strong> Give SSKI (5 drops every 6 hours) after thionamide to <strong>reduce the release of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone</strong></li>\n<li><strong>Glucocorticoids:</strong> Hydrocortisone (100 mg IV every 8 hours) or <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> (2 mg every 6 hours).</li>\n<li><strong>Cholestyramine</strong> (Bile acid sequestrant)<strong>:</strong> 4 grams orally 4 times daily for severe cases to reduce <span class=\"customMeta\" data-dictid=\"6fa49bcdd91692777187965db2303d\">enterohepatic</span> recycling of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone.</li>\n<li><strong>Surgery:</strong> Thyroidectomy for patients with contraindications to thionamides after pre-treatment.</li>\n<li><strong>Definitive Treatment:</strong> Recommend <span class=\"customMeta\" data-dictid=\"2a445711f21692777197336861a4ac\">radioiodine</span> therapy or surgery for <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">hyperthyroidism</span> once stabilised.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman is scheduled for thyroidectomy. Her current thyroid function tests show decreased TSH level and elevated free T3 &amp;amp; T4. Which of the following is the most appropriate preoperative management to prevent thyroid storm?", "options": [{"label": "A", "text": "Start propranolol alone one day before surgery", "correct": false}, {"label": "B", "text": "Start methimazole and wait for normal thyroid function tests", "correct": false}, {"label": "C", "text": "Start methimazole, potassium iodide, and propranolol 7-10 days before surgery", "correct": true}, {"label": "D", "text": "Proceed directly to surgery with close monitoring", "correct": false}], "correct_answer": "C. Start methimazole, potassium iodide, and propranolol 7-10 days before surgery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman with a history of multinodular goitre undergoes a CT angiogram with iodinated contrast for suspected pulmonary embolism. Two weeks later, she presents with palpitations, heat intolerance, and weight loss. Her thyroid function tests show suppressed TSH and elevated T3 and T4. Which of the following best explains this patient's current condition?", "options": [{"label": "A", "text": "Wolff-Chaikoff effect", "correct": false}, {"label": "B", "text": "Jod-Basedow effect", "correct": true}, {"label": "C", "text": "Thyroid storm", "correct": false}, {"label": "D", "text": "Hashitoxicosis", "correct": false}], "correct_answer": "B. Jod-Basedow effect", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Wolff-Chaikoff Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Jod-Basedow Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Temporary <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> in response to high <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> exposure</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Iodine-induced hyperthyroidism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> levels <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> peroxidase, reducing T3 and T4 production</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Excess <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> stimulates autonomous <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone production in <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> individuals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Temporary (usually resolves in 1-2 weeks)</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Can persist until treated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Thyroid Function Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Initially decreased T3 and T4, increased TSH</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Increased T3 and T4, decreased TSH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>At-risk Population</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> glands</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Pre-existing <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> disease (e.g., <span class=\"customMeta\" data-dictid=\"b3ba921efb169277719315f4ec3226\">multinodular</span> goiter, Graves' disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Usually <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or mild <span class=\"customMeta\" data-dictid=\"9a04451cba1692777189ae54ac7caf\">hypothyroid</span> symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Symptoms of <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">hyperthyroidism</span> (e.g., palpitations, heat intolerance, weight loss)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old woman presents with a 2-week history of palpitations, anxiety, and weight loss. On examination, her heart rate is 110 bpm and regular, and she has a painful goitre. Thyroid function tests show decreased TSH level and elevated free T3 &amp;amp; T4 levels. A thyroid scan shows very low uptake. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Graves' disease", "correct": false}, {"label": "B", "text": "Toxic multinodular goiter", "correct": false}, {"label": "C", "text": "Subacute thyroiditis", "correct": true}, {"label": "D", "text": "TSH-secreting pituitary adenoma", "correct": false}], "correct_answer": "C. Subacute thyroiditis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/8d2Pk0p9pEN57NzHdrJM1744286982.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with a history of weight loss, palpitations, and heat intolerance. On examination, she has a diffuse goitre, Ophthalmopathy and fine tremors in her outstretched hands. Her thyroid function tests show: TSH: &amp;lt; 0.01 mIU/L (normal range: 0.4-4.0 mIU/L) Free T4: 35 pmol/L (normal range: 10-20 pmol/L) Free T3: 12 pmol/L (normal range: 3.5-6.5 pmol/L) Which of the following is the most likely cause of her hyperthyroidism?", "options": [{"label": "A", "text": "Toxic multinodular goiter", "correct": false}, {"label": "B", "text": "Graves' disease", "correct": true}, {"label": "C", "text": "TSH-secreting pituitary adenoma", "correct": false}, {"label": "D", "text": "Iodine-induced thyrotoxicosis", "correct": false}], "correct_answer": "B. Graves' disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Key Features for identification</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">Hyperthyroidism</span> (pathology within the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Graves' disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Diffuse goitre, ophthalmopathy, TSH <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antibodies (LATS- long-acting <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> stimulating antibodies)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Toxic <span class=\"customMeta\" data-dictid=\"b3ba921efb169277719315f4ec3226\">multinodular</span> goiter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Multiple autonomous nodules, older patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Toxic adenoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Single autonomous nodule</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Subacute <span class=\"customMeta\" data-dictid=\"df0e1364a11692777200ed67550c12\">thyroiditis</span> (de Quervain thyroiditis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Painful thyroid, recent <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> illness, transient</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Silent <span class=\"customMeta\" data-dictid=\"df0e1364a11692777200ed67550c12\">thyroiditis</span> (Painless lymphocytic thyroiditis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Painless, often postpartum, transient</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Iodine-induced thyrotoxicosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>History of <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> exposure (e.g., contrast, amiodarone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Drug-induced </strong>(e.g., amiodarone)</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>History of relevant medication use</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Secondary Hyperthyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>TSH-secreting <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> adenoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Inappropriate TSH secretion, other <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones may be affected</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>hCG-mediated hyperthyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Pregnancy, gestational trophoblastic disease</p>\n<p>(Alpha subunit of hCG is similar in structure to TSH)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Thyroid hormone resistance </strong>(rare)</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Genetic disorder, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> sensitivity of the body to <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Ectopic Hyperthyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Struma ovarii</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Ovarian <span class=\"customMeta\" data-dictid=\"ee123cf86916927772004fc7b0a157\">teratoma</span> with functional <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tissue</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presents with complaints of irritability, difficulty sleeping, and unexplained weight loss of 10 kg over the past 3 months despite an increased appetite. His wife mentions that his eyes seem more prominent lately. Which of the following findings would be least likely in this patient?", "options": [{"label": "A", "text": "Warm, moist palms", "correct": false}, {"label": "B", "text": "Proximal muscle weakness", "correct": false}, {"label": "C", "text": "Delayed relaxation of deep tendon reflexes", "correct": true}, {"label": "D", "text": "Frequent bowel movements", "correct": false}], "correct_answer": "C. Delayed relaxation of deep tendon reflexes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Signs and Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss despite increased appetite, Heat intolerance, Increased sweating.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia, Widened pulse pressure, and Atrial fibrillation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fine tremor, Hyperreflexia, Anxiety, irritability, and Insomnia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> movements, Diarrhoea and Malabsorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Warm, moist skin, Fine, thin hair, Onycholysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular (Graves' specific)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exophthalmos, Lid lag, Lid retraction, and Periorbital oedema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal muscle weakness, Osteoporosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reproductive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oligomenorrhea, Gynecomastia (in men)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyroid Storm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High fever, Severe tachycardia/arrhythmias, Delirium/coma, Multi-organ failure</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On the Thyroid function test, TSH is suppressed, Free T4 level is normal, and Free T3 is increased. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Subclinical hyperthyroidism", "correct": false}, {"label": "B", "text": "Euthyroid sick syndrome", "correct": false}, {"label": "C", "text": "Primary Hyperthyroidism", "correct": false}, {"label": "D", "text": "T3 thyrotoxicosis", "correct": true}], "correct_answer": "D. T3 thyrotoxicosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TSH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Free T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Free T3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary hyperthyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓ (&lt;0.1 mIU/L)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subclinical hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subclinical hyperthyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓ or approximately normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3 thyrotoxicosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Euthyroid sick syndrome</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Normal</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Normal</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">↓</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A thyroid scan is performed for a 35-year-old female patient with a thyroid disorder. The Result is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Toxic multinodular goiter", "correct": false}, {"label": "B", "text": "Graves' disease", "correct": true}, {"label": "C", "text": "Thyroiditis", "correct": false}, {"label": "D", "text": "Thyroid adenoma", "correct": false}], "correct_answer": "B. Graves' disease", "question_images": ["https://image.prepladder.com/notes/Tz2z1JODBNhavg2hredK1747898903.png"], "explanation_images": ["https://image.prepladder.com/notes/bKxDoi5t9luwHSfcUzqr1747899054.png", "https://image.prepladder.com/notes/3jjHzgd9WtVqS2qJqsFO1747899055.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman presents with palpitations, weight loss, and heat intolerance for the past 3 months. On examination, she has a diffuse goitre and mild proptosis. Thyroid function tests show suppressed TSH and elevated free T4 and T3. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Radioiodine ablation", "correct": false}, {"label": "B", "text": "Total thyroidectomy", "correct": false}, {"label": "C", "text": "Start propranolol and carbimazole", "correct": true}, {"label": "D", "text": "MRI Brain", "correct": false}], "correct_answer": "C. Start propranolol and carbimazole", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn presents with prolonged jaundice, feeding problems, and hypotonia. The mother has a history of Hashimoto's thyroiditis. Neonatal screening reveals elevated TSH and low T4 levels. Which of the following is the most likely cause of the infant's condition?", "options": [{"label": "A", "text": "Thyroid gland dysgenesis", "correct": false}, {"label": "B", "text": "Inborn error of thyroid hormone synthesis", "correct": false}, {"label": "C", "text": "Transplacental passage of TSH receptor-blocking antibodies", "correct": true}, {"label": "D", "text": "Iodine deficiency", "correct": false}], "correct_answer": "C. Transplacental passage of TSH receptor-blocking antibodies", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presents with fatigue, weight gain, and changes in her skin appearance over the past year. On examination, her skin is noted to be dry with a yellowish tinge. There is puffiness around her eyes and non-pitting edema in hands and feet. Which of the following is the most likely explanation for her skin findings?", "options": [{"label": "A", "text": "Increased dermal collagen deposition", "correct": false}, {"label": "B", "text": "Accumulation of dermal glycosaminoglycans", "correct": true}, {"label": "C", "text": "Hyperpigmentation due to adrenal insufficiency", "correct": false}, {"label": "D", "text": "Cutaneous manifestations of liver disease", "correct": false}], "correct_answer": "B. Accumulation of dermal glycosaminoglycans", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman weighing 65 Kgs comes with complaints of lethargy and weight gain. Lab investigations are carried out, which show elevated TSH level and Decresed T3 &amp;amp; T4 levels. She has no known cardiovascular disease. Which of the following is the most appropriate next step regarding this patient?", "options": [{"label": "A", "text": "Start levothyroxine 25 μg daily", "correct": false}, {"label": "B", "text": "Start levothyroxine 100 μg daily", "correct": true}, {"label": "C", "text": "Start liothyronine (T3) 5 μg three times daily", "correct": false}, {"label": "D", "text": "Observe and repeat thyroid function tests in 3 months", "correct": false}], "correct_answer": "B. Start levothyroxine 100 μg daily", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hypothyroidism- Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Primary Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Levothyroxine (T4) replacement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Initial Dosing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Young, otherwise healthy adults: 1.6 μg/kg/day (typically 100-150 μg daily) <strong>(Option B)</strong></p>\n<p>- Elderly or those with <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease: Start with 25-50 μg daily and <span class=\"customMeta\" data-dictid=\"6ed68ca4781692777200701c57e5a3\">titrate</span> up slowly <strong>(Option A ruled out)</strong></p>\n<p>- Pregnancy: May require <strong>30-50% dose increase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Dose Adjustments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Based on TSH levels</p>\n<p>- Adjust in 12.5-25 μg increments</p>\n<p>- Allow 6-8 weeks between dose changes for TSH to stabilize</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Check TSH 6-8 weeks after starting treatment or changing dose</p>\n<p>- Once stable, check TSH annually</p>\n<p>- Target TSH: 0.4-4.0 mIU/L for most adults, &lt; 2.5 mIU/L in 1st trimester.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Alternative Treatments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- T3 (liothyronine) alone: Not recommended due to short half-life</p>\n<p>- Combination T4/T3 therapy: Controversial, not routinely recommended</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 78-year-old woman was brought to the emergency department by her family due to progressive lethargy over the past week. On examination, she is unresponsive with a core temperature of 32°C, BP of 80/50 mmHg, and HR of 40 bpm. Her skin is dry and cool, and she has periorbital edema. Initial lab results show: Sodium: 128 mEq/L (normal 135-145) TSH: 75 mIU/L (normal 0.4-4.0) Free T4: 3 pmol/L (normal 10-20) Which of the following is the most appropriate initial management?", "options": [{"label": "A", "text": "Oral levothyroxine 100 μg daily", "correct": false}, {"label": "B", "text": "Intravenous liothyronine 10 μg, followed by 10 μg every 8 hours", "correct": true}, {"label": "C", "text": "Oral levothyroxine 50 μg daily and oral liothyronine 5 μg twice daily", "correct": false}, {"label": "D", "text": "Supportive care only and repeat thyroid function tests in 24 hours", "correct": false}], "correct_answer": "B. Intravenous liothyronine 10 μg, followed by 10 μg every 8 hours", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Myxedema coma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Precipitating Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Infection</p>\n<p>- Cold exposure</p>\n<p>- Trauma</p>\n<p>- Medications (sedatives, anaesthetics)</p>\n<p>- Discontinuation of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Clinical presentation</p>\n<p>- Elevated TSH, low Free T4</p>\n<p>- Associated lab abnormalities (hyponatremia, hypoglycemia, hypercapnia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Initial Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>1. Intravenous T3 (liothyronine): 10-20 μg bolus, then 10 μg q8h</p>\n<p>2. Intravenous levothyroxine: 300-500 μg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose</p>\n<p>3. Hydrocortisone: 100 mg q8h (for potential <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency)</p>\n<p>4. Supportive care: Mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> if needed, cautious rewarming, <span class=\"customMeta\" data-dictid=\"bc3c2594d31692777203b12c564dae\">fluid resuscitation</span> with Hypertonic saline</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man is admitted to the ICU with severe sepsis secondary to pneumonia. On day 3 of his admission, routine blood tests reveal the following thyroid function results: TSH: 0.6 mIU/L (normal range: 0.4-4.0 mIU/L) Free T4: 12 pmol/L (normal range: 10-20 pmol/L) Free T3: 2.1 pmol/L (normal range: 3.5-6.5 pmol/L) The patient has no history of thyroid disease. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Start levothyroxine replacement therapy", "correct": false}, {"label": "B", "text": "Start liothyronine (T3) replacement therapy", "correct": false}, {"label": "C", "text": "Start propylthiouracil to treat subclinical hyperthyroidism", "correct": false}, {"label": "D", "text": "No specific thyroid treatment; continue to manage underlying sepsis with TFT monitoring.", "correct": true}], "correct_answer": "D. No specific thyroid treatment; continue to manage underlying sepsis with TFT monitoring.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Sick <span class=\"customMeta\" data-dictid=\"a0cba39e531692777187f51570565d\">Euthyroid</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> function tests in critically ill patients <strong>without underlying <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Severe illness (e.g., sepsis, myocardial infarction)</p>\n<p>- Major surgery</p>\n<p>- Trauma</p>\n<p>- Starvation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Typical Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Low free T3 (most common)</p>\n<p>- Normal free T4</p>\n<p>- Normal TSH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>- Decreased <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> conversion of T4 to T3</p>\n<p>- Increased reverse T3 (rT3)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the drug of choice for the management of Grave’s disease in the pregnancy?", "options": [{"label": "A", "text": "Methimazole", "correct": false}, {"label": "B", "text": "Propylthiouracil", "correct": true}, {"label": "C", "text": "Radioactive iodine", "correct": false}, {"label": "D", "text": "Levothyroxine", "correct": false}], "correct_answer": "B. Propylthiouracil", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant female who is a known case of hypothyroidism is on levothyroxine. What are the levothyroxine dose changes recommended during pregnancy?", "options": [{"label": "A", "text": "Decrease the dose of levothyroxine", "correct": false}, {"label": "B", "text": "Increase the dose of levothyroxine", "correct": true}, {"label": "C", "text": "Maintain the same dose of levothyroxine", "correct": false}, {"label": "D", "text": "Discontinue levothyroxine during pregnancy", "correct": false}], "correct_answer": "B. Increase the dose of levothyroxine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/p0aDhDoFztcBWtHJ0qrR1744287287.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maternal complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neonatal complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abortion</li>\n<li>Preterm labor</li>\n<li>Pre-eclampsia</li>\n<li>Abruption</li>\n<li>PPH</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality</li>\n<li>Cretinism</li>\n<li>Neuropsychiatric illness</li>\n<li>Deafness and growth restriction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 20 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 6-year-old boy is brought to the emergency department after a sudden onset of fever, vomiting, and irritability. The child’s parents report that he had a productive cough and runny nose for the past few days, which seemed to improve before the acute deterioration. On examination, the child appears lethargic and is febrile (39°C or 102.2°F). There is hypotension (blood pressure 85/50 mmHg), and he is tachycardic (heart rate 120 bpm). Physical examination reveals diffuse petechial rashes on the lower extremities and trunk. Laboratory findings show: WBC count : 18,000/µL (elevated) Blood cultures : Which laboratory finding is most commonly associated with Waterhouse-Friderichsen syndrome?", "options": [{"label": "A", "text": "Hypernatremia", "correct": false}, {"label": "B", "text": "Hypokalemia", "correct": false}, {"label": "C", "text": "Hyponatremia", "correct": true}, {"label": "D", "text": "Hyperaldosteronism", "correct": false}], "correct_answer": "C. Hyponatremia", "question_images": ["https://image.prepladder.com/notes/Gks7t7bE147E6sH3fIv91744299001.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old woman presents to your clinic with complaints of progressive fatigue, headaches, and increased skin pigmentation over the past few months. She has a history of Cushing's disease, which was diagnosed 4 years ago, and underwent a bilateral adrenalectomy. Upon physical examination, she appears lethargic and has a noticeable darkening of the skin around her neck and on her palms. She also mentions new-onset visual disturbances. Which of the following is false about her condition?", "options": [{"label": "A", "text": "Visual disturbances are due to Nerve compression", "correct": false}, {"label": "B", "text": "Very low ACTH levels", "correct": true}, {"label": "C", "text": "Rapid pituitary tumor enlargement", "correct": false}, {"label": "D", "text": "Develops post adrenalectomy", "correct": false}], "correct_answer": "B. Very low ACTH levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nelson's syndrome</strong> is a condition that typically occurs <strong>after <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> adrenalectomy</strong> for the treatment of <strong>Cushing's disease</strong> (pituitary-dependent Cushing’s syndrome). The removal of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> glands leads to a lack of <span class=\"customMeta\" data-dictid=\"267c66363316927771936565b4c6a4\">negative feedback</span> on the pituitary, resulting in <strong>increased <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of ACTH</strong>. Over time, the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> may develop a <strong>pituitary adenoma</strong> (or <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of an existing adenoma), which secretes <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> in excess. <strong>(Option C and D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prophylactic radiation therapy may be indicated to prevent the development of Nelson’s syndrome after adrenalectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperpigmentation</li>\n<li>Bitemporal hemianopia</li>\n<li>Progressive visual loss in cases of large tumors<strong>(Option A ruled out)</strong></li>\n<li>Headache</li>\n<li>Weakness and fatigue</li>\n<li>Inhibition of the release of other <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Evaluation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> Levels:</strong>\n<ul>\n<li>Very high levels.<strong> (Option B)</strong></li>\n<li>Diagnosis confirmed by an <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> increase &gt;30% of the initial result on three consecutive samples after <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> adrenalectomy.</li>\n</ul>\n</li>\n<li>Decreased levels of <strong>anterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones</strong>.</li>\n<li><strong>Brain <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> </strong>shows <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> tumors or <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of existing tumors.</li>\n<li>Screening:\n\t\t\t\t<ul>\n<li>Regular screening with <strong>fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> levels</strong> and brain <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> in patients after <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> adrenalectomy.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical Removal of the Tumor</li>\n<li>Radiotherapy / Radiosurgery</li>\n<li>Medical Treatment</li>\n<li>Hormonal Replacement Therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with a confirmed diagnosis of Cushing's disease presents with symptoms of central obesity, hypertension, and muscle weakness. Imaging reveals a 5 mm pituitary adenoma. Which of the following is the most appropriate initial treatment approach for this patient?", "options": [{"label": "A", "text": "Ketoconazole therapy", "correct": false}, {"label": "B", "text": "Bilateral adrenalectomy", "correct": false}, {"label": "C", "text": "Selective transsphenoidal surgery", "correct": true}, {"label": "D", "text": "Pasireotide injection", "correct": false}], "correct_answer": "C. Selective transsphenoidal surgery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with weight gain, fatigue and difficulty climbing stairs. On physical examination, she has central obesity, a rounded face and broad purple striae on her abdomen. The internist suspects the case to be Cushing's syndrome. What is the most likely additional clinical feature associated with this patient?", "options": [{"label": "A", "text": "Hypotension", "correct": false}, {"label": "B", "text": "Osteoporosis", "correct": true}, {"label": "C", "text": "Increased deep tendon reflexes", "correct": false}, {"label": "D", "text": "Decreased white blood cell count", "correct": false}], "correct_answer": "B. Osteoporosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old man presents with symptoms of weight gain, central obesity, hypertension, purple abdominal striae, hyperpigmentation of knuckles, and muscle weakness. Imaging reveals a lung mass. Which of the following is the most likely cause in this patient?", "options": [{"label": "A", "text": "Adrenocortical carcinoma (ACC)", "correct": false}, {"label": "B", "text": "Ectopic ACTH secretion", "correct": true}, {"label": "C", "text": "Primary bilateral macronodular adrenal hyperplasia (PBMAH)", "correct": false}, {"label": "D", "text": "Primary pigmented nodular adrenal disease (PPNAD)", "correct": false}], "correct_answer": "B. Ectopic ACTH secretion", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/AFzMP2jq6yDPL13tIO9X1744299957.png", "https://image.prepladder.com/notes/YAoPtvrCkjLRmc3nkbaR1744299728.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of neuroendocrine tumors (NETs) presents with symptoms of carcinoid syndrome, including frequent episodes of watery diarrhea and flushing. Which of the following is the most appropriate first-line treatment to control these symptoms, particularly diarrhea?", "options": [{"label": "A", "text": "Loperamide", "correct": false}, {"label": "B", "text": "Telotristat ethyl", "correct": false}, {"label": "C", "text": "Somatostatin analogues", "correct": true}, {"label": "D", "text": "Antihistamines", "correct": false}], "correct_answer": "C. Somatostatin analogues", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Carcinoid Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carcinoid syndrome is caused by hormone <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> (mainly <strong>serotonin</strong>) from <strong>neuroendocrine tumors (NETs). </strong></li>\n<li>Commonly arises from NETs in the <strong>small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> or appendix</strong>.</li>\n<li>The syndrome typically occurs when the tumor has metastasized to the liver or retroperitoneum, allowing the hormones to enter <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> circulation.</li>\n<li><strong>Histamine and tachykinins</strong> (e.g., substance P) may also contribute to the syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Flushing: Sudden onset of an intense red or purplish color, especially on the upper body, neck, and face, often with a sensation of warmth.</li>\n<li>Diarrhea: Frequent watery stools, often over 10 times/day, significantly impacting daily life.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Less Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wheezing or asthma-like symptoms</li>\n<li>Impaired cognitive function in advanced cases</li>\n<li>Pellagra-like skin lesions due to <span class=\"customMeta\" data-dictid=\"acad87464816927771937783e41318\">niacin</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (from <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> being used to produce <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> instead of niacin).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Somatostatin analogues</strong>: <strong>Mainstay </strong>treatment that <strong>mimics somatostatin</strong><strong>,</strong> which inhibits hormone <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> (e.g., serotonin).\n\t\t\t\t<ul>\n<li>Most NETs (around 90%) have <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> receptors and respond to these analogues.</li>\n</ul>\n</li>\n<li><strong>Telotristat ethyl</strong>: Blocks <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> production; used as <strong>adjunctive therapy </strong>for patients who don't fully respond to <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> analogues. <strong>(Option B ruled out)</strong></li>\n<li>Surgery: Considered for <strong>localized tumors </strong>but often not possible in patients with metastatic disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the emergency room with severe headaches, palpitations and profuse sweating. His blood pressure is measured at 180/110 mmHg. Initial biochemical testing shows elevated plasma metanephrines and catecholamines. An MRI reveals a mass in the extra-adrenal retroperitoneal area. Which of the following is the most appropriate initial management strategy to control his blood pressure before surgery?", "options": [{"label": "A", "text": "Labetalol", "correct": false}, {"label": "B", "text": "Phenoxybenzamine", "correct": true}, {"label": "C", "text": "Nitroprusside infusion", "correct": false}, {"label": "D", "text": "Propranolol", "correct": false}], "correct_answer": "B. Phenoxybenzamine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Paraganglioma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Catecholamine-producing tumors from <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> or <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> nervous systems.</li>\n<li>Can be <span class=\"customMeta\" data-dictid=\"a325d0c14e16927771992fe8a96758\">sporadic</span> or <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> (25-33% <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 2, VHL syndromes).</li>\n<li>Location: Skull base and neck.</li>\n<li>Called pheochromocytomas if present in retroperitoneal, pelvic, and <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> regions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Referred to as \"<strong>the great masquerader</strong>\" due to <strong>variable presentation.</strong></li>\n<li>Common symptoms: <strong>Headaches, sweating, palpitations, tachycardia, hypertension, anxiety, panic attacks.</strong></li>\n<li><strong>Hypertension is the main sign</strong> (can lead to heart failure, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, arrhythmias, and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hemorrhage).</li>\n<li>Rarely, <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> may occur if <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> predominates.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Biochemical testing: <strong>Plasma or urine-fractionated catecholamines/ metanephrines</strong> (most sensitive).</li>\n<li>Imaging: CT, <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> (T2-weighted, <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">gadolinium</span> for extra-adrenal), PET (68Ga-DOTATATE PET) for tumor localization.</li>\n<li>Genetic screening is advised for young-onset, multifocal, extra-adrenal, or metastatic tumors.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical removal: <strong>Adrenalectomy </strong>(partial or total); preserve <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> to avoid Addison’s disease.</li>\n<li>Medical management: <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">Preoperative</span> <strong>blood pressure control below 160/90 mmHg</strong> is essential.\n\t\t\t\t<ul>\n<li><strong>Alpha-adrenergic blockers</strong>: <strong>Phenoxybenzamine </strong>(non-selective, preferred) to prevent <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> crises; prazosin/ <span class=\"customMeta\" data-dictid=\"4b193b485f169277719585706f10f3\">phentolamine</span> for paroxysms; liberal salt and <span class=\"customMeta\" data-dictid=\"a195b609f61692777189953f3adaa6\">hydration</span> to avoid orthostasis.</li>\n<li><strong>Beta blockers</strong>: <strong>Added after </strong>alpha blockade.</li>\n<li>Other antihypertensives: <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> channel blockers and <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors.</li>\n<li>Intraoperative BP control with <span class=\"customMeta\" data-dictid=\"4e995cdee9169277719375efd43d38\">nitroprusside</span> if necessary.</li>\n</ul>\n</li>\n<li>Metastatic Paraganglioma:\n\t\t\t\t<ul>\n<li>Treatment options include surgery, alpha-blockers, chemotherapy, radiotherapy, and <span class=\"customMeta\" data-dictid=\"0a8c532a1e169277719364f20439e2\">nuclear medicine</span> therapy (e.g., 131I-MIBG).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most sensitive diagnostic test for detecting pheochromocytoma?", "options": [{"label": "A", "text": "Plasma renin activity", "correct": false}, {"label": "B", "text": "Plasma-fractionated metanephrines", "correct": true}, {"label": "C", "text": "Serum aldosterone levels", "correct": false}, {"label": "D", "text": "Syntropin test", "correct": false}], "correct_answer": "B. Plasma-fractionated metanephrines", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with episodic headaches, sweating, and palpitations. She has been experiencing high blood pressure that is difficult to control despite multiple antihypertensive medications. On physical examination, her heart rate is 100 beats per minute, and her blood pressure is 180/110 mmHg.Laboratory studies reveal elevated plasma-free metanephrines. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hyperaldosteronism", "correct": false}, {"label": "B", "text": "Pheochromocytoma", "correct": true}, {"label": "C", "text": "Hyperthyroidism", "correct": false}, {"label": "D", "text": "Postural Tachycardia Syndrome (POTS)", "correct": false}], "correct_answer": "B. Pheochromocytoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pheochromocytomas are rare tumors arising from <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> medulla.</li>\n<li>The clinical features result from excessive <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of catecholamines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These tumors can be <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> or <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> and are frequently associated with <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> syndromes like <span class=\"customMeta\" data-dictid=\"6518acf261169277719312127935af\">neurofibromatosis</span> type 1, multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> type II, and Von-Hippel Lindau disease.</li>\n<li>Catecholamines are produced in the <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells starting with the rate-limiting step of tyrosine <span class=\"customMeta\" data-dictid=\"0b592280091692777189e27f90a885\">hydroxylase</span> (TH), regulating the conversion of tyrosine to dihydroxyphenylalanine (DOPA).</li>\n<li>Pheochromocytomas release these catecholamines in various patterns ranging from paroxysmal, continuous, and mixed patterns.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histology of the <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> characteristically shows zellballen nests of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells with strong positivity to chromogranin, synaptophysin, CD56, and focally to S100.</li>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells in the <span class=\"customMeta\" data-dictid=\"5d5198131c16927771873e61ef8092\">extra-adrenal</span> tissue is the only <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> characteristic of the <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the entity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Classical triad: </strong>Episode of <span class=\"customMeta\" data-dictid=\"c226fe76dd1692777194b984788b28\">palpitation</span> + Headache +Profuse sweating</li>\n</ul>\n<ul>\n<li><strong>Dominant sign is Hypertension- </strong>40% have sustained hypertension</li>\n<li>Tachycardia</li>\n<li>Anxiety</li>\n<li>Subcutaneous neurofibromas</li>\n<li>Cafe-au-lait macules</li>\n<li>Thyroid mass</li>\n<li>Axillary freckling</li>\n<li>Lisch nodules on the iris</li>\n<li>Retinal angiomas</li>\n<li>Abdominal mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> can be established by biochemical confirmation of <span class=\"customMeta\" data-dictid=\"0f03f178b51692777189f3658408a0\">hypersecretion</span> of metanephrines and catecholamines.</li>\n</ul>\n<p><strong>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> test</strong></p>\n<ul>\n<li>Catecholamines</li>\n<li>Fractionated metanephrines</li>\n<li>Total metanephrines</li>\n</ul>\n<p><strong>Plasma tests</strong></p>\n<ul>\n<li>Catecholamines</li>\n<li>Free metanephrines</li>\n</ul>\n<p><strong>Imaging</strong>:</p>\n<ul>\n<li>CT scan of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> to locate the tumor.</li>\n<li>18F-FDG PET <span class=\"customMeta\" data-dictid=\"c497b556951692777198b599e4ba86\">scanning</span> is recommended for metastatic disease.</li>\n<li>MIBG scintigraphy</li>\n<li>Somatostatin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> scintigraphy</li>\n<li>Gallium DOTATATE PET scanning</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> is <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection.</li>\n<li>Blood pressure is controlled by <strong>alpha-adrenergic blockers</strong>(phenoxybenzamine 0.5-4 mg/kg of body weight)</li>\n<li><strong>Oral Prazosin or IV <span class=\"customMeta\" data-dictid=\"4b193b485f169277719585706f10f3\">phentolamine</span> </strong>can be used to control paroxysm.</li>\n</ul>\n<p><strong>Unilateral Pheochromocytoma:</strong></p>\n<ul>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> adrenalectomy</li>\n<li>Open adrenalectomy</li>\n</ul>\n<p><strong>Bilateral pheochromocytomas: </strong></p>\n<ul>\n<li>Bilateral partial or <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> sparing <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> (open or laparoscopic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myocardial infarction</li>\n<li>Cardiogenic shock</li>\n<li>Renal Failure</li>\n<li>Pulmonary edema</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</li>\n<li>Lactic acidosis</li>\n<li>Hypertensive retinopathy</li>\n<li>Hypertensive encephalopathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following genetic conditions are associated with pheochromocytomas?", "options": [{"label": "A", "text": "Marfan syndrome", "correct": false}, {"label": "B", "text": "Neurofibromatosis type 1", "correct": true}, {"label": "C", "text": "Cushing's syndrome", "correct": false}, {"label": "D", "text": "Turner syndrome", "correct": false}], "correct_answer": "B. Neurofibromatosis type 1", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/5mbeLd0hZeKfucLc1lc41744299139.png", "https://image.prepladder.com/notes/3m6hyL6n6lq1YE7a1fqS1744299228.png", "https://image.prepladder.com/notes/tZMmmwedXwjMabvp7FyX1744299377.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pheochromocytomas are rare tumors arising from <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> medulla.</li>\n<li>The clinical features result from excessive <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of catecholamines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Estimated to occur in 2 to 8 of 1 million persons per year.</li>\n<li>The mean age at diagnosis is 40 years, although the tumours can occur from early childhood until late in life.</li>\n<li>The classic ‘rule of tens’ is 10% bilateral, 10% <span class=\"customMeta\" data-dictid=\"5d5198131c16927771873e61ef8092\">extra-adrenal</span> (Paragangliomas), and 10% metastatic. It is <strong>not used </strong>nowadays.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These tumors can be <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> or <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> and are frequently associated with <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> syndromes like\n\t\t\t\t<ul>\n<li><strong>Neurofibromatosis type 1, </strong></li>\n<li><strong>multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> type II, and </strong></li>\n<li><strong>Von-Hippel Lindau disease.</strong></li>\n</ul>\n</li>\n<li>Catecholamines are produced in the <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells starting with the rate-limiting step of tyrosine <span class=\"customMeta\" data-dictid=\"0b592280091692777189e27f90a885\">hydroxylase</span> (TH), regulating the conversion of tyrosine to dihydroxyphenylalanine (DOPA).</li>\n<li>Pheochromocytomas release these catecholamines in various patterns ranging from paroxysmal, continuous, and mixed patterns. <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">Norepinephrine</span> is released continuously and can result in persistent hypertension, while <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> is released in a <span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\">paroxysmal</span> pattern resulting in tachyarrhythmias.\n\t\t\t\t<ul>\n<li>Ryanodine-2 receptors (RyR2).</li>\n<li>Beta-2 adrenoceptors</li>\n<li>Alpha(1)-adrenoreceptors</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histology of the <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> characteristically shows zellballen nests of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells with strong positivity to chromogranin, synaptophysin, CD56, and focally to S100.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pheochromocytoma\" data-author=\"Nephron - Own work\" data-hash=\"8684\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Paraganglioma#/media/File:Carotid_body_tumour_2_intermed_mag.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/5mbeLd0hZeKfucLc1lc41744299139.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells in the <span class=\"customMeta\" data-dictid=\"5d5198131c16927771873e61ef8092\">extra-adrenal</span> tissue is the only <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> characteristic of the <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the entity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Classical <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> </strong>\n<ul>\n<li>Episode of palpitation</li>\n<li>Headache</li>\n<li>Profuse sweating</li>\n</ul>\n</li>\n<li><strong>Dominant sign is Hypertension</strong></li>\n<li>Tachycardia</li>\n<li>Anxiety</li>\n<li>Subcutaneous neurofibromas</li>\n<li>Cafe-au-lait macules</li>\n<li>Thyroid mass</li>\n<li>Axillary freckling</li>\n<li>Lisch nodules on the iris</li>\n<li>Retinal angiomas</li>\n<li>Abdominal mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> can be established by biochemical confirmation of <span class=\"customMeta\" data-dictid=\"0f03f178b51692777189f3658408a0\">hypersecretion</span> of metanephrines and catecholamines.</li>\n</ul>\n<p><strong>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> test</strong></p>\n<ul>\n<li>Catecholamines</li>\n<li>Fractionated metanephrines</li>\n<li>Total metanephrines</li>\n</ul>\n<p><strong>Imaging</strong>:</p>\n<ul>\n<li>CT scan of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> to locate the tumor.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pheochromocytoma MRI\" data-author=\"Gaillard F, Campos A, Weerakkody Y, et al\" data-hash=\"8689\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/phaeochromocytoma-1\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/3m6hyL6n6lq1YE7a1fqS1744299228.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>18F-FDG PET <span class=\"customMeta\" data-dictid=\"c497b556951692777198b599e4ba86\">scanning</span> is recommended for metastatic disease.</li>\n<li>MIBG scintigraphy</li>\n<li>Somatostatin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> scintigraphy</li>\n<li>Gallium DOTATATE PET scanning \n\t\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pheochromocytoma- Imaging\" data-author='\"Jorge A. Carrasquillo, Clara C. Chen, Abhishek Jha, Alexander Ling, Frank I. Lin, Daniel A. Pryma and Karel Pacak ' data-hash=\"8693\" data-license=\"NA\" data-source=\"https://jnm.snmjournals.org/content/62/8/1033\" data-tags=\"April2025\" height=\"217\" src=\"https://image.prepladder.com/notes/tZMmmwedXwjMabvp7FyX1744299377.png\" width=\"387\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperthyroidism</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</li>\n<li>Hyperaldosteronism</li>\n<li>Cardiomyopathy</li>\n<li>Postural <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> syndrome (POTS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> is <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection.</li>\n<li>Preoperative preparation of the patient has to be considered, and <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> should be consistently &lt; 160/90 mm Hg.</li>\n<li>Blood pressure is controlled by alpha-adrenergic blockers(phenoxybenzamine 0.5-4 mg/kg of body weight)</li>\n<li>Oral Prazosin or IV <span class=\"customMeta\" data-dictid=\"4b193b485f169277719585706f10f3\">phentolamine</span> can be used to control paroxysm.</li>\n</ul>\n<p><strong>Unilateral Pheochromocytoma:</strong></p>\n<ul>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> adrenalectomy: Preferred treatment for most <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> pheochromocytomas.</li>\n<li>Open adrenalectomy</li>\n</ul>\n<p><strong>Bilateral pheochromocytomas: </strong></p>\n<ul>\n<li>Bilateral total <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> is associated with a lifelong need for <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> replacement with long-term side effects.</li>\n<li>Bilateral partial or <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> sparing <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> (open or laparoscopic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myocardial infarction</li>\n<li>Cardiogenic shock</li>\n<li>Renal Failure</li>\n<li>Pulmonary edema</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</li>\n<li>Lactic acidosis</li>\n<li>Hypertensive retinopathy</li>\n<li>Hypertensive encephalopathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with persistent hypertension, weight gain, and muscle weakness. Her laboratory results reveal elevated cortisol levels and suppressed ACTH. Imaging studies show an adrenal mass, as shown below. Which of the following layers of the adrenal gland is most likely responsible for the hormone excess in this patient?", "options": [{"label": "A", "text": "Zona glomerulosa", "correct": false}, {"label": "B", "text": "Zona fasciculata", "correct": true}, {"label": "C", "text": "Zona reticularis", "correct": false}, {"label": "D", "text": "Adrenal medulla", "correct": false}], "correct_answer": "B. Zona fasciculata", "question_images": ["https://image.prepladder.com/notes/xYUvUo8HFK8q5pOBVz1G1744298792.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:742px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Layers of <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">Adrenal</span> Gland </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zona glomerulosa (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The outermost layer of the cortex.</li>\n<li>It secretes aldosterone, a <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">mineralocorticoid</span> that regulates sodium <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> and <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> and <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> excretion.</li>\n<li>Aldosterone production is mainly stimulated by <span class=\"customMeta\" data-dictid=\"c4d00ed86c1692777181c0c43a452a\">angiotensin</span> II, which is part of the renin-angiotensin system- This is not under the control of ACTH.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zona fasciculata (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The middle layer of the <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> secretes cortisol.</li>\n<li>It also secretes <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> androgens.</li>\n<li>An <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> mass in this layer could cause increased <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> production, resulting in symptoms such as hypertension, muscle weakness, and weight gain, consistent with Cushing’s syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zona reticularis (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Innermost layer of the cortex.</li>\n<li>It secretes <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> and <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> androgens.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"ce703232dd1692777202121148f8ee\">zona</span> fasciculata and <span class=\"customMeta\" data-dictid=\"ce703232dd1692777202121148f8ee\">zona</span> reticularis function together as one unit in response to the <span class=\"customMeta\" data-dictid=\"9bbbb7c9b316927771806ddc890ba2\">adrenocorticotropic</span> hormone (ACTH).</li>\n<li>An <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> mass in this layer results in <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> androgens resulting in <span class=\"customMeta\" data-dictid=\"6f0308f1301692777202568e634059\">virilization</span> and other symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adrenal Medulla (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Part of the <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> nervous system</li>\n<li>Secretes catecholamines (adrenaline and noradrenaline) into capillaries</li>\n<li>Symptoms related to <span class=\"customMeta\" data-dictid=\"69ccfc60d016927771837a12cdddb2\">catecholamine</span> <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> include palpitations and tachycardia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the key difference in the bloodwork between primary and secondary Addison's disease?", "options": [{"label": "A", "text": "High renin levels in secondary Addison's", "correct": false}, {"label": "B", "text": "Low aldosterone levels in secondary Addison's", "correct": false}, {"label": "C", "text": "Low ACTH levels in secondary Addison's", "correct": true}, {"label": "D", "text": "Elevated potassium in secondary Addison's", "correct": false}], "correct_answer": "C. Low ACTH levels in secondary Addison's", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false?", "options": [{"label": "A", "text": "Random plasma cortisol of &amp;gt;500 nmol/L excludes adrenal insufficiency", "correct": false}, {"label": "B", "text": "Plasma renin will be high in mineralocorticoid deficiency", "correct": false}, {"label": "C", "text": "Aldosterone level will be low or in the lower part of the reference range in mineralocorticoid deficiency", "correct": false}, {"label": "D", "text": "None of the above", "correct": true}], "correct_answer": "D. None of the above", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Investigations Random plasma cortisol measurement (values &gt;500 nmol/L exclude adrenal insufficiency) (Option A ruled out). Short ACTH stimulation test- if random cortisol levels are between 100-500, 1 microgram ACTH, serum cortisol levels of &lt;500 is considered confirmatory for adrenal insufficiency Plasma renin and aldosterone (high renin with low/lower part of the reference range aldosterone in mineralocorticoid deficiency) (Options B &amp; C ruled out). Dehydroepiandrosterone sulfate (DHEAS) and androstenedione in women Adrenal autoantibodies for autoimmune causes; imaging (CT/MRI) if antibodies are negative.</li><li>↳ Investigations</li><li>↳ Investigations</li><li>↳ Investigations</li><li>↳ Random plasma cortisol measurement (values &gt;500 nmol/L exclude adrenal insufficiency) (Option A ruled out). Short ACTH stimulation test- if random cortisol levels are between 100-500, 1 microgram ACTH, serum cortisol levels of &lt;500 is considered confirmatory for adrenal insufficiency Plasma renin and aldosterone (high renin with low/lower part of the reference range aldosterone in mineralocorticoid deficiency) (Options B &amp; C ruled out). Dehydroepiandrosterone sulfate (DHEAS) and androstenedione in women Adrenal autoantibodies for autoimmune causes; imaging (CT/MRI) if antibodies are negative.</li><li>↳ Random plasma cortisol measurement (values &gt;500 nmol/L exclude adrenal insufficiency) (Option A ruled out). Short ACTH stimulation test- if random cortisol levels are between 100-500, 1 microgram ACTH, serum cortisol levels of &lt;500 is considered confirmatory for adrenal insufficiency Plasma renin and aldosterone (high renin with low/lower part of the reference range aldosterone in mineralocorticoid deficiency) (Options B &amp; C ruled out). Dehydroepiandrosterone sulfate (DHEAS) and androstenedione in women Adrenal autoantibodies for autoimmune causes; imaging (CT/MRI) if antibodies are negative.</li><li>↳ Random plasma cortisol measurement (values &gt;500 nmol/L exclude adrenal insufficiency) (Option A ruled out).</li><li>↳ (Option A ruled out).</li><li>↳ Short ACTH stimulation test- if random cortisol levels are between 100-500, 1 microgram ACTH, serum cortisol levels of &lt;500 is considered confirmatory for adrenal insufficiency</li><li>↳ Plasma renin and aldosterone (high renin with low/lower part of the reference range aldosterone in mineralocorticoid deficiency) (Options B &amp; C ruled out).</li><li>↳ (Options B &amp; C ruled out).</li><li>↳ Dehydroepiandrosterone sulfate (DHEAS) and androstenedione in women</li><li>↳ Adrenal autoantibodies for autoimmune causes; imaging (CT/MRI) if antibodies are negative.</li><li>↳ Management 1. Glucocorticoid Replacement: Oral hydrocortisone is preferred, and Prednisolone and dexamethasone may also be used. 2. Mineralocorticoid Replacement: Fludrocortisone</li><li>↳ Management</li><li>↳ Management</li><li>↳ Management</li><li>↳ 1. Glucocorticoid Replacement: Oral hydrocortisone is preferred, and Prednisolone and dexamethasone may also be used. 2. Mineralocorticoid Replacement: Fludrocortisone</li><li>↳ 1. Glucocorticoid Replacement: Oral hydrocortisone is preferred, and Prednisolone and dexamethasone may also be used.</li><li>↳ 2. Mineralocorticoid Replacement: Fludrocortisone</li><li>↳ Addisonian Crisis An Addisonian crisis is a life-threatening medical emergency that occurs when there is a severe deficiency of cortisol and aldosterone. It is most commonly seen in people with Addison's disease (primary adrenal insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery). Management: IV Hydrocortisone</li><li>↳ Addisonian Crisis</li><li>↳ Addisonian Crisis</li><li>↳ Addisonian Crisis</li><li>↳ An Addisonian crisis is a life-threatening medical emergency that occurs when there is a severe deficiency of cortisol and aldosterone. It is most commonly seen in people with Addison's disease (primary adrenal insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery). Management: IV Hydrocortisone</li><li>↳ An Addisonian crisis is a life-threatening medical emergency that occurs when there is a severe deficiency of cortisol and aldosterone. It is most commonly seen in people with Addison's disease (primary adrenal insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery).</li><li>↳ Addisonian crisis</li><li>↳ Addison's disease</li><li>↳ Management: IV Hydrocortisone</li><li>↳ Management: IV Hydrocortisone</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Random <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> measurement (values &gt;500 nmol/L exclude <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency) <strong>(Option A ruled out).</strong></li>\n<li>Short <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> test- if random <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels are between 100-500, 1 <span class=\"customMeta\" data-dictid=\"c61e3b709016927771920d8bd6503d\">microgram</span> ACTH, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels of &lt;500 is considered confirmatory for <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency </li>\n<li>Plasma <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> and <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> (high <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> with low/lower part of the reference range <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> in <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">mineralocorticoid</span> deficiency) <strong>(Options B &amp; C ruled out).</strong></li>\n<li>Dehydroepiandrosterone <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> (DHEAS) and <span class=\"customMeta\" data-dictid=\"2b218bfcc816927771817d02ae5257\">androstenedione</span> in women</li>\n<li>Adrenal autoantibodies for <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> causes; <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> (CT/MRI) if antibodies are negative.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"6045a2ba311692777188aaeacafe4f\">Glucocorticoid</span> Replacement: Oral <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> is preferred, and <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">Prednisolone</span> and <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> may also be used.</p>\n<p>2. <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">Mineralocorticoid</span> Replacement: Fludrocortisone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Addisonian Crisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <strong>Addisonian crisis</strong> is a life-threatening medical emergency that occurs when there is a severe <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> and aldosterone. It is most commonly seen in people with <strong>Addison's disease</strong> (primary <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency), especially when their hormone replacement therapy is inadequate or missed or during periods of extreme stress (e.g., illness, trauma, or surgery).</p>\n<p><strong>Management: IV <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">Hydrocortisone</span> </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a clinical feature of Addison’s disease?", "options": [{"label": "A", "text": "Glucocorticoid insufficiency", "correct": false}, {"label": "B", "text": "Mineralocorticoid insufficiency", "correct": false}, {"label": "C", "text": "ACTH insufficiency", "correct": true}, {"label": "D", "text": "Androgen insufficiency", "correct": false}], "correct_answer": "C. ACTH insufficiency", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autoimmune: M/C/C Worldwide\n\t\t\t\t<ul>\n<li>Sporadic</li>\n<li>Polyglandular syndromes</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Tuberculosis: M/C/C in India</li>\n<li>Histoplasmosis</li>\n<li>HIV/AIDS</li>\n<li>Metastatic carcinoma</li>\n<li>Bilateral adrenalectomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glucocorticoid <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> <strong>(Option A ruled out)</strong>:\n\t\t\t\t<ul>\n<li>Weight loss, anorexia, malaise, weakness, nausea, vomiting, <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> or constipation, postural hypotension, shock, hypoglycemia, <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> (dilutional), hypercalcemia</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Mineralocorticoid <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> <strong>(Option B ruled out)</strong>:\n\n\t\t\t\t<ul>\n<li>Hypotension, shock, hyponatremia, hyperkalemia</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>ACTH <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <strong>(Option C)</strong>: Pigmentation</li>\n</ul>\n<ul>\n<li>Adrenal <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> insufficiency<strong> (Option D ruled out)</strong>: Decreased body hair and loss of libido, especially in females</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which part of the kidney is affected in Gordon syndrome?", "options": [{"label": "A", "text": "Distal nephron", "correct": true}, {"label": "B", "text": "Proximal nephron", "correct": false}, {"label": "C", "text": "Ascending limb of the loop of Henle", "correct": false}, {"label": "D", "text": "Descending limb of the loop of Henle", "correct": false}], "correct_answer": "A. Distal nephron", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:566px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autosomal dominant (mostly)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutations in the<strong> WNK1, WNK4, CUL3, or KLHL3 genes</strong> result in abnormalities in serine/threonine kinases that dysregulate the thiazide-sensitive sodium-chloride <span class=\"customMeta\" data-dictid=\"b7f35e85b71692777185cd0aa6cf3a\">cotransporter</span> (NCC) in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"32562f5afa1692777193c891837db9\">nephron</span> <strong>(Option A).</strong> This leads to increased sodium and <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> reabsorption, causing <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> volume expansion and subsequent hypertension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-specific symptoms like muscle weakness, fatigue, <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (not always)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperkalemia</li>\n<li>Hyperchloremic <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis</li>\n<li>Hypercalciuria</li>\n<li>Low or low-normal <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> activity</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> levels (relative to hyperkalemia)</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function/normal <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> filtration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Correction of <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> abnormalities</li>\n<li>Salt restriction</li>\n<li>Thiazide diuretics</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are clinical manifestations of Liddle’s syndrome except?", "options": [{"label": "A", "text": "Hypokalemia", "correct": false}, {"label": "B", "text": "Hyporeninemia", "correct": false}, {"label": "C", "text": "Hypertension", "correct": false}, {"label": "D", "text": "Hyperaldosteronism", "correct": true}], "correct_answer": "D. Hyperaldosteronism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <strong>autosomal dominant</strong> genetic disorder characterized by <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> with <span class=\"customMeta\" data-dictid=\"ca346360e1169277718995a1e81f6f\">hypokalemic</span> <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis, hyporeninemia, and suppressed <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> secretion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutations in <strong>SCNN1A, SCNN1B, and SCNN1G genes → </strong>α, β, and γ subunits of<strong> ENaC</strong> (Epithelial Sodium Channel) altered → Increased <span class=\"customMeta\" data-dictid=\"f344edc7f31692777187e4860634ff\">Epithelial Sodium Channel</span> activity→Elevated sodium <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"32562f5afa1692777193c891837db9\">nephron</span> → Sodium retention</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Early-onset <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (as early as 2 years of age) <strong>(Option C ruled out)</strong></p>\n<p>- Hypokalemia<strong> (Option A ruled out)</strong> and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis</p>\n<p>- Suppressed <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> <strong>(Option B ruled out)</strong> and <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> levels <strong>(Option D)</strong></p>\n<p>- Fatigue, muscle weakness, dizziness, and vision changes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Potassium-sparing diuretics: Amiloride or Triamterene</p>\n<p>- Salt restriction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents to the clinic with complaints of persistent high blood pressure and muscle weakness. She has a history of hypertension that has been difficult to control with standard antihypertensive medications. On examination, her blood pressure is 160/95 mmHg, and she has mild generalized muscle weakness. Her laboratory results show: Serum potassium: 3.2 mEq/L Serum sodium: 142 mEq/L Which of the following drugs can be used in hyperaldosteronism?", "options": [{"label": "A", "text": "Spironolactone", "correct": false}, {"label": "B", "text": "Eplerenone", "correct": false}, {"label": "C", "text": "Amiloride", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Investigations</li><li>↳ Investigations</li><li>↳ Investigations</li><li>↳ Investigations</li><li>↳ Serum electrolytes - Hypokalaemia - Sodium: Upper end of normal reference range in primary hyperaldosteronism, low in secondary hyperaldosteronism</li><li>↳ Serum electrolytes</li><li>↳ Serum electrolytes</li><li>↳ Serum electrolytes</li><li>↳ - Hypokalaemia - Sodium: Upper end of normal reference range in primary hyperaldosteronism, low in secondary hyperaldosteronism</li><li>↳ - Hypokalaemia</li><li>↳ - Sodium: Upper end of normal reference range in primary hyperaldosteronism, low in secondary hyperaldosteronism</li><li>↳ Other tests - Plasma renin activity is low and aldosterone concentration is high representing a positive screening test - Aldosterone: Renin Ratio (ARR) - Saline infusion test- Aldosterone levels are high even after 2L infusion over 4 hours, which is confirmatory. - Suppression tests (sodium loading) - Stimulation tests (captopril or furosemide) - Adrenal Vein Catheterisation - CT/MRI- IOC</li><li>↳ Other tests</li><li>↳ Other tests</li><li>↳ Other tests</li><li>↳ - Plasma renin activity is low and aldosterone concentration is high representing a positive screening test - Aldosterone: Renin Ratio (ARR) - Saline infusion test- Aldosterone levels are high even after 2L infusion over 4 hours, which is confirmatory. - Suppression tests (sodium loading) - Stimulation tests (captopril or furosemide) - Adrenal Vein Catheterisation - CT/MRI- IOC</li><li>↳ - Plasma renin activity is low and aldosterone concentration is high representing a positive screening test</li><li>↳ - Plasma renin activity is low and aldosterone concentration is high representing a positive screening test</li><li>↳ - Aldosterone: Renin Ratio (ARR)</li><li>↳ - Saline infusion test- Aldosterone levels are high even after 2L infusion over 4 hours, which is confirmatory.</li><li>↳ Saline infusion test- Aldosterone levels are high even after 2L infusion over 4 hours, which is confirmatory.</li><li>↳ - Suppression tests (sodium loading)</li><li>↳ - Stimulation tests (captopril or furosemide)</li><li>↳ - Adrenal Vein Catheterisation</li><li>↳ - CT/MRI- IOC</li><li>↳ - CT/MRI- IOC</li><li>↳ Management</li><li>↳ Management</li><li>↳ Management</li><li>↳ Management</li><li>↳ Medical Management - Mineralocorticoid receptor antagonists: Spironolactone, Eplerenone (risk of gynecomastia in 20% of males with spironolactone). - Amiloride</li><li>↳ Medical Management</li><li>↳ Medical Management</li><li>↳ Medical Management</li><li>↳ - Mineralocorticoid receptor antagonists: Spironolactone, Eplerenone (risk of gynecomastia in 20% of males with spironolactone). - Amiloride</li><li>↳ - Mineralocorticoid receptor antagonists: Spironolactone, Eplerenone (risk of gynecomastia in 20% of males with spironolactone).</li><li>↳ Spironolactone, Eplerenone</li><li>↳ - Amiloride</li><li>↳ Amiloride</li><li>↳ Surgical Management - Adrenalectomy</li><li>↳ Surgical Management</li><li>↳ Surgical Management</li><li>↳ Surgical Management</li><li>↳ - Adrenalectomy</li><li>↳ - Adrenalectomy</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum electrolytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Hypokalaemia</p>\n<p>- Sodium: Upper end of normal reference range in primary hyperaldosteronism, low in secondary hyperaldosteronism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>- <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> activity is low and <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> concentration is high representing a positive screening test </strong></p>\n<p>- Aldosterone: <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">Renin</span> Ratio (ARR)</p>\n<p>- <strong>Saline <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> test- <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">Aldosterone</span> levels are high even after 2L <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> over 4 hours, which is confirmatory.</strong></p>\n<p>- <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">Suppression</span> tests (sodium loading)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> tests (captopril or furosemide)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">Adrenal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> Catheterisation</p>\n<p><strong>- CT/MRI- IOC</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">Mineralocorticoid</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists:<strong> Spironolactone, Eplerenone</strong> (risk of <span class=\"customMeta\" data-dictid=\"78cd34126d16927771887bf6b44cf6\">gynecomastia</span> in 20% of males with spironolactone).</p>\n<p>- <strong>Amiloride</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Adrenalectomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male with a history of hypertension presents with muscle weakness and frequent headaches. On examination, his blood pressure is 165/95 mmHg, and laboratory tests reveal hypokalemia. Further evaluation shows suppressed plasma renin activity and elevated plasma aldosterone concentration. Which of the following is the most likely clinical feature associated with this condition?", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": true}, {"label": "B", "text": "Hypernatremia", "correct": false}, {"label": "C", "text": "Decreased blood pressure", "correct": false}, {"label": "D", "text": "Increased plasma renin activity", "correct": false}], "correct_answer": "A. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old female presents with persistent hypertension and hypokalemia despite being on multiple antihypertensive medications. Laboratory findings reveal suppressed plasma renin activity and elevated plasma aldosterone concentration. Her imaging studies are unremarkable, showing no adrenal masses. Genetic testing later reveals a KCNJ5 gene mutation. Which of the following conditions is most likely responsible for her hyperaldosteronism?", "options": [{"label": "A", "text": "Primary unilateral adrenal hyperplasia (PAH)", "correct": false}, {"label": "B", "text": "Familial hyperaldosteronism type I (FH-I)", "correct": false}, {"label": "C", "text": "Familial hyperaldosteronism type II (FH-II)", "correct": true}, {"label": "D", "text": "Syndrome of apparent mineralocorticoid excess (SAME)", "correct": false}], "correct_answer": "C. Familial hyperaldosteronism type II (FH-II)", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presents with episodes of severe headaches, palpitations, and sweating. His blood pressure is consistently elevated, and during an episode, it spikes to 190/110 mmHg. Laboratory findings reveal elevated levels of catecholamines in the plasma and urine. Imaging studies confirm a mass in the adrenal gland. Which of the following hormones is most likely being secreted in excess due to the adrenal medullary mass?", "options": [{"label": "A", "text": "Aldosterone", "correct": false}, {"label": "B", "text": "Cortisol", "correct": false}, {"label": "C", "text": "Adrenaline", "correct": true}, {"label": "D", "text": "Androgens", "correct": false}], "correct_answer": "C. Adrenaline", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 65-year-old patient presents with constipation, abdominal pain, nausea, vomiting, confusion, and bone pain. Laboratory tests reveal elevated calcium levels. Considering the role of the calcium-sensing receptor (CaSR) in calcium homeostasis, which of the following is regulated by CaSR?", "options": [{"label": "A", "text": "PTH", "correct": true}, {"label": "B", "text": "FGF-23", "correct": false}, {"label": "C", "text": "Vitamin D3", "correct": false}, {"label": "D", "text": "Calcitonin", "correct": false}], "correct_answer": "A. PTH", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/1HBDexJ187jbGJD5hYTv1744291680.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old female presents with complaints of abdominal pain, constipation, and recent episodes of confusion and depression. Laboratory tests reveal elevated serum calcium and alkaline phosphatase (SAP) levels and decreased phosphate levels. Which of the following clinical features is not typically associated with this condition?", "options": [{"label": "A", "text": "Recurrent nephrolithiasis", "correct": false}, {"label": "B", "text": "Osteitis fibrosa cystica", "correct": false}, {"label": "C", "text": "Tetany", "correct": true}, {"label": "D", "text": "Urinary tract infection", "correct": false}], "correct_answer": "C. Tetany", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/zC2nkRKOsjWytbyjR5bD1744291763.png", "https://image.prepladder.com/notes/04VrWXktLZgyHTGta2dQ1744292204.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old woman presents with persistent constipation, abdominal pain, and intermittent lower back pain. She has a history of recurrent kidney stones and reports fatigue. Lab tests reveal elevated calcium and decreased phosphate levels. She has been advised to undergo a sestamibi Tc-99 scan. Which of the following is not an indication for surgery in this condition?", "options": [{"label": "A", "text": "Nephrolithiasis", "correct": false}, {"label": "B", "text": "Renal impairment", "correct": false}, {"label": "C", "text": "Age &amp;gt;50 years", "correct": true}, {"label": "D", "text": "Osteoporosis", "correct": false}], "correct_answer": "C. Age &gt;50 years", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4c1DQDMYC0ABuMAl26JM1744291823.png", "https://image.prepladder.com/notes/b4C5tc3fSvFyw373Ftnk1744291868.png", "https://image.prepladder.com/notes/lsjWAEUPBsisyNqVrwA21744292136.png", "https://image.prepladder.com/notes/0PaBe5aoSkjlACHK7diG1744292002.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subperiosteal erosions and <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> in the <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">phalanges</span> (usually starts in the middle <span class=\"customMeta\" data-dictid=\"e9451cd23d1692777195fe471f486e\">phalanx</span> of the index finger's <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> side) </strong>along with bone demineralisation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Subperiosteal erosions and trminal resorption in phalanges\" data-author=\"Jones J, Chieng R, Vadera S, et al. \" data-hash=\"8559\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/subperiosteal-bone-resorption\" data-tags=\"April2025\" height=\"212\" src=\"https://image.prepladder.com/notes/4c1DQDMYC0ABuMAl26JM1744291823.png\" width=\"290\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The \"salt and pepper\" appearance, or pepper pot skull</strong> (lytic lesions in the skull).</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Pepper Pot Skull\" data-author=\"Niknejad M, Bell D, Gaillard F, et al.\" data-hash=\"8560\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/salt-and-pepper-sign-skull-1\" data-tags=\"April2025\" height=\"214\" src=\"https://image.prepladder.com/notes/b4C5tc3fSvFyw373Ftnk1744291868.png\" width=\"267\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brown tumour or <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> fibrosa cystica:</strong> <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> lesions in bone from excessive <span class=\"customMeta\" data-dictid=\"fc8c28347a16927771945680bd00be\">osteoclastic</span> <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> appear as low-density, multiloculated cysts that can lead to bone expansion, accompanied by <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Brown Tumor\" data-author=\"Frank Gaillard\" data-hash=\"8568\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Brown_tumor\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/lsjWAEUPBsisyNqVrwA21744292136.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sestamibi scan (Tc-99): Localize the tumour</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Sestamibi scan (Tc-99)\" data-author=\" Mostafa Elfeky\" data-hash=\"8563\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/tc-99m-sestamibi\" data-tags=\"April2025\" height=\"142\" src=\"https://image.prepladder.com/notes/0PaBe5aoSkjlACHK7diG1744292002.png\" width=\"266\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old man with chronic kidney disease (CKD) returns for a follow-up, reporting fatigue, bone pain, and muscle weakness. Examination reveals bone tenderness, and lab tests show elevated parathyroid hormone (PTH) levels. Which of the following findings is not typically associated with this condition?", "options": [{"label": "A", "text": "Elevated serum calcium levels", "correct": true}, {"label": "B", "text": "Raised serum alkaline phosphatase levels", "correct": false}, {"label": "C", "text": "Elevated serum phosphate levels", "correct": false}, {"label": "D", "text": "Raised urinary albumin creatinine ratio", "correct": false}], "correct_answer": "A. Elevated serum calcium levels", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/b4C5tc3fSvFyw373Ftnk1744291868.png", "https://image.prepladder.com/notes/lsjWAEUPBsisyNqVrwA21744292136.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Secondary Hyperparathyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD) - most common</strong></li>\n<li>Vitamin D <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> or impaired production (or action)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Secondary &lt;span class=\" custommeta\"=\"\" data-dictid=\"a21c150dc716927771893624a49628\"/>Hyperparathyroidism Pathophysiology\" data-author=\"NA\" data-hash=\"8566\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/LT0MWGuZjX1pm3qdqUb11744292083.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypocalcemic and <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> symptoms </strong>include bone pain, tenderness, <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures, osteoporosis, and muscle weakness.</li>\n<li><strong>Other manifestations: </strong>\n<ul>\n<li>Soft tissue calcification</li>\n<li>Vascular calcification</li>\n<li>Chondrocalcinosis</li>\n<li>Symptoms like azotemia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, etc (CKD)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subperiosteal erosions and <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> of phalanges.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Subperiosteal erosions and trminal &lt;span class=\" custommeta\"=\"\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\"/>resorption in phalanges\" data-author=\"Jones J, Chieng R, Vadera S, et al. \" data-hash=\"8559\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/subperiosteal-bone-resorption\" data-tags=\"April2025\" height=\"170\" src=\"https://image.prepladder.com/notes/4c1DQDMYC0ABuMAl26JM1744291823.png\" width=\"233\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salt pepper appearance of the skull (lytic lesions in the skull)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pepper Pot Skull\" data-author=\"Niknejad M, Bell D, Gaillard F, et al.\" data-hash=\"8560\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/salt-and-pepper-sign-skull-1\" data-tags=\"April2025\" height=\"212\" src=\"https://image.prepladder.com/notes/b4C5tc3fSvFyw373Ftnk1744291868.png\" width=\"208\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brown tumour or <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> fibrosa cystica (excessive <span class=\"customMeta\" data-dictid=\"fc8c28347a16927771945680bd00be\">osteoclastic</span> resorption)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Brown Tumor\" data-author=\"Frank Gaillard\" data-hash=\"8568\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Brown_tumor\" data-tags=\"April2025\" height=\"191\" src=\"https://image.prepladder.com/notes/lsjWAEUPBsisyNqVrwA21744292136.png\" width=\"200\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lab Investigations </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PTH (parathyroid hormone) levels: Elevated</li>\n<li><strong>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels: Decreased </strong><strong>(Option A)</strong></li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> levels: Increased <strong>(Option C)</strong></li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> level (SAP): Increased <strong>(Option B)</strong></li>\n<li>GFR: Reduced</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> and <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ratio: Increased <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Kidney transplantation</li>\n<li>Calcium and vitamin D3 supplements</li>\n<li>Calcimimetic drugs <strong>(Cinacalcet)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents to the emergency department with muscle cramps, tingling in her fingers, and a tight sensation around her mouth. She has a history of thyroid surgery for papillary carcinoma. Examination revealed increased neuromuscular excitability. Lab results show low PTH, low calcium, and elevated phosphate levels. Which syndrome is most likely associated with this presentation?", "options": [{"label": "A", "text": "Cushing’s syndrome", "correct": false}, {"label": "B", "text": "McCune-Albright Syndrome", "correct": false}, {"label": "C", "text": "Turner syndrome", "correct": false}, {"label": "D", "text": "DiGeorge syndrome", "correct": true}], "correct_answer": "D. DiGeorge syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/jDuqlFR5X9GiVdUfklM01744291957.png", "https://image.prepladder.com/notes/cKJC0ZmdwTHv8Q93C0v31744294176.png", "https://image.prepladder.com/notes/QoICNO5v6zRKddSEKz7T1744291924.png", "https://image.prepladder.com/notes/9g1ty3PxYUFi8ZRlY4bd1744294406.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman undergoes total thyroidectomy for a large goiter. Two days post-surgery, investigations reveal low serum calcium and low parathyroid hormone (PTH) levels. During clinical examination, the following observation is made. What is this sign known as ?", "options": [{"label": "A", "text": "Trousseau sign", "correct": false}, {"label": "B", "text": "Chvostek sign", "correct": true}, {"label": "C", "text": "Hoffman's sign", "correct": false}, {"label": "D", "text": "Brudzinski's sign", "correct": false}], "correct_answer": "B. Chvostek sign", "question_images": ["https://image.prepladder.com/notes/idZc2Bh1uHIKPrxiYq6q1744292233.png"], "explanation_images": ["https://image.prepladder.com/notes/04VrWXktLZgyHTGta2dQ1744292204.png", "https://image.prepladder.com/notes/idZc2Bh1uHIKPrxiYq6q1744292233.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hypoparathyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paresthesia and <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> sensation of fingers and lips</li>\n<li>Seizures</li>\n<li>Bronchospasm</li>\n<li>Laryngospasm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical signs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Q-T prolongation </strong></li>\n<li><strong>Trousseau sign </strong>\n<ul>\n<li>It is elicited by inflating a <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> over the upper arm to 20 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> above the patient’s <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> for three minutes.</li>\n<li>This temporarily occludes the <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> artery, resulting in the development of <span class=\"customMeta\" data-dictid=\"ae4dc0619116927771831407152055\">carpopedal</span> spasm, often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as <strong>\"Obstetrician's hand.\"</strong></li>\n</ul>\n</li>\n<li><strong>Chvostek sign </strong>is observed when gentle tapping on the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> border of the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> causes <span class=\"customMeta\" data-dictid=\"90e9d2db7f1692777201d0a9b101c5\">twitching</span> of the muscles around the lips.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Trousseau's Sign\" data-author=\"Tmdswan\" data-hash=\"8569\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Trousseau_sign_of_latent_tetany\" data-tags=\"April2025\" height=\"237\" src=\"https://image.prepladder.com/notes/04VrWXktLZgyHTGta2dQ1744292204.png\" width=\"292\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Chvostek Sign\" data-author=\"NA\" data-hash=\"8571\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"264\" src=\"https://image.prepladder.com/notes/idZc2Bh1uHIKPrxiYq6q1744292233.png\" width=\"264\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old man diagnosed with hypoparathyroidism six months ago after neck surgery presents with tingling in his hands and feet, muscle cramps, and fatigue. His lab results indicate low serum calcium, elevated phosphate, and severely low parathyroid hormone (PTH) levels. What is the most appropriate treatment for his condition?", "options": [{"label": "A", "text": "Initiate intravenous calcium gluconate therapy", "correct": false}, {"label": "B", "text": "Administration of Alendronate", "correct": false}, {"label": "C", "text": "Administration of Teriparatide", "correct": true}, {"label": "D", "text": "Start oral calcium and Vitamin D supplement", "correct": false}], "correct_answer": "C. Administration of Teriparatide", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:641px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypoparathyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serum <strong>calcium</strong>: ↓</li>\n<li>Serum<strong> <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> hormone</strong>: ↓↓↓</li>\n<li>Serum <strong>albumin</strong>: Normal</li>\n<li><strong>ECG</strong>: QT prolongation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For <span class=\"customMeta\" data-dictid=\"59f10ee7c31692777189a8544bb404\">hypocalcemia</span> crisis: <strong>Calcium <span class=\"customMeta\" data-dictid=\"ff3235f97616927771884121a800e7\">gluconate</span> 10% IV </strong>injection is given <strong>(Option A)</strong></li>\n<li><strong>Teriparatide:</strong> <span class=\"customMeta\" data-dictid=\"357ecf18f2169277718661a76111ea\">DOC</span> for surgically <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> <span class=\"customMeta\" data-dictid=\"0b27888c2e16927771896397bdd88d\">hypoparathyroidism</span> <strong>(Option C)</strong></li>\n<li>Calcium and <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> supplements<strong> </strong><strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman with primary hyperparathyroidism presents with nausea, vomiting, confusion, and dehydration. She shows signs of hypovolemia and altered mental status. Labs reveal high serum calcium, low phosphate, and elevated PTH. What is the first line of treatment?", "options": [{"label": "A", "text": "Intravenous Bisphosphonates", "correct": false}, {"label": "B", "text": "Aggressive hydration with normal saline", "correct": true}, {"label": "C", "text": "Peritoneal dialysis", "correct": false}, {"label": "D", "text": "Calcitonin nasal spray", "correct": false}], "correct_answer": "B. Aggressive hydration with normal saline", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old adult patient presents with symptoms of chronic hypocalcemia. Which of the following features is associated with this condition?", "options": [{"label": "A", "text": "Extrapyramidal symptoms like dystonia", "correct": false}, {"label": "B", "text": "Tissue deposition of calcium due to hyperphosphatemia", "correct": false}, {"label": "C", "text": "Skin infections such as candidiasis", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/lR9nB7vwnRpVRlZtTLii1744292277.png", "https://image.prepladder.com/notes/a6vRd34BQwhSPjPkbvP31744294944.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chronic Hypocalcemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In chronic hypocalcemia, often associated with conditions like chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, <span class=\"customMeta\" data-dictid=\"2311a51162169277718909f1112ccd\">hyperphosphatemia</span> can lead to<strong> <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> calcifications in tissues.</strong> <strong>(Option B)</strong></li>\n<li>Basal <span class=\"customMeta\" data-dictid=\"f2804c808516927771887dda93e56c\">ganglia</span> <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> can occur.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Chronic Hypocalcemia\" data-author=\"Abu-Amero KK, Al-Dhalaan H, Bohlega S, Hellani A, Taylor RW.\" data-hash=\"8573\" data-license=\"CC BY SA 2.0\" data-source=\"https://en.m.wikipedia.org/wiki/File:A_computed_tomography_brain_scan_showing_bilateral_basal_ganglia_calcification.jpg\" data-tags=\"April2025\" height=\"230\" src=\"https://image.prepladder.com/notes/lR9nB7vwnRpVRlZtTLii1744292277.png\" width=\"312\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extrapyramidal symptoms<strong> </strong>like <strong>dystonia</strong><strong> </strong><strong>(Option A)</strong>, <span class=\"customMeta\" data-dictid=\"ed0e846cb21692777193e8bb1b5223\">oculogyric crisis</span> and Hemiballismus</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Occulogyric Crisis\" data-author=\"Amponsah, Emmanuel &amp; Sodnom-Ish, Buyanbileg &amp; Anyetei-Anum, Aaron &amp; Frimpong, Paul &amp; Kim, Soung. (\" data-hash=\"8625\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Oculogyric-crisis-in-a-patient-who-exhibited-paroxysmal-conjugate-tonic-ocular_fig1_351716082\" data-tags=\"April2025\" height=\"192\" src=\"https://image.prepladder.com/notes/a6vRd34BQwhSPjPkbvP31744294944.png\" width=\"314\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Ocular cataract</li>\n<li>Abnormal dentition</li>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"c5b1caa4101692777196f71f2f40d3\">polyglandular</span> syndrome\n\t\t\t\t<ul>\n<li><strong>Cutaneous candidiasis</strong> <strong>(Option C)</strong></li>\n<li>Salt wasting</li>\n<li>Postural hypotension</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> ↓</p>\n<p>Serum <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> ↑</p>\n<p>Serum <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> ↓↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium and <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">Vitamin D</span> supplements</p>\n<p>Teriparatide (if due to <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> etiology)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-year-old boy presents with characteristic skeletal and developmental defects, such as short stature and shortened 4th and 5th metacarpals. Laboratory findings show elevated PTH levels, hypocalcemia, and hyperphosphatemia. Genetic testing reveals a deficiency in the Gsα subunit. Based on these findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Pseudopseudohypoparathyroidism (PPHP)", "correct": false}, {"label": "B", "text": "Pseudohypoparathyroidism type 1a (PHP1A)", "correct": true}, {"label": "C", "text": "Pseudohypoparathyroidism type 1b (PHP1B)", "correct": false}, {"label": "D", "text": "Hypoparathyroidism", "correct": false}], "correct_answer": "B. Pseudohypoparathyroidism type 1a (PHP1A)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ivuDJQ8yA5NJR94SMgug1739905199.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypoparathyroidism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudohypoparathyroidism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudopseudohypoparathyroidism </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Injury to parathyroids</li>\n<li>Autoimmune</li>\n<li>DiGeorge’s syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant <strong>maternally</strong> transmitted <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in<strong> GNAS1 gene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant <strong>paternally </strong>transmitted <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in <strong>GNAS1 gene </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of hypoparathyroidism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inactivation of <span class=\"customMeta\" data-dictid=\"8e7861ecf81692777180ef83a3327d\">adenylate</span> <span class=\"customMeta\" data-dictid=\"b638747a661692777185a6182d6e5f\">cyclase</span> when <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> binds to its receptor.</p>\n<ul>\n<li><strong>PHP <span class=\"customMeta\" data-dictid=\"83151606011692777201b52befff51\">Type 1A</span> (PHP1A): </strong>Deficiency in the Gs <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> subunit.</li>\n<li><strong>PHP <span class=\"customMeta\" data-dictid=\"81b67496b61692777201c4e71eb946\">Type 1B</span> (PHP1B): </strong>Gs <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> subunit is present, but the tissue response to <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> is impaired.</li>\n<li><strong>PHP <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">Type 2</span> (PHP2):</strong> Gs <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> subunit is present, and there is no significant resistance to PTH.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inactivation of <span class=\"customMeta\" data-dictid=\"8e7861ecf81692777180ef83a3327d\">adenylate</span> <span class=\"customMeta\" data-dictid=\"b638747a661692777185a6182d6e5f\">cyclase</span> when <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> binds to its <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> only in the bones.</p>\n<p>Gs <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> subunit is deficient.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tetany</li>\n<li>Hypocalcemia\n\t\t\t\t<ul>\n<li>Chvostek sign</li>\n<li>Trousseau sign</li>\n</ul>\n</li>\n<li>Hyperphosphatemia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Albright <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> <span class=\"customMeta\" data-dictid=\"303281f8d5169277719437cf04ebaf\">osteodystrophy</span> (shortened 4th and 5th digit)</li>\n<li>Short stature</li>\n<li>Round face</li>\n<li>Subcutaneous calcifications</li>\n<li>Developmental delay</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Albright <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> <span class=\"customMeta\" data-dictid=\"303281f8d5169277719437cf04ebaf\">osteodystrophy</span> (shortened 4th and 5th digit)</li>\n<li>Renal response to <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum findings </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PTH ↓↓</p>\n<p>Calcium ↓</p>\n<p>Phosphate <strong>↑</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PTH <strong>↑</strong></p>\n<p>Calcium ↓</p>\n<p>Phosphate <strong>↑</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PTH - normal</p>\n<p>Calcium - normal</p>\n<p>Phosphate - normal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman with a history of chronic kidney disease secondary to hypertension presents with symptoms of nausea, vomiting, and confusion. On Investigating her Lab values are Serum calcium: 12.0 mg/dL (normal range: 8.5-10.5 mg/dL) Serum phosphate: 4.9 mg/dL (normal range: 2.5-4.5 mg/dL) Serum PTH: 200 pg/mL (normal range: 10-65 pg/mL) Which of the following is the most likely diagnosis of this patient?", "options": [{"label": "A", "text": "Primary Hyperparathyroidism", "correct": false}, {"label": "B", "text": "Secondary Hyperparathyroidism", "correct": false}, {"label": "C", "text": "Pseudohypoparathyroidism", "correct": false}, {"label": "D", "text": "Tertiary Hyperparathyroidism", "correct": true}], "correct_answer": "D. Tertiary Hyperparathyroidism", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/axiWaOEC0yrgnKMo4v2p1744292326.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:745px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Hyperparathyroidism</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Hyperparathyroidism</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tertiary Hyperparathyroidism</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudohypoparathyroidism</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adenoma (Common)</li>\n<li>Hyperplasia</li>\n<li>Carcinoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CKD</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolonged secondary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> in CKD</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in the GNAS1 gene.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PTH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phosphate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High/Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>S. <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">Alkaline</span> Phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal/Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low/Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy presents with a history of recurrent fractures and pain in his lower limbs.He has a history of poor dietary intake, particularly low dairy consumption. Clinical examination leads to the findings similar to the images given below. Based on these observations, which of the following lab findings would be most consistent with his condition?", "options": [{"label": "A", "text": "Low Parathyroid hormone, High Calcium", "correct": false}, {"label": "B", "text": "Low Calcium, High Phosphate", "correct": false}, {"label": "C", "text": "High Calcium, Low Phosphate", "correct": false}, {"label": "D", "text": "High Parathyroid hormone, Low Calcium", "correct": true}], "correct_answer": "D. High Parathyroid hormone, Low Calcium", "question_images": ["https://image.prepladder.com/notes/3xi2rUdp7TMpZlRmG0Xd1744292353.png", "https://image.prepladder.com/notes/ZxuGF0x0SxxSr70Ws9ZX1744292379.png"], "explanation_images": ["https://image.prepladder.com/notes/vOgml4l8kjV2PIVCRs6G1744292485.png", "https://image.prepladder.com/notes/qUf4q0qRWQbmzI5rp34t1744292399.png", "https://image.prepladder.com/notes/6mqvIM3Z3GEqltxV2ODY1744295654.png", "https://image.prepladder.com/notes/IDUKU2IGU2IqQjOIqCig1744292549.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Nutritional Rickets</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vitamin D (Common), <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> or <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> deficiencies due to\n\t\t\t\t<ul>\n<li>Dietary deficiency</li>\n<li>Malabsorption</li>\n<li>Congenital conditions</li>\n<li>Liver/ <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> disease</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Failure to thrive</li>\n<li>Protruded abdomen</li>\n<li>Muscle hypotonia</li>\n<li><strong>Craniotabes</strong> (Softening of skull bones)</li>\n<li>Frontal bossing</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"76e17c45ef16927771851bc19cfc04\">dentition</span> and <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> caries</li>\n<li>Increased risk of fractures</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> fontanelle</li>\n<li><strong>Rachitic rosary</strong> (Rib cage <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> with <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of <span class=\"customMeta\" data-dictid=\"bfa9e996381692777185cdc8709772\">costochondral</span> junction).</li>\n<li><strong>Harrison sulcus</strong> (Indentation at the lower rib margin)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Harrison's Groove\" data-author=\"Sarat, Gummadapu &amp; Nuthalapati, Priyanka &amp; Prabhat, Meka &amp; Lakshmi, Chintamaneni &amp; Bhavana, Sujanamulk &amp; Thabusum, Ayesha\" data-hash=\"8579\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Showing-Harrisons-groove-on-the-chest-region_fig11_303713972\" data-tags=\"April2025\" height=\"324\" src=\"https://image.prepladder.com/notes/vOgml4l8kjV2PIVCRs6G1744292485.png\" width=\"280\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Widening of wrists</li>\n<li>Bowing of legs</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bowing of Legs\" data-author=\"Baba Y\" data-hash=\"8577\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/rickets-35?lang=gb\" data-tags=\"April2025\" height=\"316\" src=\"https://image.prepladder.com/notes/qUf4q0qRWQbmzI5rp34t1744292399.png\" width=\"228\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Signs of Rickets\" data-author=\"NA\" data-hash=\"8637\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"329\" src=\"https://image.prepladder.com/notes/6mqvIM3Z3GEqltxV2ODY1744295654.png\" width=\"329\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> ￬</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> ￬</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">Alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> ￪</li>\n<li>25 (OH) Vit D3 ￬</li>\n<li>X-ray shows Osteopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin D supplementation</strong> - 10,000 to 25,000 IU daily for 2 weeks, followed by 800 to 1600 IU daily for maintenance.</p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Osteomalacia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Vitamin D <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> in adults</strong> causes <span class=\"customMeta\" data-dictid=\"f469f168b3169277719839870c0ce5\">softening</span> of bones due to inadequate mineralisation.</li>\n<li>Long-standing Hypophosphatemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent Fractures</li>\n<li>Low Bone mass Density</li>\n<li>Fatigue</li>\n<li>Bone pain</li>\n<li>Waddling gait</li>\n<li>Weakness of <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> muscles</li>\n<li>On applying pressure, bone and muscle <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> can be appreciated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations and Rx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Similar to Rickets</li>\n<li>X-ray shows <strong>Looser’s zone or Pseudofractures</strong> - <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> areas in ribs, long bones and pelvis.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Looser's Zone or Pseudofractures\" data-author=\"A. Bhatt, S. S. Mathews, A. Kumari, T. Pau\" data-hash=\"8580\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Tumour-induced-osteomalacia.-Bhatt-Mathews/01f594f85e03bb9d06a21331b06e84a7aec4ffb3\" data-tags=\"April2025\" height=\"273\" src=\"https://image.prepladder.com/notes/IDUKU2IGU2IqQjOIqCig1744292549.png\" width=\"382\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old boy with growth delays and leg bowing has not improved after six months of vitamin D treatment. Labs show low calcium, low phosphate, and elevated alkaline phosphatase. Genetic testing indicates a Vitamin D gene mutation. What is the best management option?", "options": [{"label": "A", "text": "Increase in vitamin D dosage", "correct": false}, {"label": "B", "text": "Initiate phosphate supplementation", "correct": false}, {"label": "C", "text": "Administer Calcium", "correct": false}, {"label": "D", "text": "Administer Calcitriol", "correct": true}], "correct_answer": "D. Administer Calcitriol", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/GsehDhPW1qzAEda6fb451744292627.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vitamin D Dependent <span class=\"customMeta\" data-dictid=\"3bbd4ac09b16927771974d75a8b355\">Rickets</span> (VDDR) - Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">Recessive</span> condition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type II</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect in the<strong> 25-hydroxylase enzyme,</strong> which is used in the conversion of 25 (OH) Vit D to its active form.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect in the <strong>Vitamin D receptor</strong>, causing resistance to o 1,25 (OH) Vit D3 (active form)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to Nutritional deficiency, <span class=\"customMeta\" data-dictid=\"3bbd4ac09b16927771974d75a8b355\">rickets</span> include leg bowing, growth delays, delayed <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of fontanelles, widening of growth plates, bone pain, muscle weakness, fractures, and <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> abnormalities.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High chances of alopecia, <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> abnormalities, and <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> cysts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Work-up</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Calcium levels ↓</li>\n<li>Phosphate levels ↓</li>\n<li>SAP ↑</li>\n<li>PTH ↑</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Calcium levels ↓</li>\n<li>Phosphate levels ↓</li>\n<li>SAP ↑</li>\n<li>PTH ↑</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>With <strong>Calcitriol (Active form) </strong>+ <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> +/- Phosphate</p>\n<p><strong>(Option B, C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Difficult to manage</li>\n<li>Large doses of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> are given to normalize PTH.</li>\n<li>Phosphate supplements can be given</li>\n<li>No satisfactory results.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hereditary Hypophosphatemic Rickets</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is X-linked, Autosomal dominant or <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">Recessive</span> condition</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hereditary Hypophosphatemic Rickets\" data-author=\"NA\" data-hash=\"8582\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"220\" src=\"https://image.prepladder.com/notes/GsehDhPW1qzAEda6fb451744292627.png\" width=\"702\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>nvestigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> - </strong>Normal/ Low</li>\n<li><strong>Serum <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> - </strong>Low</li>\n<li><strong>Urine <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> -</strong> High</li>\n<li><strong>PTH -</strong> Normal/Slightly elevated</li>\n<li><strong>Serum FGF23 - </strong>High</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Phosphate Supplements</strong></li>\n<li><strong>Vitamin D Supplements - </strong>To increase <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> and <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> from the gut.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presents with recurrent kidney stones, abdominal pain, and peptic ulcers. His blood pressure is elevated, and he has a family history of thyroid carcinoma. Laboratory tests reveal high serum calcium and parathyroid hormone levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "MEN Type 1", "correct": false}, {"label": "B", "text": "MEN Type 4", "correct": false}, {"label": "C", "text": "MEN Type 3", "correct": false}, {"label": "D", "text": "MEN Type 2", "correct": true}], "correct_answer": "D. MEN Type 2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:797px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">Endocrine</span> Neoplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type IV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defect of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>11q13</strong> causing <strong>MEN 1 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></li>\n<li>Also called <strong>Wermer’s syndrome</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defect of chr.10 leading to <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> of <strong>RET gene</strong></li>\n<li>Also called <strong>Sipple’s syndrome </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Also called <strong>MEN II B</strong>, it is a <strong>variant of <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">Type 2</span> </strong>MEN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect of chr.12 causing <strong>CDKN1B gene</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumors</strong></p>\n<p><strong>Included</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parathyroid adenoma</strong></p>\n<p>(most common)</p>\n<ul>\n<li>It presents with primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> (↑ <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> and ↑ Ca)</li>\n<li>All the 4 glands can be included.</li>\n<li><strong>Rx: </strong>Total/subtotal <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> resection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>most common, and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> can be normal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> (</strong>most common)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>Presents as hypercalcemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pancreatic adenoma</strong></p>\n<ul>\n<li>Presents as <strong>Gastrinoma or Zollinger-Ellison syndrome</strong></li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease in the duodenum, which is the leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> in this type.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pheochromocytoma</strong>.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pheochromocytoma </strong>(Most important <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> for both <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 2 and <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 3): Presents with elevated blood pressure.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma, causing <span class=\"customMeta\" data-dictid=\"5d8a1011e31692777181375a96c9c8\">amenorrhea</span> and Infertility</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></p>\n<ul>\n<li>Calcitonin is the <span class=\"customMeta\" data-dictid=\"19ae68448b16927772016d48bd7fc3\">tumor marker</span> present</li>\n<li>Cold nodules are seen on the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> scan</li>\n<li>Metastasis can be traced with PET scan</li>\n<li>Visible neck mass, causing dysphagia</li>\n<li><strong>Rx</strong>- <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">Prophylactic</span> thyroidectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reproductive <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> tumors</strong></p>\n<ul>\n<li>Testicular tumors</li>\n<li>Neuroendocrine tumor (Cervix)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angiofibroma</li>\n<li>Collagenoma</li>\n<li>Adrenocortical tumor</li>\n<li>Carcinoid tumors/Argentaffinoma</li>\n<li>Pheochromocytoma (only in 1%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital aganglionosis,</li>\n<li>Hirschsprung disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Marfanoid habitus</li>\n<li>Medullated corneal nerve fibers</li>\n<li>Mucosal neuromas</li>\n<li>Megacolon and Multiple diverticulae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occasionally with</p>\n<ul>\n<li>Renal tumor</li>\n<li>Adrenal tumor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presents with notable fatigue, frequent urination, and increased thirst. He has a family history of autoimmune disorders. Laboratory tests reveal elevated blood glucose levels and positive autoantibodies. Autoimmune Polyendocrine Syndrome(APS) is suspected. Which of the following statements regarding the diagnosis is not true?", "options": [{"label": "A", "text": "Type 1 is a mutation of the AIRE gene", "correct": false}, {"label": "B", "text": "Type 2 APS can be associated with Celiac sprue", "correct": false}, {"label": "C", "text": "Type 1 APS can be associated with mucocutaneous candida.", "correct": false}, {"label": "D", "text": "Hypoparathyroidism is a part of Type 1 APS", "correct": true}], "correct_answer": "D. Hypoparathyroidism is a part of Type 1 APS", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autoimmune <span class=\"customMeta\" data-dictid=\"df8c884f491692777196c97ae5d3b9\">Polyendocrine</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Onset is early</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Onset is late</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare condition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comparatively more common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No sex differentiation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Female &gt; Male</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chr.21, the AIRE gene is affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to gene defects in the <strong>HLA complex</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrine conditions</strong></p>\n<ul>\n<li>Addison’s disease</li>\n<li>Hypoparathyroidism</li>\n<li>Hypogonadism</li>\n<li>Graves’ disease or <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> thyroiditis</li>\n<li>Type 1 Diabetes mellitus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrine conditions:</strong> Similar to Type 1, but <span class=\"customMeta\" data-dictid=\"0b27888c2e16927771896397bdd88d\">Hypoparathyroidism</span> is not a part.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-endocrine associations</strong></p>\n<ul>\n<li><strong>Mucocutaneous candidiasis</strong></li>\n<li>Chronic active hepatitis</li>\n<li>Asplenism</li>\n<li>Ectodermal dysplasia</li>\n<li>Malabsorption syndromes</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-endocrine associations</strong></p>\n<ul>\n<li><strong>Celiac disease</strong></li>\n<li>Dermatitis herpetiformis</li>\n<li>Myasthenia gravis</li>\n<li>Parkinson’s disease</li>\n<li>Idiopathic thrombocytopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common non-endocrine associations of APS</strong></p>\n<ul>\n<li>Pernicious anemia</li>\n<li>Vitiligo</li>\n<li>IgA deficiency</li>\n<li>Alopecia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents with complaints of irregular menstrual cycles and infertility &amp;amp; reports increased headaches and visual changes over the past few months. An MRI reveals a large pituitary tumor. Family history is significant for several relatives with breast and thyroid cancers. Which syndrome is most likely associated with her condition?", "options": [{"label": "A", "text": "McCune-Albright Syndrome", "correct": false}, {"label": "B", "text": "Von Hippel-Lindau (VHL) Disease", "correct": false}, {"label": "C", "text": "Cowden Syndrome", "correct": true}, {"label": "D", "text": "Carney Complex", "correct": false}], "correct_answer": "C. Cowden Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Identify the gene commonly involved in the carcinoma shown in the image below:", "options": [{"label": "A", "text": "RAS", "correct": false}, {"label": "B", "text": "RET", "correct": false}, {"label": "C", "text": "BRAF V600", "correct": true}, {"label": "D", "text": "P53", "correct": false}], "correct_answer": "C. BRAF V600", "question_images": ["https://image.prepladder.com/content/pZsT6MVPe1J5vA2rxZZp1724849727.png"], "explanation_images": [], "explanation": "<p>Correct Option C - BRAF V6\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with headaches, palpitations, and hypertension. On laboratory examination, urine VMA is positive. His biopsy findings are given below. Which of the following is a correct statement?", "options": [{"label": "A", "text": "Mostly malignant", "correct": false}, {"label": "B", "text": "Mostly in children", "correct": false}, {"label": "C", "text": "Mostly bilateral", "correct": false}, {"label": "D", "text": "Associated with MEN2A", "correct": true}], "correct_answer": "D. Associated with MEN2A", "question_images": ["https://image.prepladder.com/content/7HAe7cyzygGAEYUUFyBi1724852454.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Associated with MEN2A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone is secreted by the structure marked with an arrow?", "options": [{"label": "A", "text": "Glucocorticoid", "correct": true}, {"label": "B", "text": "DHEA", "correct": false}, {"label": "C", "text": "Androgens", "correct": false}, {"label": "D", "text": "Mineralocorticoid", "correct": false}], "correct_answer": "A. Glucocorticoid", "question_images": ["https://image.prepladder.com/notes/XUZE5QwbIdTTZvmQj8rR1747650950.png"], "explanation_images": ["https://image.prepladder.com/content/dWq3B3d1eMUXwno1t2H31747311407.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Layers of Adrenal Gland</strong></td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adrenal Cortex</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zones of the cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormones produced</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Main function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology of Zone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona Glomerulosa </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mineralocorticoid <strong>(Option D ruled out)</strong></p>\n<ul>\n<li>Aldosterone(main)</li>\n<li>Deoxycorticosterone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sodium balance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small clumps of cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona fasciculata </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucocorticoids <strong>(Option A)</strong></p>\n<ul>\n<li>Cortisol</li>\n<li>Corticosterone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sugars</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Columnar cells that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> long cords</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona reticularis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sex steroids</p>\n<ul>\n<li>Dehydroepiandrosterone (DHEA) <strong>(Option B ruled out)</strong></li>\n<li>Androstenedione <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sexual functioning</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Network of <span class=\"customMeta\" data-dictid=\"cfd35769b016927771901681bcc115\">intercalated</span> cells</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adrenal medulla</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medulla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Catecholamines:</p>\n<ul>\n<li>Norepinephrine</li>\n<li>Epinephrine</li>\n<li>Small amounts of dopamine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carbohydrate and fat metabolisms</li>\n<li>Fight or flight responses</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specialised <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> ganglion</p>\n<p>Clumps and strands of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a new intranuclear immunohistochemistry marker for neuroendocrine tumors?", "options": [{"label": "A", "text": "Synaptophysin", "correct": false}, {"label": "B", "text": "Chromogranin", "correct": false}, {"label": "C", "text": "INSM", "correct": true}, {"label": "D", "text": "NCAM1/ CD56", "correct": false}], "correct_answer": "C. INSM", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – INSM\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with neck swelling with compression of the trachea and esophagus. Histopathological assessment shows cell nest and pink extracellular amyloid stroma. What is the origin of the tumor?", "options": [{"label": "A", "text": "Parafollicular C cells", "correct": true}, {"label": "B", "text": "Hurthle cell", "correct": false}, {"label": "C", "text": "Follicular cells", "correct": false}, {"label": "D", "text": "Askanazy cells", "correct": false}], "correct_answer": "A. Parafollicular C cells", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1YxooIqymHH95ZRVYHSQ1718363497.png"], "explanation": "<p>Correct Option A - Parafollicular C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old female patient presents with a palpable thyroid nodule and occasional neck discomfort. She has no history of radiation exposure to the neck. On physical examination, a solitary, firm, non-tender thyroid nodule is noted. Ultrasound reveals a hypoechoic nodule with microcalcifications. Fine-needle aspiration biopsy is performed, and histological analysis reveals characteristic nuclear changes. What is the most common thyroid cancer in this patient?", "options": [{"label": "A", "text": "Papillary carcinoma", "correct": true}, {"label": "B", "text": "Follicular carcinoma", "correct": false}, {"label": "C", "text": "Medullary carcinoma", "correct": false}, {"label": "D", "text": "Anaplastic carcinoma", "correct": false}], "correct_answer": "A. Papillary carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 19-year-old female presents with a neck swelling that shifts during swallowing. Ultrasound reveals a 2 cm x 2 cm mass in the left lobe of the thyroid, reaching the strap muscles. Histopathology shows findings as shown in the image. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Medullary CA thyroid", "correct": false}, {"label": "B", "text": "Follicular CA thyroid", "correct": false}, {"label": "C", "text": "Thyroglossal cyst", "correct": false}, {"label": "D", "text": "Papillary CA thyroid", "correct": true}], "correct_answer": "D. Papillary CA thyroid", "question_images": ["https://image.prepladder.com/notes/5HTbNPe7Qy5XSTAGVFNR1745256514.png"], "explanation_images": ["https://image.prepladder.com/notes/tSpOdmhOGyplk36Pb0es1745256773.png", "https://image.prepladder.com/notes/OWOWmVAQdCk8lbAaGLdn1745256837.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a patient who presents with a swelling in the midline of the neck, based on the biopsy findings, which reveal orphan Annie's eye nuclei as depicted in the image provided?", "options": [{"label": "A", "text": "Follicular carcinoma", "correct": false}, {"label": "B", "text": "Papillary carcinoma", "correct": true}, {"label": "C", "text": "Toxic nodular goiter", "correct": false}, {"label": "D", "text": "Medullary carcinoma", "correct": false}], "correct_answer": "B. Papillary carcinoma", "question_images": ["https://image.prepladder.com/content/xZfbNS3NUCe6Av5EI3VM1746083891.png"], "explanation_images": ["https://image.prepladder.com/content/tmySiIXWGIvGH7epfFAz1746083925.png", "https://image.prepladder.com/content/eu7mbfKr5V5Xltn4ImLz1747908550.png", "https://image.prepladder.com/content/A02sEs0AqYyOLQcUQHnO1746083925.png", "https://image.prepladder.com/content/LTVz2nzcHNtYvrDMd1x31747922252.png", "https://image.prepladder.com/content/Y7wz3urTYRV7HQqLlKCo1746083925.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to the OPD with long hands and feet and a protruding lower jaw. Which of the following genes is most likely implicated in this scenario?", "options": [{"label": "A", "text": "GATA1", "correct": false}, {"label": "B", "text": "PIT1", "correct": true}, {"label": "C", "text": "TPIT", "correct": false}, {"label": "D", "text": "SF1", "correct": false}], "correct_answer": "B. PIT1", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the minimum biopsy specimen requirement for an adequate sample in the case of a thyroid biopsy?", "options": [{"label": "A", "text": "15 follicular cell clusters containing 10-12 cells", "correct": false}, {"label": "B", "text": "10 follicular cell clusters containing 6-8 cells", "correct": false}, {"label": "C", "text": "3 follicular cell clusters containing 10-15 cells", "correct": false}, {"label": "D", "text": "6 follicular cell clusters containing 10-15 cells", "correct": true}], "correct_answer": "D. 6 follicular cell clusters containing 10-15 cells", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-diagnostic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 1c</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-diagnostic cystic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-neoplastic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follicular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspicion of malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thy 5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a midline swelling in the neck. A biopsy reveals Orphan Annie's eye nuclei, as shown in the image below. What is the diagnosis?", "options": [{"label": "A", "text": "Follicular carcinoma", "correct": false}, {"label": "B", "text": "Papillary carcinoma", "correct": true}, {"label": "C", "text": "Toxic nodular goitre", "correct": false}, {"label": "D", "text": "Medullary carcinoma", "correct": false}], "correct_answer": "B. Papillary carcinoma", "question_images": ["https://image.prepladder.com/content/2aoiM1aBQAnCzMXndGxL1745217730.png"], "explanation_images": ["https://image.prepladder.com/content/60oDEsfgPmsXpR3BrgNs1745217800.png", "https://image.prepladder.com/content/zpM0RvA4N29RggDMuwcq1745217800.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged woman presents with thyroid swelling. Blood tests show elevated TSH levels and the presence of thyroid peroxidase antibodies. Histopathological examination revealed the presence of Hurthle cells. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hashimoto thyroiditis", "correct": true}, {"label": "B", "text": "Graves’ disease", "correct": false}, {"label": "C", "text": "Follicular carcinoma of thyroid", "correct": false}, {"label": "D", "text": "Medullary carcinoma of thyroid", "correct": false}], "correct_answer": "A. Hashimoto thyroiditis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DHgzeC6cNTunYijv0K3V1745218825.png", "https://image.prepladder.com/notes/yWacePijOKX8LDa4Xzj41746438249.png", "https://image.prepladder.com/notes/RFKMByNhcs3aNqI76L6I1746438359.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who has swelling in the middle of their neck, along with weight loss, and a thyroid biopsy showing the presence of 'Orphan Annie eye nuclei?", "options": [{"label": "A", "text": "Follicular thyroid carcinoma", "correct": false}, {"label": "B", "text": "Papillary thyroid carcinoma", "correct": true}, {"label": "C", "text": "Anaplastic thyroid carcinoma", "correct": false}, {"label": "D", "text": "Medullary thyroid carcinoma", "correct": false}], "correct_answer": "B. Papillary thyroid carcinoma", "question_images": ["https://image.prepladder.com/content/r2TNoSQ0M73dD1G2gzrR1746696791.png"], "explanation_images": ["https://image.prepladder.com/content/Z80HcghGwich1VpKUVIu1746696881.png", "https://image.prepladder.com/content/1664NwS8CXuVVfiBoK271746696890.png", "https://image.prepladder.com/content/C5AIl3l3Nw2tpg3GccD51746696903.png", "https://image.prepladder.com/content/ImAS2IjWtDn1IVgV5uXu1746696913.png", "https://image.prepladder.com/content/iSged9AVaI3Ecgcgl5rV1746696922.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a painless neck swelling . The histology of the tissue is as given in the image below. What is the diagnosis?", "options": [{"label": "A", "text": "Medullary carcinoma", "correct": false}, {"label": "B", "text": "NHL", "correct": false}, {"label": "C", "text": "Graves disease", "correct": false}, {"label": "D", "text": "Hashimoto’s thyroiditis", "correct": true}], "correct_answer": "D. Hashimoto’s thyroiditis", "question_images": ["https://image.prepladder.com/content/wjYrB5Pdf4YERxyru87k1711958369.png"], "explanation_images": ["https://image.prepladder.com/content/SDzW160sbePHJRYUxufJ1711959140.png", "https://image.prepladder.com/content/VquIvV08xHBhL2gXcSKz1711958663.png", "https://image.prepladder.com/content/PnOZiac9G1Dpn2jslwy21711958912.png", "https://image.prepladder.com/content/wjYrB5Pdf4YERxyru87k1711958369.png", "https://image.prepladder.com/content/SDzW160sbePHJRYUxufJ1711959140.png"], "explanation": "<p>Correct Option D - Hashimoto’s Th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male comes to the outdoor patient department with complaints of episodic headaches, palpitations, and sweating . On physical examination, his chest shows pectus excavatum and a high extremities-to-body ratio . Growth is seen on her tongue, and a mass on the left flank is also palpated. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "MEN 1", "correct": false}, {"label": "B", "text": "MEN 2A", "correct": false}, {"label": "C", "text": "MEN 2B", "correct": true}, {"label": "D", "text": "Neurofibromatosis type 2", "correct": false}], "correct_answer": "C. MEN 2B", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\"&gt;MEN&lt;/span&gt; 2B\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>MEN 1</strong></td>\n<td><strong>MEN 2A</strong></td>\n<td><strong>MEN 2B</strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Mode of inheritance</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Autosomal dominant inheritance</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Autosomal dominant inheritance</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Autosomal dominant inheritance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Associated gene mutations</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>MEN1 gene mutation</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>RET gene mutation</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>RET gene mutation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Endocrine tumors</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Parathyroid adenoma</li>\n<li>Pancreatic <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> tumors</li>\n<li>Pituitary tumors</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</li>\n<li>Pheochromocytoma</li>\n<li>Parathyroid hyperplasia</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</li>\n<li>Pheochromocytoma</li>\n<li>Marfanoid habitus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pheochromocytoma produces all, except:", "options": [{"label": "A", "text": "Nor-epinephrine", "correct": false}, {"label": "B", "text": "Secretin", "correct": true}, {"label": "C", "text": "Vasoactive intestinal polypeptide", "correct": false}, {"label": "D", "text": "Somatostatin", "correct": false}], "correct_answer": "B. Secretin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 15 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 26-year-old male presents with recurrent episodes of abdominal pain, diarrhoea, occasional rectal bleeding, and unintentional weight loss. On examination, there are signs of tenderness in the right lower quadrant, and perianal fissures are noted. Colonoscopy revealed linear ulcers in the colon with rectal sparing. What is the most likely diagnosis based on this clinical presentation?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": false}, {"label": "B", "text": "Celiac disease", "correct": false}, {"label": "C", "text": "Crohn's disease", "correct": true}, {"label": "D", "text": "Irritable bowel syndrome", "correct": false}], "correct_answer": "C. Crohn's disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/WEVTrF2xf7OIudJvJFBM1745577252.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crohn’s Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any part of GIT from mouth to anus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily, the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> is involved.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rectal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> is often spared.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It almost always involves the rectum, hence associated with rectal bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin lesions, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> wall thickening, Strictures, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">Perianal</span> manifestations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transmural and segmental</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucosal and continuous involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Noncaseating granulomas are characteristic of Crohn’s disease.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Granulomas are not typically present.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents to her primary care physician with abdominal pain, diarrhea, and rectal bleeding. She reports increased urgency to defecate, especially after meals, with a family history of Crohn's disease. Which of the following is true regarding Crohn's disease?", "options": [{"label": "A", "text": "Smoking is a protective factor for Crohn’s disease.", "correct": false}, {"label": "B", "text": "Undergoing an appendicectomy increases the risk of Crohn's disease.", "correct": false}, {"label": "C", "text": "Infections in the first year of life are associated with an increased risk of Crohn's disease.", "correct": true}, {"label": "D", "text": "Oral contraceptives are not associated with an increased risk of crohn’s disease.", "correct": false}], "correct_answer": "C. Infections in the first year of life are associated with an increased risk of Crohn's disease.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ulcerative <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">Colitis</span> </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Crohn’s Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protective factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protective factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Jewish ethnicity</li>\n<li>Infections in the first year of life</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Smoking</li>\n<li>Appendectomy <strong>(Option B ruled out)</strong></li>\n<li>Breastfeeding</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Smoking <strong>(Option A ruled out)</strong></li>\n<li>Oral contraceptives <strong>(Option D ruled out)</strong></li>\n<li>Infections in the first year of life. <strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breastfeeding</li>\n<li>Vitamin D</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old man presents with chronic diarrhoea, abdominal pain, and weight loss. He has a history of recurrent infections and eczema since childhood. Genetic testing reveals a mutation in the FOXP3 gene. Which of the following genetic disorders is associated with the development of Inflammatory Bowel Disease (IBD) in this patient?", "options": [{"label": "A", "text": "Turner’s syndrome", "correct": false}, {"label": "B", "text": "Wiskott-Aldrich syndrome", "correct": false}, {"label": "C", "text": "Hermansky-Pudlak syndrome", "correct": false}, {"label": "D", "text": "Immune dysregulation polyendocrinopathy, enteropathy X-linked (IPEX)", "correct": true}], "correct_answer": "D. Immune dysregulation polyendocrinopathy, enteropathy X-linked (IPEX)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Genetic syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Genetic association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Turner’s syndrome (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of a part or complete X chromosome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sexual dysfunction,</li>\n<li>short stature,</li>\n<li>associated with <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> (UC) and <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> Crohn's disease (CD).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hermansky-Pudlak syndrome (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder caused by mutations in genes involved in the <span class=\"customMeta\" data-dictid=\"2a7dfbac301692777183497b04697a\">biogenesis</span> of lysosome-related organelles, particularly melanosomes and platelet-dense granules.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Granulomatous colitis, <span class=\"customMeta\" data-dictid=\"708fd5bd2e1692777194079e0a8588\">oculocutaneous</span> albinism, <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> leading to <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders, and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wiskott-Aldrich syndrome (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"dd35346fc716927772029e2f0bb10f\">X-linked</span> <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder, characterised by mutations in the <span class=\"customMeta\" data-dictid=\"4b76723d2c16927772029ec2d65ac5\">WASP</span> gene that lead to a loss of function of the WAS protein.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Triad of symptoms: <strong>Eczema, <span class=\"customMeta\" data-dictid=\"fc28c74bb716927772003aee4aa43c\">thrombocytopenia</span> (low <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count), and immunodeficiency- <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> infections.</strong></p>\n<p>Colitis is due to severe immunodeficiency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glycogen storage disease type B1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder caused by mutations in the SLC37A4 gene, it results in a <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of the glucose-6-phosphate <span class=\"customMeta\" data-dictid=\"300946cc45169277720012fb104361\">translocase</span> enzyme, leading to impaired <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> metabolism.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Granulomatous colitis,</p>\n<p>presents in <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> with</p>\n<p>hypoglycemia, growth</p>\n<p>failure, hepatomegaly,</p>\n<p>and neutropenia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immune <span class=\"customMeta\" data-dictid=\"3704fc52401692777186c42775c9fb\">dysregulation</span> polyendocrinopathy, <span class=\"customMeta\" data-dictid=\"f541d82b561692777187c75c724452\">enteropathy</span> <span class=\"customMeta\" data-dictid=\"dd35346fc716927772029e2f0bb10f\">X-linked</span> (IPEX)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"dd35346fc716927772029e2f0bb10f\">X-linked</span> <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder caused by mutations in the FOXP3 gene.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcerative colitis-like autoimmune</p>\n<p>enteropathy, with</p>\n<p>endocrinopathy (neonatal</p>\n<p>type 1 diabetes or</p>\n<p>thyroiditis), dermatitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early-Onset IBD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deficient IL-10 and IL-10</p>\n<p>receptor function</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe, <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> <span class=\"customMeta\" data-dictid=\"5eddae989e1692777189a59921cc61\">IBD</span> in</p>\n<p>early life (no response to treatment).</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient presents to the gastroenterology clinic with symptoms of abdominal pain, diarrhea, and rectal bleeding. Physical examination reveals tenderness in the lower abdomen, and lab tests show elevated CRP and ESR. The clinician suspects inflammatory bowel disease (IBD) and plans further diagnostic evaluation. Which of the following statements accurately distinguishes between Crohn's disease (CD) and ulcerative colitis (UC) regarding the colonic involvement?", "options": [{"label": "A", "text": "UC is associated with perianal involvement, while CD rarely presents with perianal manifestations.", "correct": false}, {"label": "B", "text": "UC typically presents with skip lesions, while CD is characterised by continuous inflammation and ulcers in the colon.", "correct": false}, {"label": "C", "text": "UC primarily affects the mucosa and submucosa, while CD predominantly involves transmural inflammation.", "correct": true}, {"label": "D", "text": "UC often spares the rectum, while CD invariably involves the rectum.", "correct": false}], "correct_answer": "C. UC primarily affects the mucosa and submucosa, while CD predominantly involves transmural inflammation.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YOCH2VObY80Xxn40vvGu1744379010.png", "https://image.prepladder.com/notes/nmX7puCKCulubYb5PAWh1744378818.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:711px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crohn’s disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common site</strong><br/>\n<strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ileum (Rectum usually spared)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rectum/ <span class=\"customMeta\" data-dictid=\"d54167c73316927771970038452d57\">Rectosigmoid</span> junctions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Entire GIT (mouth to <span class=\"customMeta\" data-dictid=\"08e2e9f18c169277718155d36ba98e\">anus</span> except rectum)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colon only</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pattern of <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patchy; Skip lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse: Proximally <span class=\"customMeta\" data-dictid=\"2a2420d6bc1692777185ac0cb7e93d\">contiguous</span> from the rectum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thickness of inflammation</strong><br/>\n<strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transmural</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Submucosal or mucosal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perianal involvement </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents to the gastroenterology clinic with a history of chronic bloody diarrhoea and abdominal pain. A colonoscopy reveals continuous inflammation involving the entire colon, extending proximally from the rectum. Biopsies from the terminal ileum show mild endoscopic changes and microscopic abnormalities, including villous atrophy and crypt regeneration. Which of the following conditions is most likely associated with the findings in the terminal ileum?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": true}, {"label": "B", "text": "Crohn's disease", "correct": false}, {"label": "C", "text": "Diverticulitis", "correct": false}, {"label": "D", "text": "Pseudomembranous colitis", "correct": false}], "correct_answer": "A. Ulcerative colitis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following endoscopic features is most likely to be observed in a patient with ulcerative colitis?", "options": [{"label": "A", "text": "Cobblestone appearance and serpiginous ulcers", "correct": false}, {"label": "B", "text": "Continuous inflammation with pseudopolyps", "correct": true}, {"label": "C", "text": "Skip lesions and transmural inflammation", "correct": false}, {"label": "D", "text": "Rectal sparing with aphthous ulcers", "correct": false}], "correct_answer": "B. Continuous inflammation with pseudopolyps", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythematous <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> with a <strong>fine <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> surface</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemorrhagic, edematous, and ulcerated mucosa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of<strong> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> polyps</strong> (pseudopolyps) due to epithelial regeneration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Remission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucosa may appear normal.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Longstanding disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atrophic and featureless mucosa, narrowing and shortening of the entire colon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fulminant disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Toxic <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> or <span class=\"customMeta\" data-dictid=\"944688061e16927771929fa8717176\">megacolon</span> with thinning of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall and severe mucosal ulceration, potential perforation.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old male presents to the clinic with complaints of recurrent abdominal pain, diarrhea, and unintended weight loss over the past year. On examination, there is tenderness in the right lower quadrant of the abdomen. Imaging studies demonstrate segmental bowel wall thickening with a \"cobblestone\" appearance and skip lesions. Which of the following complications is not associated with this condition?", "options": [{"label": "A", "text": "Malabsorption Syndrome", "correct": false}, {"label": "B", "text": "Perianal fistula", "correct": false}, {"label": "C", "text": "Intestinal Obstruction", "correct": false}, {"label": "D", "text": "Toxic megacolon", "correct": true}], "correct_answer": "D. Toxic megacolon", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications of <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">Ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications of Crohn’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Toxic megacolon</li>\n<li>Intestinal perforation</li>\n<li>Anaemia</li>\n<li>Colonic <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (UC is a <span class=\"customMeta\" data-dictid=\"feb5b6aaeb16927771964c9d7c801c\">premalignant</span> condition)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Perianal fistula</li>\n<li>Abscess</li>\n<li>Malabsorption syndrome</li>\n<li>Strictures</li>\n<li>Intestinal obstruction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications of <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">Ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications of Crohn’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Toxic megacolon</li>\n<li>Intestinal perforation</li>\n<li>Anaemia</li>\n<li>Colonic <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (UC is a <span class=\"customMeta\" data-dictid=\"feb5b6aaeb16927771964c9d7c801c\">premalignant</span> condition)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Perianal fistula</li>\n<li>Abscess</li>\n<li>Malabsorption syndrome</li>\n<li>Strictures</li>\n<li>Intestinal obstruction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old female with complaints of abdominal pain, diarrhea, and occasional rectal bleeding is found to have a segment of her colon with a characteristic appearance on colonoscopy, as shown in the image given below. Based on this finding, which of the following conditions is most likely to be associated with this presentation?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": false}, {"label": "B", "text": "Crohn's disease", "correct": true}, {"label": "C", "text": "Ischemic colitis", "correct": false}, {"label": "D", "text": "Pseudomembranous colitis", "correct": false}], "correct_answer": "B. Crohn's disease", "question_images": ["https://image.prepladder.com/notes/Ey0Orv6FSbzQhZ5BthC31744379295.png"], "explanation_images": ["https://image.prepladder.com/notes/3s7SNr1Eck3gIrH5mYei1744379522.png", "https://image.prepladder.com/notes/Ko8voQyx61rMaouW5kE21744379820.png", "https://image.prepladder.com/notes/gVxjYoVQQl7HWjvFk5CA1744379662.png", "https://image.prepladder.com/notes/rBfhppzMtI2AAiGn6JUQ1744379950.png", "https://image.prepladder.com/notes/3s7SNr1Eck3gIrH5mYei1744379522.png", "https://image.prepladder.com/notes/Ko8voQyx61rMaouW5kE21744379820.png", "https://image.prepladder.com/notes/gVxjYoVQQl7HWjvFk5CA1744379662.png", "https://image.prepladder.com/notes/rBfhppzMtI2AAiGn6JUQ1744379950.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crohn’s disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ischemic colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudomembranous colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease which can involve any part of GIT from mouth to <span class=\"customMeta\" data-dictid=\"08e2e9f18c169277718155d36ba98e\">anus</span> with rectal sparing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease characterized by <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and ulcers limiting to the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> and rectum.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ischemic injury of the GIT.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the inner lining of the large <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> by <span class=\"customMeta\" data-dictid=\"27791cc8181692777184b363360a3c\">Clostridium</span> difficile.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aphthous ulcer, cobblestone appearance, skip lesions, and rectal sparing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythematous mucosa, friability, decreased <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> pattern, continuous mucosal inflammation, and presence of mucosal ulcerations.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Petechial hemorrhages, edematous and fragile mucosa, <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> erythema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow, adherent pseudomembranes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Crohn’s disease\" data-author=\"Hajj Hussein, Inaya &amp; Toushan, Mazen &amp; Amin, Mitual &amp; Blenc, Ann. \" data-hash=\"9440\" data-license=\"\" data-source=\"https://www.researchgate.net/figure/b-Cobblestone-appearance_fig2_315951310\" data-tags=\"April2025\" height=\"139\" src=\"https://image.prepladder.com/notes/3s7SNr1Eck3gIrH5mYei1744379522.png\" width=\"144\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ulcerative colitis\" data-author=\"Kauczuk \" data-hash=\"9444\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ulcerative_colitis.jpg\" data-tags=\"April2025\" height=\"152\" src=\"https://image.prepladder.com/notes/Ko8voQyx61rMaouW5kE21744379820.png\" width=\"175\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ischemic colitis\" data-author=\"melvil -\" data-hash=\"9442\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Ischemic_colitis#/media/File:Ischemic_colitis_t-colon.jpg\" data-tags=\"April2025\" height=\"149\" src=\"https://image.prepladder.com/notes/gVxjYoVQQl7HWjvFk5CA1744379662.png\" width=\"125\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pseudomembranous colitis\" data-author=\"Samir\" data-hash=\"9445\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pseudomembranous_colitis_1.jpg\" data-tags=\"April2025\" height=\"142\" src=\"https://image.prepladder.com/notes/rBfhppzMtI2AAiGn6JUQ1744379950.png\" width=\"163\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crohn’s disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ischemic colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudomembranous colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aphthous ulcer, cobblestone appearance, rectal sparing, skip lesions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythematous <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">Ulcerative</span> mucosa, friability, decreased <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> pattern.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Petechial haemorrhages, edematous and fragile mucosa, <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> erythema.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow, adherent pseudomembranes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Crohn’s disease\" data-author=\"Hajj Hussein, Inaya &amp; Toushan, Mazen &amp; Amin, Mitual &amp; Blenc, Ann. \" data-hash=\"9440\" data-license=\"\" data-source=\"https://www.researchgate.net/figure/b-Cobblestone-appearance_fig2_315951310\" data-tags=\"April2025\" height=\"156\" src=\"https://image.prepladder.com/notes/3s7SNr1Eck3gIrH5mYei1744379522.png\" width=\"160\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Ulcerative colitis\" data-author=\"Kauczuk \" data-hash=\"9444\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ulcerative_colitis.jpg\" data-tags=\"April2025\" height=\"155\" src=\"https://image.prepladder.com/notes/Ko8voQyx61rMaouW5kE21744379820.png\" width=\"179\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Ischemic colitis\" data-author=\"melvil -\" data-hash=\"9442\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Ischemic_colitis#/media/File:Ischemic_colitis_t-colon.jpg\" data-tags=\"April2025\" height=\"160\" src=\"https://image.prepladder.com/notes/gVxjYoVQQl7HWjvFk5CA1744379662.png\" width=\"213\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Pseudomembranous colitis\" data-author=\"Samir\" data-hash=\"9445\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pseudomembranous_colitis_1.jpg\" data-tags=\"April2025\" height=\"145\" src=\"https://image.prepladder.com/notes/rBfhppzMtI2AAiGn6JUQ1744379950.png\" width=\"166\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old man presents to the gastroenterology clinic with a six-month history of recurrent abdominal pain, bloody diarrhea, and unintentional weight loss. He describes experiencing frequent urgency to defecate, especially after meals. Endoscopy findings reveal aphthous ulcers and skip lesions in the terminal ileum and colon. Which of the following markers is most useful in the diagnosis of this condition?", "options": [{"label": "A", "text": "Anti-tissue Transglutaminase Antibodies", "correct": false}, {"label": "B", "text": "Carbohydrate Antigen 19-9 (CA 19-9)", "correct": false}, {"label": "C", "text": "Carcinoembryonic Antigen (CEA)", "correct": false}, {"label": "D", "text": "Fecal Calprotectin", "correct": true}], "correct_answer": "D. Fecal Calprotectin", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13-year-old boy presented to the pediatric clinic with a chronic history of bloody diarrhoea and delayed growth. Lab investigations were positive for antibodies to Escherichia coli outer membrane protein C (OmpC), I2, and anti-flagellin (anti-CBir1). What implications does this serologic profile have for the patient’s disease course?", "options": [{"label": "A", "text": "Reduced risk of aggressive CD progression", "correct": false}, {"label": "B", "text": "Potential for more severe disease and shorter time to complications", "correct": true}, {"label": "C", "text": "Indication for immediate surgical intervention", "correct": false}, {"label": "D", "text": "Unlikely progression to CD based on serologic markers", "correct": false}], "correct_answer": "B. Potential for more severe disease and shorter time to complications", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serological Markers in Crohn's Disease (CD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serological Markers in <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">Ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">Colitis</span> (UC)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Anti-Saccharomyces cerevisiae antibodies (ASCAs):</strong></p>\n<ul>\n<li>Found in approximately 60-70% of CD patients.</li>\n<li>Lower <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> (10-15%) in UC patients.</li>\n<li>Associated with increased risk of small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> involvement and fibrostenosing disease phenotype.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"2da8fc47cf169277719576cea1851f\">Perinuclear</span> antineutrophil cytoplasmic antibodies (pANCAs):</strong></p>\n<ul>\n<li>Positive in around 60-70% of UC patients.</li>\n<li>Much lower <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> (5-10%) in CD patients.</li>\n<li>Associated with increased risk of UC development and may aid in differentiating UC from CD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Antibodies to <span class=\"customMeta\" data-dictid=\"c2ea0d4bf01692777187d486aa6385\">Escherichia</span> <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> outer <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <span class=\"customMeta\" data-dictid=\"513666ee611692777196b8732b54db\">porin</span> protein C (OmpC):</strong></p>\n<ul>\n<li>Positive in about 55% of CD patients.</li>\n<li>Linked to more aggressive disease behaviour and internal <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> complications.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Other Antibodies:</strong></p>\n<ul>\n<li>While less commonly used, serological markers like anti-colon antibodies have been investigated in UC but are not as clinically impactful as pANCAs.</li>\n<li>ASCA (Anti-Saccharomyces cerevisiae antibody)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Antibodies to bacterial homologs (I2 and anti-CBir1):</strong></p>\n<ul>\n<li>I2 antibodies are found in 50-54% of CD patients.</li>\n<li>Anti-CBir1 antibodies are identified in approximately 50% of CD patients.</li>\n<li>The presence of these antibodies may indicate a more aggressive disease and a shorter time to complications.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old patient presents with a recent onset of bloody diarrhea, abdominal cramps, and weight loss over the past five weeks. ASCA (Anti-Saccharomyces cerevisiae antibody)and pANCA antibodies are positive. Which of the following is the earliest radiological sign typically observed in this disease?", "options": [{"label": "A", "text": "Collar stud ulcerations", "correct": false}, {"label": "B", "text": "Granular mucosal ulcerations", "correct": true}, {"label": "C", "text": "Loss of haustrations", "correct": false}, {"label": "D", "text": "Toxic megacolon", "correct": false}], "correct_answer": "B. Granular mucosal ulcerations", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/jHWqviTKVDVcAf3fbBT21744439882.png", "https://image.prepladder.com/notes/WYkK5oS1LRpL50q0ZNBc1744440029.png", "https://image.prepladder.com/notes/zYTJajwd5zz4bMeOgnod1744440420.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 36-year-old male with a history of chronic gastrointestinal disease presents with worsening symptoms and suspected peri-rectal fistulas. His colonoscopy reports aphthous ulceration and skip lesions. Which imaging modality would be preferred to visualise and characterise these complications better?", "options": [{"label": "A", "text": "Small-bowel follow-through (SBFT)", "correct": false}, {"label": "B", "text": "Enteroclysis", "correct": false}, {"label": "C", "text": "Computed tomography enterography (CTE)", "correct": false}, {"label": "D", "text": "Pelvic magnetic resonance imaging (MRI)", "correct": true}], "correct_answer": "D. Pelvic magnetic resonance imaging (MRI)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents with a six-month history of recurrent abdominal pain, diarrhoea, and occasional rectal bleeding. She reports feeling fatigued and has noticed unintended weight loss. On examination, there is tenderness in the right lower quadrant of the abdomen. Biopsy taken during colonoscopy shows transmural inflammation. Which of the following is not a likely radiological finding in this patient?", "options": [{"label": "A", "text": "String sign", "correct": false}, {"label": "B", "text": "Fat halo sign", "correct": false}, {"label": "C", "text": "Lead pipe sign", "correct": true}, {"label": "D", "text": "Rose thorn ulcer", "correct": false}], "correct_answer": "C. Lead pipe sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/B8Lmk0UnR0GyahlJUkaE1744441197.png", "https://image.prepladder.com/notes/EK8rvhOunNsYNePKFnHs1744441340.png", "https://image.prepladder.com/notes/s3qF2T0dccxQBxHPwmLt1744441593.png", "https://image.prepladder.com/notes/EtwAVrH2NCnwTuIHFRzi1744441754.png", "https://image.prepladder.com/notes/bIUjH6CUoVrUt2DdLyJl1744441913.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Radiological findings in <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> colitis</strong></td>\n<td><strong>Radiological findings in Crohn’s disease</strong></td>\n</tr>\n<tr>\n<td>\n<p><strong>Granular mucosa</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Granular mucosa\" data-author=\"Deepak, Parakkal &amp; Bruining, David\" data-hash=\"9822\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Double-contrast-barium-enema-illustrating-granular-mucosa-in-a-patient-with-active_fig2_262424329\" data-tags=\"April2025\" height=\"342\" src=\"https://image.prepladder.com/notes/B8Lmk0UnR0GyahlJUkaE1744441197.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td>\n<p><strong>Fat <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> sign</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Fat &lt;span class=\" custommeta\"=\"\" data-dictid=\"95af91681416927771887742113c38\"/>halo sign\" data-author=\"Aina Venkatasamy, Quentin Minault &amp; Francis Veillon \" data-hash=\"9824\" data-license=\"\" data-source=\"https://link.springer.com/article/10.1007/s00261-018-1492-5#Fig1\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/bK00wlg4coXx9Q5qO4sy1744441474.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Collar button ulcer</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Collar button ulcer\" data-author=\"Chiba, Mitsuro &amp; Tsuda, Satoko &amp; Tsuji, Tsuyotoshi &amp; Nakane, Kunio &amp; Komatsu, Masafumi &amp; Miura, Yoshiko &amp; Ishida, Toshiya &amp; Shibahara, Toru &amp; Nishimoto, Tadashi. \" data-hash=\"9823\" data-license=\"CC BY ND 4.0\" data-source=\"https://www.researchgate.net/figure/Radiograph-of-barium-enema-study-Clear-collar-button-signs-were-observed-in-the-A_fig3_264640061\" data-tags=\"April2025\" height=\"302\" src=\"https://image.prepladder.com/notes/EK8rvhOunNsYNePKFnHs1744441340.png\" width=\"416\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n<td>\n<p><strong>Rose thorn ulcer</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Rose thorn ulcer\" data-author=\"\" data-hash=\"9825\" data-license=\"\" data-source=\"https://epos.myesr.org/posterimage/esr/ecr2005/5202/mediagallery/93033?deliveroriginal=1\" data-tags=\"April2025\" height=\"386\" src=\"https://image.prepladder.com/notes/s3qF2T0dccxQBxHPwmLt1744441593.png\" width=\"257\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Lead pipe appearance</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Lead pipe appearance\" data-author=\"Jones J, Niknejad M, Machang'a K, et al\" data-hash=\"9826\" data-license=\"\" data-source=\"https://radiopaedia.org/articles/lead-pipe-sign-colon\" data-tags=\"April2025\" height=\"261\" src=\"https://image.prepladder.com/notes/EtwAVrH2NCnwTuIHFRzi1744441754.png\" width=\"431\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td>\n<p><strong>String sign</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"String sign\" data-author=\"Amini B, Niknejad M, Yap J, et al\" data-hash=\"9827\" data-license=\"\" data-source=\"https://radiopaedia.org/articles/string-sign-bowel\" data-tags=\"April2025\" height=\"250\" src=\"https://image.prepladder.com/notes/bIUjH6CUoVrUt2DdLyJl1744441913.png\" width=\"250\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents to the clinic with painful skin lesions with central ulceration and violaceous borders, as shown in the image. She reports a history of ulcerative colitis and mentions that the skin lesions appeared a few weeks after her gastrointestinal symptoms started. Which of the following statements is not true regarding the extra-intestinal manifestations of Inflammatory Bowel disease (IBD)?", "options": [{"label": "A", "text": "Osteoporosis and Osteonecrosis are the least common extra-intestinal manifestations of IBD.", "correct": true}, {"label": "B", "text": "Pyoderma gangrenosum is common in Ulcerative colitis.", "correct": false}, {"label": "C", "text": "Primary Sclerosing Cholangitis is common in Ulcerative colitis.", "correct": false}, {"label": "D", "text": "Renal calculi is common in Crohn’s disease.", "correct": false}], "correct_answer": "A. Osteoporosis and Osteonecrosis are the least common extra-intestinal manifestations of IBD.", "question_images": ["https://image.prepladder.com/notes/OCUnErCLJFzwBU1186a51744442052.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presents to the gastroenterology clinic with chronic diarrhea, abdominal pain, and unintended weight loss. He reports watery stools multiple times a day, especially after meals, and notices greasy, foul-smelling stools. On examination, mild abdominal tenderness is noted. Laboratory tests show low vitamin B12, folic acid, and albumin levels. Imaging reveals deep serpiginous ulcers in the jejunum and ileum. Which of the following extraintestinal manifestations is most likely associated with his condition?", "options": [{"label": "A", "text": "Erythema nodosum", "correct": false}, {"label": "B", "text": "Ankylosing spondylitis", "correct": false}, {"label": "C", "text": "Hyperoxaluria with nephrolithiasis", "correct": true}, {"label": "D", "text": "Pancreatitis", "correct": false}], "correct_answer": "C. Hyperoxaluria with nephrolithiasis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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She reports experiencing frequent episodes of diarrhoea, often with mucus and blood. A colonoscopy was performed, which showed multiple aphthous ulcers scattered throughout the terminal ileum and proximal colon. A biopsy was done, which is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": false}, {"label": "B", "text": "Irritable bowel syndrome", "correct": false}, {"label": "C", "text": "Crohn’s disease", "correct": true}, {"label": "D", "text": "Diverticulitis", "correct": false}], "correct_answer": "C. Crohn’s disease", "question_images": ["https://image.prepladder.com/notes/7FQuWimHGbURzAIwT4or1744375760.png"], "explanation_images": ["https://image.prepladder.com/notes/oiO8vz4f2FYB759B7HUw1744375901.png", "https://image.prepladder.com/notes/GQ5oYzgSYR37z3L6GLpT1744376562.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic/gross findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aphthous ulcers</strong> (<strong>earliest finding</strong>): May progress, and multiple lesions often coalesce into elongated, serpentine ulcers oriented along the <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> of the bowel.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abundant <strong>neutrophils infiltrate</strong> and damage the <span class=\"customMeta\" data-dictid=\"d2a83e1b4c1692777185c446d81c0c\">crypt</span> epithelium.</p>\n<p><strong>Submucosal <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> aggregates</strong> may also be seen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Edema and loss of normal mucosal folds.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clusters of neutrophils within a <span class=\"customMeta\" data-dictid=\"d2a83e1b4c1692777185c446d81c0c\">crypt</span> are <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as <strong>crypt abscesses</strong> and are often associated with <span class=\"customMeta\" data-dictid=\"d2a83e1b4c1692777185c446d81c0c\">crypt</span> destruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cobblestone appearance</strong> of the mucosa: Occurs due to <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> with sparing of interspersed mucosa, a result of the patchy distribution of lesions.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Crohns Disease Cobblestone appearance\" data-author=\"Ye, Ziyin &amp; Lin, Yuan &amp; Cao, Qinghua &amp; He, Yulong &amp; Xue, Ling\" data-hash=\"9401\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Endoscopic-features-of-intestinal-tuberculosis-ITB-and-Crohns-disease-CD_fig2_286480371\" data-tags=\"April2025\" height=\"321\" src=\"https://image.prepladder.com/notes/oiO8vz4f2FYB759B7HUw1744375901.png\" width=\"387\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epithelial metaplasia:</strong></p>\n<ul>\n<li>Pseudopyloric metaplasia.</li>\n<li>Paneth cell metaplasia.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Crohn's &lt;span class=\" custommeta\"=\"\" data-dictid=\"e6955110f21692777184d2090a400c\"/>colitis biopsy\" data-author=\"CoRus13\" data-hash=\"9406\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Crohn%27s_colitis_-_biopsy,_intermed._mag.jpg\" data-tags=\"April2025\" height=\"280\" src=\"https://image.prepladder.com/notes/izmMPQ7i1qRkBtfnPAvd1744376295.png\" width=\"417\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fissure</strong> development is common and may extend deeply to become <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tracts or sites of perforation.</p>\n</td>\n<td colspan=\"1\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Non-caseating granulomas</strong> are a hallmark of Crohn’s disease and occur in areas of active disease or uninvolved regions within any layer of the intestinal wall.</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The intestinal wall is thickened and rubbery as a consequence of <strong>transmural oedema, inflammation, <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> fibrosis,</strong> and <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> of the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> propria, all of which contribute to <strong>stricture</strong> formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In cases with extensive <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">transmural</span> disease, mesenteric <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue frequently extends over the <span class=\"customMeta\" data-dictid=\"5ce9b6c57f1692777198cdc854b76a\">serosal</span> surface, known as <strong>creeping fat.</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucosal and <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> involvement.</li>\n<li>Pseudopolyps.</li>\n<li>Collar button ulcers.</li>\n<li>Backwash ileitis.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ulcerative &lt;span class=\" custommeta\"=\"\" data-dictid=\"e6955110f21692777184d2090a400c\"/>colitis <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> image\" data-author=\"Samir\" data-hash=\"9409\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ulcerative_colitis.jpg\" data-tags=\"April2025\" height=\"342\" src=\"https://image.prepladder.com/notes/IQ91tAcc5HzkqUs3tz9t1744376443.png\" width=\"395\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inflammatory infiltrates.</li>\n<li>Cryptitis and <span class=\"customMeta\" data-dictid=\"d2a83e1b4c1692777185c446d81c0c\">crypt</span> abscesses.</li>\n<li>Absence of non-caseating granulomas.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"UC Histopathology\" data-author=\"KGH\" data-hash=\"9411\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ulcerative_colitis_(2)_active.jpg\" data-tags=\"April2025\" height=\"351\" src=\"https://image.prepladder.com/notes/GQ5oYzgSYR37z3L6GLpT1744376562.png\" width=\"465\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female presents to the gastroenterology clinic with a three-month history of bloody diarrhoea, abdominal pain, and weight loss. She reports passing loose stools up to 10 times per day and has noticed blood in her stool intermittently. A colonoscopy was done, which showed continuous involvement and mucosal erythema of the rectum with pseudopolyps and barium enema, and a lead pipe appearance was found. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Crohn’s disease", "correct": false}, {"label": "B", "text": "Shigellosis", "correct": false}, {"label": "C", "text": "Ulcerative colitis", "correct": true}, {"label": "D", "text": "Ischemic colitis", "correct": false}], "correct_answer": "C. Ulcerative colitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/EU552CBO1L7oVXMkp8N91744376832.png", "https://image.prepladder.com/notes/rhd8SXtiHrbTyCX3LCTH1744376723.png", "https://image.prepladder.com/notes/ziSTa5WOjrarD2trtP7v1744376961.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic findings </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> may be slightly red and <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> or have extensive, broad-based ulcers. <strong>Fine mucosal granularity</strong> can be seen.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to Crohn’s disease. They include <strong>inflammatory infiltrates</strong>, <strong>crypt abscesses</strong>, <span class=\"customMeta\" data-dictid=\"d2a83e1b4c1692777185c446d81c0c\">crypt</span> distortion, and pseudo pyloric epithelial metaplasia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isolated islands of regenerating <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> often bulge into the lumen</p>\n<p>to create <strong>pseudopolyps</strong>, and the <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">tips</span> of these polyps may <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> to create mucosal bridges.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Granulomas are <strong>absent</strong> in <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> (differentiating it from Crohn’s disease).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic disease may lead to <strong>mucosal atrophy</strong> with a smooth mucosal surface that lacks normal folds.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> is generally <strong>limited to the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> submucosa.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcerative <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> is <strong>not transmural</strong>. As a result, the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> wall is not thickened, the <span class=\"customMeta\" data-dictid=\"5ce9b6c57f1692777198cdc854b76a\">serosal</span> surface is normal, and strictures do not occur.</p>\n<br/>\n\t\t\t </td>\n<td colspan=\"1\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In severe cases, extensive mucosal destruction may be accompanied by ulcers that extend into the submucosa, but the <strong>muscularis propria is rarely involved.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"UC Histopathology\" data-author=\"KGH\" data-hash=\"9415\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ulcerative_colitis_(2)_endoscopic_biopsy.jpg\" data-tags=\"April2025\" height=\"329\" src=\"https://image.prepladder.com/notes/EU552CBO1L7oVXMkp8N91744376832.png\" width=\"436\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Collar button ulcers</strong> are seen. They are small, deep ulcers where the button corresponds to the eroded <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> base and the button neck corresponds to the undermined and preserved mucosa.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"UC granularity\" data-author=\"Kauczuk\" data-hash=\"9413\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:UC_granularity.png\" data-tags=\"April2025\" height=\"322\" src=\"https://image.prepladder.com/notes/rhd8SXtiHrbTyCX3LCTH1744376723.png\" width=\"371\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aphthous ulcers.</li>\n<li>Transmural and <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> involvement.</li>\n<li>Skip lesions.</li>\n<li>Cobblestone appearance.</li>\n<li>Longitudinal ulcers.</li>\n<li>Fistulas and strictures (severe cases).</li>\n<li>Creeping fat (in severe cases).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Crohns Disease Cobblestone appearance\" data-author=\"Ye, Ziyin &amp; Lin, Yuan &amp; Cao, Qinghua &amp; He, Yulong &amp; Xue, Ling\" data-hash=\"9417\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Endoscopic-features-of-intestinal-tuberculosis-ITB-and-Crohns-disease-CD_fig2_286480371\" data-tags=\"April2025\" height=\"358\" src=\"https://image.prepladder.com/notes/ziSTa5WOjrarD2trtP7v1744376961.png\" width=\"410\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inflammatory infiltrates.</li>\n<li>Crypt abscesses.</li>\n<li>Epithelial metaplasia.</li>\n<li>Non-caseating granulomas.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Crohn's &lt;span class=\" custommeta\"=\"\" data-dictid=\"e6955110f21692777184d2090a400c\"/>colitis biopsy\" data-author=\"CoRus13\" data-hash=\"9422\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Crohn%27s_colitis_-_biopsy,_intermed._mag.jpg\" data-tags=\"April2025\" height=\"333\" src=\"https://image.prepladder.com/notes/cjXfYCx4TIhoqYywrp5L1744377472.png\" width=\"498\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male diagnosed with ulcerative colitis presents with 2-3 episodes of bloody stools per day. Which of the following drugs can be used for management?", "options": [{"label": "A", "text": "5-aminosalicylic acid", "correct": true}, {"label": "B", "text": "Azathioprine", "correct": false}, {"label": "C", "text": "Infliximab", "correct": false}, {"label": "D", "text": "Corticosteroids", "correct": false}], "correct_answer": "A. 5-aminosalicylic acid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presented with bloody diarrhoea, abdominal pain and tenesmus for the past two weeks. On colonoscopy, pseudopolyps were noted in the colon. Which of the following drugs can be used in this condition?", "options": [{"label": "A", "text": "Sulphadoxine", "correct": false}, {"label": "B", "text": "Sulfamethoxazole", "correct": false}, {"label": "C", "text": "Sulfinpyrazone", "correct": false}, {"label": "D", "text": "Sulfasalazine", "correct": true}], "correct_answer": "D. Sulfasalazine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents with recurrent abdominal pain, diarrhoea, and weight loss. She has a history of Crohn's disease confirmed by colonoscopy and biopsy. Which of the following dietary recommendations is most commonly advised for Crohn's disease management?", "options": [{"label": "A", "text": "Increasing intake of high-fiber foods", "correct": false}, {"label": "B", "text": "Foods high in fat and and low in sugar", "correct": false}, {"label": "C", "text": "Incorporating probiotics into the diet", "correct": true}, {"label": "D", "text": "Less frequent larger meals", "correct": false}], "correct_answer": "C. Incorporating probiotics into the diet", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents with recurrent and persistent abdominal pain, diarrhoea, and weight loss. She has a history of Crohn's disease confirmed by colonoscopy and biopsy. There is no fistulization present on colonoscopy. Despite initial treatment with mesalamine, her symptoms have not improved significantly. Which of the following treatment options is most appropriate as a next step in managing her Crohn's disease?", "options": [{"label": "A", "text": "Corticosteroids", "correct": false}, {"label": "B", "text": "Azathioprine", "correct": false}, {"label": "C", "text": "Infliximab", "correct": true}, {"label": "D", "text": "Methotrexate", "correct": false}], "correct_answer": "C. Infliximab", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medication, recently approved by the FDA for treating Crohn's disease, is a selective Janus kinase (JAK) inhibitor?", "options": [{"label": "A", "text": "Vedolizumab", "correct": false}, {"label": "B", "text": "Infliximab", "correct": false}, {"label": "C", "text": "Ustekinumab", "correct": false}, {"label": "D", "text": "Upadacitinib", "correct": true}], "correct_answer": "D. Upadacitinib", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:bottom\">\n<p><strong>Medication</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:bottom\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:bottom\">\n<p><strong>Common Side Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p><strong>Vedolizumab (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Integrin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist; blocks <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> trafficking</p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Infusion reactions, headache, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p><strong>Ustekinumab (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Targets IL-12 and IL-23 cytokines involved in inflammation</p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infections, headache, fatigue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p><strong>Tofacitinib</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Janus <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (JAK) <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> modulates immune response</p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections, headache, diarrhoea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p><strong>Upadacitinib</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Selective JAK1 inhibitor; reduces inflammation</p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections, nausea, elevated liver enzymes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p><strong>Risankizumab</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>IL-23 <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> targets <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> pathways</p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:2px solid #000000; border-right:2px solid #000000; border-top:2px solid #000000; vertical-align:middle\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections, headache, nausea</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 17 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 6 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old male presents with recurrent episodes of abdominal pain associated with altered bowel habits for the past six months. He reports experiencing abdominal discomfort relieved by defecation. The physician provided the diagnosis of IBS based on Rome IV criteria. Which of the following statements is true regarding Rome IV diagnostic criteria for IBS?", "options": [{"label": "A", "text": "1 out of the 3 features should be present for the diagnostic of IBS", "correct": false}, {"label": "B", "text": "Recurrent abdominal pain present at least 1 day per week in the last 3 months", "correct": true}, {"label": "C", "text": "Symptoms should be associated with pain or discomfort that is relieved by eating.", "correct": false}, {"label": "D", "text": "Symptoms should be associated with rectal bleeding.", "correct": false}], "correct_answer": "B. Recurrent abdominal pain present at least 1 day per week in the last 3 months", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/sy1FifLyrs71yKQOFhOX1745576821.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a 3-month history of crampy abdominal pain associated with diarrhea. Which of the features supports a diagnosis of irritable bowel syndrome?", "options": [{"label": "A", "text": "Persistent diarrhea after a 48-hour fast", "correct": false}, {"label": "B", "text": "Nocturnal diarrhea", "correct": false}, {"label": "C", "text": "Onset of Symptoms during a period of stress", "correct": true}, {"label": "D", "text": "Steatorrhea", "correct": false}], "correct_answer": "C. Onset of Symptoms during a period of stress", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features in favor of IBS:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features not in favor of IBS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal pain that worsens/improves with defaecation</li>\n<li>Associated with stress or emotional symptoms</li>\n<li>Small volume of stools</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nocturnal diarrhea</li>\n<li>Steatorrhea</li>\n<li>Blood in stools <strong>(Option D ruled out).</strong></li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> volume</li>\n<li>Fever or high ESR</li>\n<li>Weight loss, malabsorption.</li>\n<li>1st symptom after 50 years of age.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Irritable <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of blood in <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> - <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">Anemia</span> <strong>(Option A ruled out)</strong></li>\n<li>Example- Protein-induced enteropathy</li>\n<li>Weight loss due to hypoproteinemia, hypoalbuminemia</li>\n<li>Symptoms are very bothersome and will always interfere with sleep.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sleep <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">deprivation</span> - rare</li>\n<li>Pain increases with anxiety</li>\n<li>Female - increase in symptoms during <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle</li>\n<li>Weight loss and blood in the stools are not present</li>\n<li>Age group &lt; 45 years usually.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 30-year-old female with recurrent abdominal pain and altered bowel habits for the past year, symptoms exacerbated during periods of stress and a history of childhood trauma and ongoing anxiety. Considering these factors, which underlying mechanism is likely to contribute significantly to the pathophysiology of her symptoms?", "options": [{"label": "A", "text": "Dietary intolerance to lactose.", "correct": false}, {"label": "B", "text": "Impaired Gastric Acid Secretion", "correct": false}, {"label": "C", "text": "Gut Dysbiosis", "correct": true}, {"label": "D", "text": "Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs)", "correct": false}], "correct_answer": "C. Gut Dysbiosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/zhhOSFs0mEH3RgLm7Kpk1745576867.png", "https://image.prepladder.com/notes/4gXIrpQL5hm1Ojbxf9Cy1745576907.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male presents with symptoms of bloating, abdominal pain, and irregular bowel habits consistent with irritable bowel syndrome (IBS). After confirming the diagnosis, which of the following dietary interventions is most likely to provide symptomatic relief for this patient?", "options": [{"label": "A", "text": "High-carbohydrate diet", "correct": false}, {"label": "B", "text": "Low FODMAP diet", "correct": true}, {"label": "C", "text": "High-protein diet", "correct": false}, {"label": "D", "text": "High-fiber diet", "correct": false}], "correct_answer": "B. Low FODMAP diet", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/s1Bi3LfM50gzsX5h5qRt1745576966.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old female with IBS presents for a second opinion, with complaints of recurrent abdominal pain and constipation. She has been adherent to a low-FODMAP diet for the last two months, on the advice of her first physician. What is the next best step?", "options": [{"label": "A", "text": "Dicyclomine &amp;amp; Loperamide", "correct": false}, {"label": "B", "text": "Lubiprostone &amp;amp; Dicyclomine", "correct": true}, {"label": "C", "text": "Continue diet", "correct": false}, {"label": "D", "text": "Mesalamine", "correct": false}], "correct_answer": "B. Lubiprostone &amp; Dicyclomine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:751px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For diarrhea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For constipation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antispasmodiacs - Dicyclomine</li>\n<li>Tricyclic Antidepressants - Amitriptyline</li>\n<li>SSRI - Citalopram</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Opiate - Loperamide</li>\n<li>5HT3 <span class=\"customMeta\" data-dictid=\"2e432a4f3c1692777181e8e244ca0e\">antagonist</span> - Alosteron</li>\n<li>Bile acid sequestrants - <span class=\"customMeta\" data-dictid=\"8cbc9195731692777184663e492746\">Cholestyramine</span> resin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laxative - Psyllium, Isaphagula husk</li>\n<li>Cl channel <span class=\"customMeta\" data-dictid=\"a095f733351692777180a29940c98a\">activator</span> - Lubipristone</li>\n<li>5HT4 <span class=\"customMeta\" data-dictid=\"7d8d28cda71692777180c89a3c86ce\">agonist</span> - Tegaserod</li>\n<li>SSRI - Paroxetine</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common pattern of symptoms seen in irritable bowel syndrome?", "options": [{"label": "A", "text": "Diarrhea only", "correct": false}, {"label": "B", "text": "Constipation only", "correct": false}, {"label": "C", "text": "Prolonged constipation followed by diarrhea", "correct": false}, {"label": "D", "text": "Constipation alternating with episodes of diarrhea", "correct": true}], "correct_answer": "D. Constipation alternating with episodes of diarrhea", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/aAHsJYpI6HHmAd7nUDda1745577049.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 16 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 13 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 32-year-old female presents to the clinic with complaints of chronic diarrhea, bloating, abdominal pain, and unintentional weight loss for the past few months. She mentions that these symptoms worsen after consuming foods containing barley. Laboratory investigations reveal iron deficiency anemia and elevated tissue transglutaminase antibodies (tTG-IgA). Which of the following will be the appropriate treatment for this patient?", "options": [{"label": "A", "text": "Initiating a diet rich in barley to assess tolerance", "correct": false}, {"label": "B", "text": "Starting a gluten-free diet", "correct": true}, {"label": "C", "text": "Prescribing antibiotics to treat potential bacterial overgrowth", "correct": false}, {"label": "D", "text": "Administering corticosteroids to reduce inflammation", "correct": false}], "correct_answer": "B. Starting a gluten-free diet", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female presents with chronic diarrhea, bloating, and weight loss over the past few months. She reports feeling fatigued despite adequate rest. Physical examination reveals mild pallor and abdominal distension. Laboratory investigations show microcytic anemia with low serum iron and ferritin levels. The physician suspects a malabsorption syndrome. Which of the following diagnostic tests would confirm the diagnosis of celiac disease in this patient?", "options": [{"label": "A", "text": "Upper gastrointestinal endoscopy with biopsy of duodenal mucosa", "correct": true}, {"label": "B", "text": "Colonoscopy with biopsy of colonic mucosa", "correct": false}, {"label": "C", "text": "Stool antigen testing", "correct": false}, {"label": "D", "text": "Hydrogen breath test for lactose intolerance", "correct": false}], "correct_answer": "A. Upper gastrointestinal endoscopy with biopsy of duodenal mucosa", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents with chronic diarrhea, abdominal bloating, and fatigue for several months. She reports irregular bowel habits and unintentional weight loss. Laboratory investigations reveal microcytic anemia with low serum iron and ferritin levels. Serological testing shows elevated levels of anti-tissue transglutaminase antibodies (anti-tTG IgA). A small intestinal mucosal biopsy is performed, revealing histopathological changes consistent with hyperplastic crypts with partial villous atrophy. Which of the following Marsh classifications best describes the histopathological findings in this patient?", "options": [{"label": "A", "text": "Type II", "correct": false}, {"label": "B", "text": "Type IIIa", "correct": true}, {"label": "C", "text": "Type IIIb", "correct": false}, {"label": "D", "text": "Type IIIc", "correct": false}], "correct_answer": "B. Type IIIa", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:660px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal duodenal biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal mucosal architecture with increased <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> lymphocytes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II (Option A ruled out)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperplastic crypts, but near normal Villi</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IIIa (Option B)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperplastic crypts with partial <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> atrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IIIb (Option C ruled out)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperplastic crypts with <span class=\"customMeta\" data-dictid=\"457e639de21692777199eaaef481ed\">subtotal</span> <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> atrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IIIc (Option D ruled out)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperplastic crypts with total <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> atrophy</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal duodenal biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal mucosal architecture with increased <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> lymphocytes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperplastic crypts, but near normal Villi</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IIIa</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperplastic crypts with partial <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> atrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IIIb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperplastic crypts with <span class=\"customMeta\" data-dictid=\"457e639de21692777199eaaef481ed\">subtotal</span> <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> atrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IIIc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperplastic crypts with total <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> atrophy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with chronic diarrhea, steatorrhea, and weight loss over the past few months. Upon further evaluation, he is found to have deficiencies in fat-soluble vitamins. Which of the following mechanisms best explains the underlying cause of his symptoms?", "options": [{"label": "A", "text": "Insufficient bile salt synthesis leads to impaired emulsification of fats.", "correct": true}, {"label": "B", "text": "Reduced absorption of short-chain fatty acids in the colon.", "correct": false}, {"label": "C", "text": "Hyposecretion of fibroblast growth factor 19 (FGF19) causes inhibition of bile acid synthesis.", "correct": false}, {"label": "D", "text": "Defective assembly of chylomicrons due to apolipoprotein deficiency.", "correct": false}], "correct_answer": "A. Insufficient bile salt synthesis leads to impaired emulsification of fats.", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with complaints of joint pain and stiffness persisting for the past 6 years. He also reports significant unintentional weight loss, chronic diarrhea, and intermittent abdominal pain. On examination, he appears malnourished with signs of cachexia. Laboratory investigations reveal anemia and hypoalbuminemia. Biopsy shows PAS-positive macrophages. What condition is most likely responsible for the patient's clinical presentation?", "options": [{"label": "A", "text": "Rheumatoid arthritis", "correct": false}, {"label": "B", "text": "Inflammatory bowel disease", "correct": false}, {"label": "C", "text": "Whipple's disease", "correct": true}, {"label": "D", "text": "Celiac disease", "correct": false}], "correct_answer": "C. Whipple's disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with a history of chronic diarrhea, weight loss, arthralgia, and migratory polyarthritis. On examination, he has bilateral lymphadenopathy and a low-grade fever. Laboratory investigations reveal macrocytic anemia, hypoalbuminemia, and elevated erythrocyte sedimentation rate (ESR). Which of the following is incorrect about the causative agent responsible for these clinical findings?", "options": [{"label": "A", "text": "Gram-positive, non-acid fast", "correct": false}, {"label": "B", "text": "PAS-positive", "correct": false}, {"label": "C", "text": "Fluoroquinolones are effective against the causative agent", "correct": true}, {"label": "D", "text": "Cotrimoxazole is used in maintenance therapy in the disease caused by this organism", "correct": false}], "correct_answer": "C. Fluoroquinolones are effective against the causative agent", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial phase (IV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maintenance phase (Oral)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ceftriaxone or <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">Penicillin</span> G for 2 weeks.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>(OR)</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Meropenem for 2 to 4 weeks.</li>\n</ul>\n<p>(In case of ceftriaxone or <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> allergy)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trimethoprim-sulfamethoxazole (Cotrimoxazole) for one year<strong> (Option D ruled out)</strong>.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>(OR)</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Doxycycline + Hydroxycholoquine for one year.</li>\n</ul>\n<p>(In case of <span class=\"customMeta\" data-dictid=\"e6a50302661692777199484845ac1d\">Sulfa</span> allergy)</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presents with a 6-month history of progressive memory loss and confusion. He also complains of intermittent episodes of involuntary eye and facial movements. On examination, he is noted to have supranuclear gaze palsy. His medical history is significant for chronic diarrhea, weight loss, and joint pain. Further investigations reveal periodic acid-Schiff (PAS)-positive macrophages in the cerebrospinal fluid. Which neurological manifestations are considered pathognomonic for the patient’s condition?", "options": [{"label": "A", "text": "Recurrent headaches and visual disturbances", "correct": false}, {"label": "B", "text": "Peripheral neuropathy and autonomic dysfunction", "correct": false}, {"label": "C", "text": "Cerebellar ataxia and ophthalmoplegia", "correct": false}, {"label": "D", "text": "Oculomasticatory myorhythmia and oculofacial myorhythmia", "correct": true}], "correct_answer": "D. Oculomasticatory myorhythmia and oculofacial myorhythmia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presents with complaints of bloating, abdominal cramps, and diarrhea that occur consistently within 30 minutes to 2 hours after consuming dairy products. He reports no blood in the stool and denies weight loss or fever. His symptoms started several months ago and are relieved when he avoids milk and milk-based products. Laboratory tests reveal normal complete blood count and inflammatory markers. All of the following are true about this patient's condition except:", "options": [{"label": "A", "text": "It can be confirmed using a hydrogen breath test.", "correct": false}, {"label": "B", "text": "Dietary calcium supplementation may be necessary to prevent deficiencies.", "correct": false}, {"label": "C", "text": "The condition involves an immune-mediated response to dairy proteins.", "correct": true}, {"label": "D", "text": "These patients have elevated luminal lactose levels upon ingestion of lactose.", "correct": false}], "correct_answer": "C. The condition involves an immune-mediated response to dairy proteins.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman presents with chronic diarrhea, weight loss, and fatigue for 6 months. She gave a history of traveling to Southeast Asia, where she consumed untreated water. On examination, she is mildly anemic. Laboratory tests show microcytic anemia and low levels of vitamin B12 and folate. A small bowel biopsy reveals mild villous atrophy. Which organism is most commonly associated with this condition?", "options": [{"label": "A", "text": "Yersinia enterocolitica", "correct": true}, {"label": "B", "text": "Campylobacter jejuni", "correct": false}, {"label": "C", "text": "Klebsiella species", "correct": false}, {"label": "D", "text": "Salmonella", "correct": false}], "correct_answer": "A. Yersinia enterocolitica", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child presents with chronic diarrhea, failure to thrive, and progressive night blindness. The child’s mother reports the presence of greasy, foul-smelling stools, and the child has not been gaining weight appropriately for the past year. Physical examination reveals mild abdominal distension. Laboratory studies show low cholesterol, triglycerides, and fat-soluble vitamins E and A. A small bowel biopsy reveals lipid-laden enterocytes. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Familial hypobetalipoproteinemia", "correct": false}, {"label": "B", "text": "Abetalipoproteinemia", "correct": true}, {"label": "C", "text": "Tangier’s disease", "correct": false}, {"label": "D", "text": "MCAD deficiency", "correct": false}], "correct_answer": "B. Abetalipoproteinemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presents with chronic diarrhea, bloating, and unintentional weight loss. She has a history of scleroderma, which has caused gastrointestinal motility issues. On examination, she shows signs of vitamin B12 deficiency. Which of the following is NOT a recognized cause of small bowel bacterial overgrowth in this patient?", "options": [{"label": "A", "text": "Scleroderma", "correct": false}, {"label": "B", "text": "Chronic intestinal pseudo-obstruction", "correct": false}, {"label": "C", "text": "Billroth II anastomosis", "correct": false}, {"label": "D", "text": "Chronic pancreatitis", "correct": true}], "correct_answer": "D. Chronic pancreatitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about protein-losing enteropathy (PLE) are correct? PLE can be caused by mucosal ulceration, such as in ulcerative colitis and GI carcinomas, leading to protein loss through damaged mucosa. Lymphopenia may be seen. PLE caused by lymphatic obstruction is most effectively treated with immunosuppressive agents like methotrexate. Alpha-1 antitrypsin testing in stool is diagnostic for PLE, with an elevated level confirming the diagnosis. A diagnosis of PLE is confirmed by measuring serum protein levels, which will show selective loss of only albumin.", "options": [{"label": "A", "text": "1, 2, 3", "correct": false}, {"label": "B", "text": "2, 4, 5", "correct": false}, {"label": "C", "text": "1, 2, 4", "correct": true}, {"label": "D", "text": "2, 3, 4", "correct": false}], "correct_answer": "C. 1, 2, 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucosal ulceration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of blood and proteins\n\t\t\t\t<ul>\n<li>E.g.: <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">Ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> and Crohn's disease</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Seen in GI <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <strong>(Statement 1)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Altered blood <span class=\"customMeta\" data-dictid=\"1c7103a9b516927771955682b6aaa4\">permeability</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Crypt <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> – <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> sprue</li>\n<li>Explains protein loss and muscle wasting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes\n\t\t\t\t<ul>\n<li>Seen in Non-Hodgkin's lymphoma</li>\n</ul>\n</li>\n<li>High protein loss due to obstruction</li>\n<li>Intestinal lymphangiectasia: <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> –\n\t\t\t\t<ul>\n<li>Normal enterocytes with dilated lymphatics</li>\n<li>Clubbing of the villi</li>\n<li>Diagnosis based on small intestinal mucosal biopsy</li>\n</ul>\n</li>\n<li>Cardiovascular causes: <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">Constrictive</span> pericarditis\n\t\t\t\t<ul>\n<li>Fontan physiology: Pediatrics</li>\n<li>Back pressure will affect the <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> changes</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT typically used in the initial evaluation of malabsorption?", "options": [{"label": "A", "text": "Stool Sudan III stain", "correct": false}, {"label": "B", "text": "Urinary D-xylose test", "correct": false}, {"label": "C", "text": "MRI enterography", "correct": false}, {"label": "D", "text": "Colonoscopy", "correct": true}], "correct_answer": "D. Colonoscopy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>GI Symptoms:</strong>\n<ul>\n<li>Abdominal pain</li>\n<li>Diarrhea</li>\n<li>Weight loss</li>\n<li>Bloating</li>\n<li>Fatigue/weakness</li>\n</ul>\n</li>\n<li><strong>Signs of Nutrient Deficiencies:</strong>\n<ul>\n<li>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (nail spooning)</li>\n<li>Vitamin D &amp; <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (bone pain, fractures)</li>\n<li>Vitamin B12 <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (peripheral neuropathy)</li>\n<li>Protein <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (hair loss)</li>\n</ul>\n</li>\n<li><strong>Medical History:</strong>\n<ul>\n<li>Chronic pancreatitis</li>\n<li>Liver disease (primary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> cholangitis, primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> cholangitis)</li>\n<li>Small-bowel <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (e.g., Crohn’s disease, trauma, ischemic <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease)</li>\n</ul>\n</li>\n<li><strong>Travel History:</strong>\n<ul>\n<li>To rule out <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> causes</li>\n</ul>\n</li>\n<li><strong>Risk Factors:</strong>\n<ul>\n<li>Prior GI surgery, infections, or diseases affecting absorption</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs of Nutritional Deficiency:</strong></p>\n<ul>\n<li>Bitemporal <span class=\"customMeta\" data-dictid=\"9971eacaaf1692777202d2ece15a2a\">wasting</span> (weight loss)</li>\n<li>Decreased mid-arm circumference</li>\n<li>Nail spooning (Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia)</li>\n<li>Cheilosis (Vitamin B deficiency)</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> (Vitamin B12 deficiency)</li>\n</ul>\n<p><strong>Signs of Malabsorption:</strong></p>\n<ul>\n<li>Weight loss, edema, bloating, hair loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basic Labs:</strong></p>\n<ul>\n<li>Hemoglobin (Hb) - To check for anemia</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"91d0e4c6fa16927772025f96b44b27\">ferritin</span> - Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia</li>\n<li>INR (Prothrombin time) - <span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\">Vitamin K</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (fat-soluble vitamins)</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"9d36aa5ee4169277718357330504c0\">carotene</span> - Fat malabsorption</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Specific <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">Malabsorption</span> Tests:</strong></p>\n<ul>\n<li>Stool tests:\n\t\t\t\t<ul>\n<li>Sudan III <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> - <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">Qualitative</span> test for <span class=\"customMeta\" data-dictid=\"0e5348eb421692777199f7a9fc4b0c\">steatorrhea</span> (fecal fat)</li>\n<li>Stool <span class=\"customMeta\" data-dictid=\"c931cf36561692777187f402c906d7\">elastase</span> - To diagnose pancreatic insufficiency</li>\n</ul>\n</li>\n<li>Stool <span class=\"customMeta\" data-dictid=\"0075add4461692777194372fe86121\">osmolar</span> gap - For osmotic vs <span class=\"customMeta\" data-dictid=\"9e7aec9ff416927771984a1e3100b7\">secretory</span> diarrhea:</li>\n</ul>\n\t\t\t \n\n\t\t\t<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>290 – 2 (stool [Na+] + <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> [K+])</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n\t\t\t \n\n\t\t\t<ul>\n<li>Osmotic diarrhea: Gap &gt;50-100</li>\n<li>Secretory diarrhea: Gap &lt;50</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Urinary D-xylose test:</strong> Carbohydrate <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">malabsorption</span> (especially for duodenal disease)</p>\n<ul>\n<li>Excretion &lt;4.5g suggests mucosal damage in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> small bowel.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging Studies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Exams:</strong></p>\n<ul>\n<li>Barium small-bowel <span class=\"customMeta\" data-dictid=\"858805ab951692777203ea929e3df0\">follow-through</span> - To detect diseases like Crohn’s, celiac, diverticulosis.</li>\n<li>MRI <span class=\"customMeta\" data-dictid=\"e1fea778701692777187155d3315ec\">enterography</span> (MRE) or CT <span class=\"customMeta\" data-dictid=\"e1fea778701692777187155d3315ec\">enterography</span> - To assess for <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> diseases like Crohn’s disease, strictures, and <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <span class=\"customMeta\" data-dictid=\"8cee6e043d1692777188350a4ab7dd\">hepatobiliary</span> system.</li>\n</ul>\n<p><strong>Endoscopy:</strong></p>\n<ul>\n<li>Upper <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> with small-bowel <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> - For suspected mucosal disease, e.g., <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> disease, Whipple’s disease, lymphoma.</li>\n<li>Capsule <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> - For <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of the entire small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> if <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> is inconclusive.</li>\n<li>Small-bowel enteroscopy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Findings and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse Mucosal Pathology:</strong></p>\n<ul>\n<li><strong>Whipple’s disease: </strong>PAS-positive macrophages (diagnosed with immunohistochemistry)</li>\n<li><strong>Agammaglobulinemia: </strong>Reduced <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells, normal or flat mucosal architecture</li>\n<li><strong>Abetalipoproteinemia: </strong>Vacuolated enterocytes post-prandially</li>\n</ul>\n<p><strong>Patchy Lesions:</strong></p>\n<ul>\n<li>Lymphoma: <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">Malignant</span> cells in <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria and submucosa</li>\n<li>Lymphangiectasia: Dilated lymphatics in <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> with protein loss (hypoproteinemia)</li>\n</ul>\n<p><strong>Nonspecific Findings:</strong></p>\n<ul>\n<li>Villus atrophy: <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">Celiac</span> disease, tropical sprue, bacterial overgrowth</li>\n<li>Crypt hyperplasia: <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">Celiac</span> sprue, extensive tropical sprue</li>\n<li>Eosinophilic gastroenteritis: <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">Eosinophilic</span> <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> (may be patchy)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Confirmatory Diagnosis and Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Celiac Disease:</strong></p>\n<ul>\n<li>IgA tissue <span class=\"customMeta\" data-dictid=\"4a47b71b801692777200d06df00a08\">transglutaminase</span> (tTG) <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> and <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> deamidated <span class=\"customMeta\" data-dictid=\"21f6d7d8df1692777188deb1006c47\">gliadin</span> <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> antibody.</li>\n<li>Gluten-free diet (monitor with follow-up <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> titers).</li>\n</ul>\n<p><strong>Whipple's Disease:</strong></p>\n<ul>\n<li>PAS-positive macrophages in biopsy.</li>\n<li>Antibiotic therapy (Ceftriaxone + <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics).</li>\n</ul>\n<p><strong>Tropical Sprue:</strong></p>\n<ul>\n<li>Clinical diagnosis; <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> may show <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> atrophy.</li>\n<li>Antibiotics (Empirical treatment with <span class=\"customMeta\" data-dictid=\"8784b5a7ad16927772005323b514b8\">tetracycline</span> or folic acid).</li>\n</ul>\n<p><strong>Pancreatic Insufficiency:</strong></p>\n<ul>\n<li>Stool <span class=\"customMeta\" data-dictid=\"c931cf36561692777187f402c906d7\">elastase</span> levels.</li>\n<li>Pancreatic <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> replacement.</li>\n</ul>\n<p><strong>Lymphangiectasia:</strong></p>\n<ul>\n<li>Biopsy: Dilated lymphatics in submucosa.</li>\n<li>Treatment: Low-fat, high-protein diet; medium-chain triglycerides.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follow-Up and Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nutrient <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> monitoring (Iron, B12, Vitamin D/E/K)</li>\n<li>Dietary adjustments (e.g., gluten-free, <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> replacement)</li>\n<li>Reassess with imaging/endoscopy if symptoms persist.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>290 – 2 (stool [Na+] + <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> [K+])</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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He reports bloating, occasional nausea, and temporary relief with antacids. Upper GI endoscopy reveals peptic ulcers in the gastric antrum. What is the most likely cause of this patient’s gastritis?", "options": [{"label": "A", "text": "Autoimmune destruction of parietal cells", "correct": false}, {"label": "B", "text": "Helicobacter pylori infection", "correct": true}, {"label": "C", "text": "Chronic alcohol consumption alone", "correct": false}, {"label": "D", "text": "Stress-related mucosal injury", "correct": false}], "correct_answer": "B. Helicobacter pylori infection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type B Gastritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type A Gastritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily caused by H. pylori infection and long-term <span class=\"customMeta\" data-dictid=\"b924074dfe16927771933b6d50eaac\">NSAID</span> use</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune condition, often associated with autoantibodies against <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cells and <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location of Inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antrum (lower part) of the stomach, near the pylorus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fundus (upper part) of the stomach, where <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cells are found</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epigastric pain, bloating, nausea, vomiting, and <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> in some cases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often asymptomatic, but may cause symptoms like nausea, vomiting, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peptic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease (PUD), <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pernicious <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (due to vitamin B12 deficiency)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histological Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic inflammation, increased lymphocytes and neutrophils, often with atrophic changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic inflammation, loss of <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cells, and often <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>H. pylori</em> infection, NSAIDs, alcohol, smoking</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmunity, genetic predisposition, vitamin B12 deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eradication of <em>H. pylori</em> with antibiotics and <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> pump inhibitors (PPIs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin B12 supplementation and immune modulation; PPIs may also be used</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If untreated, it can lead to <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> ulcers and an increased risk of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If untreated, it can result in <span class=\"customMeta\" data-dictid=\"5cc1ea37091692777195fbd0aa687b\">pernicious</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> and an increased risk of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> carcinoma.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with a 3-month history of epigastric discomfort, bloating, and occasional nausea. An endoscopic gastric biopsy specimen reveals the following characteristic organism, as shown below. The patient is diagnosed with chronic gastritis. Which type of gastritis is least likely to be associated with this infection?", "options": [{"label": "A", "text": "Antral predominant gastritis", "correct": false}, {"label": "B", "text": "Non-atrophic pangastritis", "correct": false}, {"label": "C", "text": "Corpus predominant gastritis", "correct": false}, {"label": "D", "text": "Granulomatous gastritis", "correct": true}], "correct_answer": "D. Granulomatous gastritis", "question_images": ["https://image.prepladder.com/notes/wLTbm3eiBev2tcoaEUww1744368446.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with epigastric pain that worsens with meals and improves with antacids. Urea breath test is positive. Which of the following conditions is the patient least likely to be at increased risk for?", "options": [{"label": "A", "text": "Gastric adenocarcinoma", "correct": false}, {"label": "B", "text": "MALT lymphoma", "correct": false}, {"label": "C", "text": "Esophageal adenocarcinoma", "correct": true}, {"label": "D", "text": "Duodenal ulcers", "correct": false}], "correct_answer": "C. Esophageal adenocarcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/DRHCSqAshp2xh4hybwcS1745572686.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old man presents with a 4-week history of burning epigastric pain that occurs 1-2 hours after meals and is temporarily relieved by food. He also complains of vomiting. On examination, his heart rate is 115 beats per minute, and his temperature is 98.6°F. Mild epigastric tenderness is noted, and laboratory tests show mild anemia. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Duodenal ulcer", "correct": true}, {"label": "B", "text": "Acute pancreatitis", "correct": false}, {"label": "C", "text": "Gastric ulcer", "correct": false}, {"label": "D", "text": "Gastroesophageal reflux disease", "correct": false}], "correct_answer": "A. Duodenal ulcer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gastric <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">Ulcer</span> (GU)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Duodenal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">Ulcer</span> (DU)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common risk factors </strong>for both GU and DU: H. pylori, <span class=\"customMeta\" data-dictid=\"867d774b951692777190c8cfebd37a\">indiscriminate</span> use of NSAIDS due to comorbidities in the patients like <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> or requiring total knee replacement, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt; 6th-decade</li>\n<li>Premalignant condition.</li>\n<li>MC site: Lesser <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of stomach.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Basal/Nocturnal acid production: ↑</li>\n<li>MC site: First part of <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> or duodenal cap, usually within 3 cm of the pylorus.</li>\n<li>Size of Ulcer: &lt;1 cm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain Pattern:</strong> Pain is <strong>precipitated by</strong> food.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain Pattern:</strong> Pain occurs 90 min to 3 h after a meal and is <strong>relieved by</strong> food or antacids.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Features:</strong></p>\n<ol>\n<li>Epigastric pain (gnawing or burning sensation)</li>\n<li>Epigastric tenderness</li>\n<li>Tachycardia and Orthostasis caused by:</li>\n</ol>\n<ul>\n<li>Vomiting, may be due to <span class=\"customMeta\" data-dictid=\"4f75cbe5e8169277719615b86767c9\">pylorospasm</span> or local edema</li>\n<li>GI bleeding</li>\n</ul>\n<ol>\n<li>Rigidity in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall is suggestive of perforation</li>\n<li>Succussion splash: <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> outlet <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (due to pyloric stenosis, pylorospasm, or local <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> due to <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> in the <span class=\"customMeta\" data-dictid=\"13da15e2e41692777195755a5d4357\">peripyloric</span> area or <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> extending to the duodenum).</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is suspected to have peptic ulcer disease and endoscopy is performed to confirm the diagnosis. Which of the following endoscopic findings is most consistent with peptic ulcer disease?", "options": [{"label": "A", "text": "No options available", "correct": false}], "correct_answer": "Unknown", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BUrX3iX4OW76ALvYlZ4q1744371677.png", "https://image.prepladder.com/notes/5beY0g8r84sj6UtupEvv1744371848.png", "https://image.prepladder.com/notes/8zgFYLH4WsGYxVOdVgyY1744372317.png", "https://image.prepladder.com/notes/p4SybfZ8g83iyWdc0hvV1744372441.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the emergency department with hematemesis and melena for the past 2 days. He reports long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic back pain. On examination, he is found to be pale and hypotensive. Upper gastrointestinal endoscopy reveals a bleeding duodenal ulcer, as shown below. Which artery is most likely involved in the bleeding?", "options": [{"label": "A", "text": "Left gastric artery", "correct": false}, {"label": "B", "text": "Gastroduodenal artery", "correct": true}, {"label": "C", "text": "Splenic artery", "correct": false}, {"label": "D", "text": "Common hepatic artery", "correct": false}], "correct_answer": "B. Gastroduodenal artery", "question_images": ["https://image.prepladder.com/notes/10qcRYxAj6KouyNNzh7p1744372619.png"], "explanation_images": ["https://image.prepladder.com/notes/dGT5gBS5yaSp6MYTEqA01744372757.png", "https://image.prepladder.com/notes/QotS7xj12m1bFekSjmSM1744373017.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:711px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">Ulcer</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duodenal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">Ulcer</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common risk factors for both GU and DU: H.pylori and <span class=\"customMeta\" data-dictid=\"867d774b951692777190c8cfebd37a\">indiscriminate</span> use of NSAIDs.</li>\n<li>Epigastric pain, described as a burning or gnawing discomfort, can be present in both DU and GU</li>\n<li>Epigastric tenderness</li>\n<li>Tachycardia or Orthostasis: <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">Vomiting</span> may be due to <span class=\"customMeta\" data-dictid=\"4f75cbe5e8169277719615b86767c9\">pylorospasm</span> or local edema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The pain pattern in GU patients: Discomfort may be precipitated by food.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The typical pain pattern in DU occurs 90 min to 3 hours after a meal and is frequently relieved by antacids or food.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>M/C site: Lesser curvature</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>M/C site: The first part of the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> or <span class=\"customMeta\" data-dictid=\"2257fb9f7f1692777186ff3e166b69\">duodenal cap</span> is usually within 3 cm of the pylorus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Artery involved: Left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Artery involved: <strong>Gastroduodenal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> </strong><strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Benign &lt;span class=\" custommeta\"=\"\" data-dictid=\"12347b15191692777188bc86d226e1\"/>gastric ulcer\" data-author=\"Ed Uthman, MD\" data-hash=\"9387\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Benign_gastric_ulcer_1.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/axhzD2Aw5nHIP3DPHEa41744372907.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Duodenal ulcer\" data-author=\"melvil\" data-hash=\"9388\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Duodenal_ulcer01.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/QotS7xj12m1bFekSjmSM1744373017.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following regimens can be used in managing H. pylori eradication except?", "options": [{"label": "A", "text": "Triple therapy: Proton pump inhibitor (PPI) + Amoxicillin + Clarithromycin", "correct": false}, {"label": "B", "text": "Quadruple therapy: PPI + Bismuth subsalicylate + Metronidazole + Tetracycline", "correct": false}, {"label": "C", "text": "Dual therapy: Proton pump inhibitor (PPI) + Erythromycin", "correct": true}, {"label": "D", "text": "Hybrid therapy: PPI + Amoxicillin + Clarithromycin + Nitroimidazole", "correct": false}], "correct_answer": "C. Dual therapy: Proton pump inhibitor (PPI) + Erythromycin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presents with a 3-month history of intermittent epigastric pain, nausea, and bloating. He has a history of duodenal ulcers diagnosed 5 years ago, which were treated with antacids. He reports occasional indigestion. Upper gastrointestinal endoscopy reveals a small duodenal ulcer. A biopsy confirms the presence of H. pylori infection. Which of the following conditions in this patient would warrant H. pylori eradication therapy? 1) Peptic ulcer disease (PUD) 2) Gastric lymphoma (MALT lymphoma) 3) Non-ulcer dyspepsia 4) Irritable bowel syndrome (IBS)", "options": [{"label": "A", "text": "1, 2, 3, 4", "correct": false}, {"label": "B", "text": "2, 3, 4", "correct": false}, {"label": "C", "text": "1 and 2", "correct": true}, {"label": "D", "text": "Only 1", "correct": false}], "correct_answer": "C. 1 and 2", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General recommendations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Strong recommendations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Functional dyspepsia.</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7861e10657169277718815c2f42a75\">gastritis</span> with dyspepsia.</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"e627149ccc169277718241f723cc82\">atrophic gastritis</span> with <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> or intestinal metaplasia.</li>\n<li>Long-term use of <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> pump inhibitor.</li>\n<li>Family history of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer (first-degree relatives with <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> ulcer).</li>\n<li>After <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of early <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancer.</li>\n<li>Long-term aspirin/NSAID medication history with <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease.</li>\n<li>H. pylori-related diseases (lymphocytic gastritis, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> hyperplastic polyps, Menetrier disease).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Peptic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease.</li>\n<li>Gastric <span class=\"customMeta\" data-dictid=\"62de0ec43c16927771912c01f6f373\">MALT</span> lymphoma.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with a history of peptic ulcer disease was treated with triple therapy (omeprazole, clarithromycin, and amoxicillin) for 14 days. Six weeks later, he presents with persistent epigastric discomfort. Which test is most appropriate to confirm the eradication of the causative organism?", "options": [{"label": "A", "text": "Urea breath test", "correct": true}, {"label": "B", "text": "H. pylori serology", "correct": false}, {"label": "C", "text": "Upper GI endoscopy", "correct": false}, {"label": "D", "text": "Rapid urease test", "correct": false}], "correct_answer": "A. Urea breath test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tests used to evaluate H.Pylori eradication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urea breath test</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is a simple, <strong>non-invasive, highly sensitive and specific test.</strong></li>\n<li>It is ideally performed <strong>at least 4 weeks after the completion of therapy</strong> to avoid any false negatives due to the <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> effects of antibiotics or PPIs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stool <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is also a <strong>noninvasive</strong> test, and to avoid false negatives, it needs to be <strong>performed</strong> <strong>after 4</strong> <strong>weeks of treatment</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy-based <span class=\"customMeta\" data-dictid=\"ebf8f256f3169277718992ac1b2330\">histology</span> tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It can be done to evaluate the success of the treatment.</li>\n<li>It can only be <strong>performed after 2 weeks of stopping PPIs and 6 weeks of stopping antibiotics.</strong></li>\n<li>It is not commonly preferred.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old female with a history of rheumatoid arthritis has been taking naproxen for the past 6 months. She presents with epigastric pain, nausea, and dark stools. Upper GI endoscopy reveals a gastric ulcer. What is the drug of choice for managing this condition?", "options": [{"label": "A", "text": "Misoprostol", "correct": false}, {"label": "B", "text": "Sucralfate", "correct": false}, {"label": "C", "text": "Proton pump inhibitors", "correct": true}, {"label": "D", "text": "H2-receptor antagonists", "correct": false}], "correct_answer": "C. Proton pump inhibitors", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old male with a history of peptic ulcer disease (PUD) is prescribed omeprazole, for the management of his condition. Which of the following is not an anticipated adverse effect of long-term PPI use?", "options": [{"label": "A", "text": "Stress fractures", "correct": false}, {"label": "B", "text": "Community acquired pneumonia", "correct": false}, {"label": "C", "text": "Chronic kidney disease", "correct": false}, {"label": "D", "text": "Hypermagnesemia", "correct": true}], "correct_answer": "D. Hypermagnesemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Adverse effects of long-term usage of <span class=\"customMeta\" data-dictid=\"6d17c6d6f1169277719687447037f2\">PPI</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> nephritis</p>\n<p>(AIN)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, eosinophilia, and decreased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output leading to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Injury (AKI)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone pain</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term PPIs increase the risk of <strong>osteoporosis and</strong> <strong>stress fractures.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clostridium difficile infections</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <strong>gastric acidity</strong>, which normally acts as a barrier to bacterial growth, there is increased risk of <strong>C. difficile infections</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Community-Acquired Pneumonia</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> for CAP is seen due to <strong>impaired <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> defense</strong>, leading to <strong>increased bacterial colonization</strong> in the upper GI tract.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic or untreated AIN can progress to <span class=\"customMeta\" data-dictid=\"e6dc8586b11692777184b083672593\">CKD</span> over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypomagnesemia</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can cause muscle cramps, tetany-like manifestations, and arrhythmias.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents with the finding shown in the image and has a family history of similar lesions. Endoscopy reveals multiple hamartomatous polyps in the small intestine. Based on the clinical presentation, which of the following statements about the most probable condition is incorrect? a) Typically associated with a mutation in the STK11. b) Associated with bleeding and intussusception. c) Associated with alopecia, nail dystrophy, and malabsorption. d) Low or no risk of malignant transformation. e) Esophageal webs and glossitis are seen.", "options": [{"label": "A", "text": "c, d, e", "correct": true}, {"label": "B", "text": "a, b", "correct": false}, {"label": "C", "text": "a, c, d", "correct": false}, {"label": "D", "text": "b, c, d, e", "correct": false}], "correct_answer": "A. c, d, e", "question_images": ["https://image.prepladder.com/notes/WaMOvmgxA0pTNYnlje8z1744373255.png"], "explanation_images": ["https://image.prepladder.com/notes/eC0CqUwnacJj0sTaHzeM1744373405.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with features suggestive of Boerhaave syndrome. What is the characteristic triad seen in this condition?", "options": [{"label": "A", "text": "Multiple episodes of vomiting + chest pain + subcutaneous emphysema (Mackler’s triad)", "correct": true}, {"label": "B", "text": "Retching + Acute epigastric pain + Inability to pass NG tube (Borchardt’s triad)", "correct": false}, {"label": "C", "text": "Aortic stenosis + Deficiency of vWF + Lower GI bleed (Heyde syndrome)", "correct": false}, {"label": "D", "text": "Jaundice + Right upper quadrant pain + UGI bleed (Quincke triad)", "correct": false}], "correct_answer": "A. Multiple episodes of vomiting + chest pain + subcutaneous emphysema (Mackler’s triad)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following classification systems can be used in GI bleeding except?", "options": [{"label": "A", "text": "Glasgow-Blatchford", "correct": false}, {"label": "B", "text": "Forrest", "correct": false}, {"label": "C", "text": "Sarin", "correct": false}, {"label": "D", "text": "Atlanta", "correct": true}], "correct_answer": "D. Atlanta", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 21 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which substance inhibits the iron transporter on the basal side of the enterocyte?", "options": [{"label": "A", "text": "Hepcidin", "correct": true}, {"label": "B", "text": "Ferritin", "correct": false}, {"label": "C", "text": "Transferrin", "correct": false}, {"label": "D", "text": "Ferroportin", "correct": false}], "correct_answer": "A. Hepcidin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B5FqfvX0h8SkcyPTPgUG1747377699.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify this movement that takes place in the intestine.", "options": [{"label": "A", "text": "Segmented movement", "correct": false}, {"label": "B", "text": "Peristalsis", "correct": true}, {"label": "C", "text": "Intersegmental contraction", "correct": false}, {"label": "D", "text": "Diffusion", "correct": false}], "correct_answer": "B. Peristalsis", "question_images": ["https://image.prepladder.com/content/3eiA4XXMJPqknkQq1Hxa1747029509.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neurotransmitter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Role</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetylcholine (ACh) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates contraction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acts on <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors, increases motility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Substance P </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Promotes <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> contraction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released by mucosal stimulation, enhances <span class=\"customMeta\" data-dictid=\"9adacf6f38169277719430ad3cd087\">orad</span> contraction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vasoactive Intestinal <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">Peptide</span> (VIP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Promotes relaxation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acts on smooth muscle to induce <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> during peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serotonin (5-HT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regulates <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and initiates reflex</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released from <span class=\"customMeta\" data-dictid=\"6c13e383a01692777187ae85e093b6\">enterochromaffin</span> cells, activates 5-HT receptors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nitric <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">Oxide</span> (NO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mediates relaxation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released by <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> neurons, assists VIP in relaxation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcitonin Gene-Related <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">Peptide</span> (CGRP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Influences <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> signaling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Modulated by serotonin, aids in coordinating reflexes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Enteropeptidase enzyme is secreted by?", "options": [{"label": "A", "text": "Stomach", "correct": false}, {"label": "B", "text": "Duodenum", "correct": true}, {"label": "C", "text": "Jejunum", "correct": false}, {"label": "D", "text": "Ileum", "correct": false}], "correct_answer": "B. Duodenum", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mouth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Salivary Amylase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down <span class=\"customMeta\" data-dictid=\"24511b2ef716927771990798c3d939\">starch</span> into maltose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lingual Lipase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Begins <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> of lipids (mainly <span class=\"customMeta\" data-dictid=\"c2680413281692777192c001cf96cb\">milk fat</span> in infants)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stomach </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pepsinogen (activated to Pepsin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down proteins into smaller peptides</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gastric Lipase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down lipids, especially in infants</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Small Intestine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enteropeptidase (Enterokinase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Activates <span class=\"customMeta\" data-dictid=\"f4289daa6816927772007d51f2e486\">trypsinogen</span> to trypsin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic Amylase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Continues carbohydrate <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> (starches to <span class=\"customMeta\" data-dictid=\"8ea673008d1692777191f46338fc58\">maltose</span> and dextrins)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic Lipase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down triglycerides into monoglycerides and free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic Proteases (Trypsin, Chymotrypsin, Carboxypeptidase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Break down proteins into peptides and <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic Nucleases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down nucleic acids (DNA, RNA) into nucleotides</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disaccharidases (Sucrase, Lactase, Maltase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Break down disaccharides into monosaccharides (e.g., glucose, galactose, fructose)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aminopeptidases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Break down peptides into <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Large Intestine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bacterial Enzymes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ferment carbohydrates (fiber) into short-chain <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids (SCFAs) and gases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following factors is responsible for increasing gastric motility?", "options": [{"label": "A", "text": "Presence of fatty food in the stomach", "correct": false}, {"label": "B", "text": "Distension of the stomach", "correct": true}, {"label": "C", "text": "Presence of tryptophan in the stomach", "correct": false}, {"label": "D", "text": "The presence of acid in the stomach", "correct": false}], "correct_answer": "B. Distension of the stomach", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> Motility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distension of the stomach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stretching of the <span class=\"customMeta\" data-dictid=\"fda3b47a5c16927771994ab38f8a22\">stomach wall</span> activates mechanoreceptors, stimulating motility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormone released in response to food, especially proteins, that stimulates <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetylcholine (ACh)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released by the <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> nervous system, promoting smooth muscle contraction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Peptides and <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of partially digested proteins or <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids triggers <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> release.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastric <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflex activated when food enters the duodenum, regulating the rate of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> enzymes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The release of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> juices and <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> enzymes aids in the mixing and movement of food.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following reflexes, gastric emptying is delayed when acidic content enters the duodenum?", "options": [{"label": "A", "text": "Gastrocolic", "correct": false}, {"label": "B", "text": "Intestino intestinal", "correct": false}, {"label": "C", "text": "Gastroileal", "correct": false}, {"label": "D", "text": "Enterogastric", "correct": true}], "correct_answer": "D. Enterogastric", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acid in the duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Releases secretin, inhibiting antral <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> and stimulating <span class=\"customMeta\" data-dictid=\"0319b53dbd16927771968db216b352\">pyloric sphincter</span> contraction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Products of fat digestion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Releases <span class=\"customMeta\" data-dictid=\"329e9ba42816927771838b17a56efc\">CCK</span> and GIP, inhibiting <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertonic solutions in the duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Releases hormones inhibiting <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Products of protein digestion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Releases gastrin, CCK, and GIP, inhibiting <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large meal volume (solids)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolongs <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> time</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stretching of duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Initiates <strong>enterogastric reflex</strong>, inhibiting <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sympathetic stimulation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> (by norepinephrine) and increased <span class=\"customMeta\" data-dictid=\"0319b53dbd16927771968db216b352\">pyloric sphincter</span> tone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormones (CCK, GIP, secretin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The least frequency of slow waves is seen in?", "options": [{"label": "A", "text": "Duodenum", "correct": false}, {"label": "B", "text": "lleum", "correct": false}, {"label": "C", "text": "Jejunum", "correct": false}, {"label": "D", "text": "Stomach", "correct": true}], "correct_answer": "D. Stomach", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8a9jnwYfJbJ9tge0qrY41745582138.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>GI <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Frequency of Slow waves (per minute)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Stomach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">3-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Duodenum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">12-20</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Jejunum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">8-12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Ileum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">6-9</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">6-10</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following increases gastric acid secretion except?", "options": [{"label": "A", "text": "Gastrin", "correct": false}, {"label": "B", "text": "Histamine", "correct": false}, {"label": "C", "text": "Acetylcholine", "correct": false}, {"label": "D", "text": "Serotonin", "correct": true}], "correct_answer": "D. Serotonin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with severe watery diarrhea resembling that of rice gruel stool. Damage of which structure is likely to have resulted in this diarrhea?", "options": [{"label": "A", "text": "Zona occludens", "correct": true}, {"label": "B", "text": "Gap junction", "correct": false}, {"label": "C", "text": "Adherens junction", "correct": false}, {"label": "D", "text": "Hemidesmosomes", "correct": false}], "correct_answer": "A. Zona occludens", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of the relaxation of the intestinal segment following the segment containing the food bolus during peristalsis?", "options": [{"label": "A", "text": "VIP", "correct": true}, {"label": "B", "text": "Substances P", "correct": false}, {"label": "C", "text": "Dopamine from adrenergic fibers", "correct": false}, {"label": "D", "text": "Acetylcholine from myenteric fibers", "correct": false}], "correct_answer": "A. VIP", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurotransmitter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Role</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acetylcholine (ACh) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulates contraction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acts on <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors, increases motility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Substance P </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Promotes <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> contraction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Released by mucosal stimulation, enhances <span class=\"customMeta\" data-dictid=\"9adacf6f38169277719430ad3cd087\">orad</span> contraction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vasoactive Intestinal <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">Peptide</span> (VIP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Promotes relaxation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acts on smooth muscle to induce <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> during peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serotonin (5-HT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulates <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and initiates reflex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Released from <span class=\"customMeta\" data-dictid=\"6c13e383a01692777187ae85e093b6\">enterochromaffin</span> cells, activates <span class=\"customMeta\" data-dictid=\"ee9dfbd7b81692777188b432973e2e\">5-HT</span> receptors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nitric <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">Oxide</span> (NO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mediates relaxation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Released by <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> neurons, assists <span class=\"customMeta\" data-dictid=\"00c49723621692777202af2d05b8d3\">VIP</span> in relaxation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcitonin Gene-Related <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">Peptide</span> (CGRP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Influences <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> signaling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modulated by serotonin, aids in coordinating reflexes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable outcome for a patient who has undergone complete ileal and partial jejunal resection?", "options": [{"label": "A", "text": "Folic acid deficiency", "correct": false}, {"label": "B", "text": "Vitamin B12 deficiency", "correct": true}, {"label": "C", "text": "Gastric ulcer", "correct": false}, {"label": "D", "text": "Constipation", "correct": false}], "correct_answer": "B. Vitamin B12 deficiency", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following functions is NOT attributed to the intestinal epithelium?", "options": [{"label": "A", "text": "Absorption of the ions", "correct": false}, {"label": "B", "text": "Bile salts secretion", "correct": true}, {"label": "C", "text": "Mucous secretion", "correct": false}, {"label": "D", "text": "Secretion of digestive enzyme", "correct": false}], "correct_answer": "B. Bile salts secretion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient underwent an endoscopic examination of the gastrointestinal tract due to recurrent abdominal discomfort and altered bowel habits. Identify the arrow-marked structure in the given image.", "options": [{"label": "A", "text": "Bruner gland", "correct": true}, {"label": "B", "text": "Interstitial cells of kajal", "correct": false}, {"label": "C", "text": "Crypts of lieberkuhn", "correct": false}, {"label": "D", "text": "Peyer's patch", "correct": false}], "correct_answer": "A. Bruner gland", "question_images": ["https://image.prepladder.com/notes/Hp0u3VsuyyPYtiYgNBGF1747378732.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who has undergone gastrectomy (surgical removal of part or all of the stomach) is at risk of deficiencies in certain nutrients. Which of the following vitamins is most likely to require supplementation in such a patient?", "options": [{"label": "A", "text": "Vitamin C", "correct": false}, {"label": "B", "text": "Vitamin D", "correct": false}, {"label": "C", "text": "Vitamin B12", "correct": true}, {"label": "D", "text": "Vitamin A", "correct": false}], "correct_answer": "C. Vitamin B12", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Vitamin B12\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following acts as a secondary messenger in the mechanism of gastric acid secretion ?", "options": [{"label": "A", "text": "cGMP", "correct": false}, {"label": "B", "text": "cAMP", "correct": true}, {"label": "C", "text": "CCK-B receptor", "correct": false}, {"label": "D", "text": "Ach", "correct": false}], "correct_answer": "B. cAMP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - cAMP\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following functions is NOT attributed to the intestinal epithelium ?", "options": [{"label": "A", "text": "Absorption of the ions", "correct": false}, {"label": "B", "text": "Bile salts secretion", "correct": true}, {"label": "C", "text": "Mucous secretion", "correct": false}, {"label": "D", "text": "Secretion of digestive enzyme", "correct": false}], "correct_answer": "B. Bile salts secretion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which co-transporter is primarily responsible for facilitating glucose absorption across the basolateral membrane of an enterocytein this scenario ?", "options": [{"label": "A", "text": "SGLT1", "correct": false}, {"label": "B", "text": "GLUT2", "correct": true}, {"label": "C", "text": "GLUT5", "correct": false}, {"label": "D", "text": "SGLT2", "correct": false}], "correct_answer": "B. GLUT2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - GLUT2: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On which receptor does Hepcidin act to hinder the absorption of iron ?", "options": [{"label": "A", "text": "DMT-1", "correct": false}, {"label": "B", "text": "Ferroportin", "correct": true}, {"label": "C", "text": "Hephaestin", "correct": false}, {"label": "D", "text": "Transferrin", "correct": false}], "correct_answer": "B. Ferroportin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - F\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the effects of dietary fibers?", "options": [{"label": "A", "text": "Reduces intestinal transit time", "correct": true}, {"label": "B", "text": "No role in metabolism", "correct": false}, {"label": "C", "text": "Causes constipation", "correct": false}, {"label": "D", "text": "Increased blood Glucose", "correct": false}], "correct_answer": "A. Reduces intestinal transit time", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Reduces &lt;span class=\"customMeta\" data-dictid=\"b643f545af1692777190088a3353d6\"&gt;intestinal transit&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which part of the liver stores vitamin A ?", "options": [{"label": "A", "text": "Ito cells", "correct": true}, {"label": "B", "text": "Hepatocytes", "correct": false}, {"label": "C", "text": "Endothelial cells", "correct": false}, {"label": "D", "text": "Kupffer cells", "correct": false}], "correct_answer": "A. Ito cells", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone among the following does not exert its effects on the pancreas?", "options": [{"label": "A", "text": "Secretin", "correct": false}, {"label": "B", "text": "Gastrin", "correct": true}, {"label": "C", "text": "Cholecystokinin", "correct": false}, {"label": "D", "text": "GIP", "correct": false}], "correct_answer": "B. Gastrin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - G\n<table>\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:bottom\">\n<p><strong>Gastrointestinal Hormone</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:bottom\">\n<p><strong>Source</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:bottom\">\n<p><strong>Action on Pancreas</strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Secretin</p>\n</td>\n<td>\n<p>Duodenum</p>\n</td>\n<td>\n<p>Stimulates the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> to <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> bicarbonate-rich pancreatic juice, aiding in neutralizing <span class=\"customMeta\" data-dictid=\"038f5d38b41692777180a957459f95\">acidity</span> in the duodenum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gastrin</p>\n</td>\n<td>\n<p>Stomach</p>\n</td>\n<td>\n<p>Indirectly affects pancreatic function by modulating the release of other hormones involved in pancreatic secretion</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cholecystokinin (CCK)</p>\n</td>\n<td>\n<p>Duodenum</p>\n</td>\n<td>\n<p>Stimulates the <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of pancreatic enzymes (lipase, amylase) to aid in <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> of fats and carbohydrates</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>GIP (Glucose-dependent Insulinotropic Peptide)</p>\n</td>\n<td>\n<p>Small Intestine</p>\n</td>\n<td>\n<p>Stimulates the release of <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> from pancreatic <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells, helping regulate blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following Darrow Yannet diagram is suggestive of which condition? Note: The solid line is the original fluid compartment and the color shaded compartment with the dotted change caused by the condition.", "options": [{"label": "A", "text": "Excessive sweating", "correct": false}, {"label": "B", "text": "Adrenal insufficiency", "correct": true}, {"label": "C", "text": "Diarrhea", "correct": false}, {"label": "D", "text": "SIADH", "correct": false}], "correct_answer": "B. Adrenal insufficiency", "question_images": ["https://image.prepladder.com/content/haAqxw2KBqDJVlWpPSkb1691490690.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\"&gt;Adrenal&lt;/span&gt; insufficiency: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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He says the pain is not relieved by taking antacids. Laboratory investigations show elevated serum gastrin levels, prompting further evaluation. Endoscopic examination reveals multiple peptic ulcers in the stomach and duodenum. 1) It is associated with MEN 2 syndrome. 2) 60% of the tumors have a malignant potential. 3) It is associated with H. pylori infection. 4) Diarrhea is the second most common clinical manifestation. 5) BAO: MAO ratio &amp;gt; 0.6 is suggestive of Zollinger-Ellison syndrome. Which of the following statements are true regarding this condition?", "options": [{"label": "A", "text": "1, 2, 3", "correct": false}, {"label": "B", "text": "2, 4, 5", "correct": true}, {"label": "C", "text": "2, 3, 4", "correct": false}, {"label": "D", "text": "1, 4, 5", "correct": false}], "correct_answer": "B. 2, 4, 5", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdominal pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to <strong>peptic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> (M/C- &gt;90%)</strong>. ZES is suspected if:</p>\n<ul>\n<li>Ulcers in unusual locations (2nd part of the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> and beyond).</li>\n<li>Refractory to medical therapy.</li>\n<li>Recurrence after acid-reducing surgery.</li>\n<li>Presents with complications like <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and perforation.</li>\n<li>It is <strong>not associated</strong> with H. pylori or NSAID intake. <strong>(Statement 3)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diarrhea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Second <strong>most common</strong> (70%) clinical manifestation.</p>\n<p>Causes are <span class=\"customMeta\" data-dictid=\"8dcd91eadf1692777193a72a442f37\">multifactorial</span> and occur due to: <strong>(Statement 4)</strong></p>\n<ul>\n<li>Marked volume <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> to the small bowel.</li>\n<li>Inactivation of pancreatic enzymes by the acid.</li>\n<li>Damage to the intestinal <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> by the acid (can cause <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">malabsorption</span> and weight loss).</li>\n<li>Diarrhea can also be <strong>secretory</strong> due to the direct <span class=\"customMeta\" data-dictid=\"e33367d4a31692777199bb835a83ea\">stimulatory</span> effect of <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> on the enterocytes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Association with <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 1 syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>25% of the cases can be associated with <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 1.</li>\n<li>ZES has a more <span class=\"customMeta\" data-dictid=\"2c27fdf0ed1692777190530a17c849\">indolent</span> course in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 1, and the gastrinomas tend to be smaller, multiple, and located in the duodenal wall more often. <strong>(Statement 1)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:75%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;1000 pg/ml</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secretin <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> test (most sensitive and specific <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> <span class=\"customMeta\" data-dictid=\"80806f031b1692777196a8db8c148e\">provocation</span> test)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An increase in <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> of ≥120 pg within 15 min of <span class=\"customMeta\" data-dictid=\"1ff46c25d416927771987897f87843\">secretin</span> injection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BAO (basal acid output)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt;15 mEq/h</strong> (normal: &lt;5 mEq/h)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BAO: MAO (maximal acid output) ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased (<strong>&gt;0.6</strong>) <strong>(Statement 5)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Localization of the tumour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CT or MRI</li>\n<li>Endoscopic ultrasound</li>\n<li><strong>PET-CT with </strong><strong><sup>68</sup></strong><strong>Ga-DOTATATE</strong> (sensitivity &amp; <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> is &gt;90%)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents to the gastroenterology clinic with complaints of acidity and recurrent abdominal pain that worsens at night and is not relieved by antacids, weight loss, and diarrhea. On further evaluation, his serum gastrin levels were elevated, and an endoscopic ultrasound showed ulcers in the second and third parts of the duodenum and a tumor of 2.5 cm in size. Which of the following is the recommended treatment option for this patient?", "options": [{"label": "A", "text": "Proton pump inhibitors", "correct": false}, {"label": "B", "text": "Omeprazole + Clarithromycin + Amoxicillin", "correct": false}, {"label": "C", "text": "Surgical removal", "correct": true}, {"label": "D", "text": "Radiofrequency ablation", "correct": false}], "correct_answer": "C. Surgical removal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with recurrent upper abdominal pain and frequent episodes of reflux. He also reports unintended weight loss from the past three months. Endoscopy reveals multiple duodenal ulcers. Further tests confirmed Zollinger-Ellison Syndrome (ZES). Which of the following statements regarding the management of ZES is false?", "options": [{"label": "A", "text": "Proton pump inhibitors (PPIs) are the mainstay of treatment.", "correct": false}, {"label": "B", "text": "Surgical resection of gastrinoma is curative in all cases.", "correct": true}, {"label": "C", "text": "High-dose PPI therapy can effectively control acid hypersecretion.", "correct": false}, {"label": "D", "text": "Somatostatin analogues can be used as adjunctive therapy to control symptoms.", "correct": false}], "correct_answer": "B. Surgical resection of gastrinoma is curative in all cases.", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged woman presents with acidity, abdominal pain, diarrhea, and weight loss for the past few months. Her symptoms are not relieved by taking antacids. An endoscopic evaluation shows ulcers on the second part of the duodenum. Which of the following conditions should be suspected in this patient?", "options": [{"label": "A", "text": "Stress ulcers", "correct": false}, {"label": "B", "text": "Zollinger-Ellison syndrome", "correct": true}, {"label": "C", "text": "H. pylori infection", "correct": false}, {"label": "D", "text": "Malignant duodenal ulcer", "correct": false}], "correct_answer": "B. Zollinger-Ellison syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;1000 pg/ml</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secretin <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> test (most sensitive and specific <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> <span class=\"customMeta\" data-dictid=\"80806f031b1692777196a8db8c148e\">provocation</span> test)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An increase in <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> of <strong>≥120 pg within 15 min</strong> of <span class=\"customMeta\" data-dictid=\"1ff46c25d416927771987897f87843\">secretin</span> injection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BAO (basal acid output)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt;15 mEq/h</strong> (normal: &lt;5 mEq/h)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BAO: <span class=\"customMeta\" data-dictid=\"0307bca2ef1692777191b7df13d4b3\">MAO</span> (maximal acid output) ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased (<strong>&gt;0.6</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Localization of the tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT or MRI- </strong>Initial Investigation</li>\n<li><strong>Endoscopic ultrasound-</strong> BEST investigation</li>\n<li><strong>PET-CT with </strong><strong><sup>68</sup></strong><strong>Ga-DOTATATE</strong> (sensitivity &amp; <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> is &gt;90%)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 14 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 9 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "An 8-year-old girl was brought by her mother to the pediatrician with a history of changes in her behavior and appearance. She has become unusually pale, experiences fatigue easily, and has developed an increased frequency of bruising. Investigations reveal the presence of the Philadelphia chromosome. Which of the following are risk factors for the condition?", "options": [{"label": "A", "text": "Ataxia telangiectasia", "correct": false}, {"label": "B", "text": "Klinefelter syndrome", "correct": false}, {"label": "C", "text": "Benzene exposure", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For the past few weeks, a 6-year-old has been experiencing fatigue, pallor, and recurrent infections. Her parents also report that she has been experiencing night sweats and loss of appetite. On examination, she appears pale and has multiple petechiae on her skin. A complete blood count reveals a hemoglobin level of 8 g/dL, a white blood cell count of 150,000/µL, and a platelet count of 30,000/µL. Physical examination reveals hepatosplenomegaly. The peripheral smear is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "ALL", "correct": true}, {"label": "B", "text": "AML", "correct": false}, {"label": "C", "text": "ITP", "correct": false}, {"label": "D", "text": "CML", "correct": false}], "correct_answer": "A. ALL", "question_images": ["https://image.prepladder.com/notes/6Lhc0hFtF05VXh444owq1744710061.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes the management phases of acute lymphoblastic leukemia (ALL)?", "options": [{"label": "A", "text": "Induction therapy aims for complete remission using only glucocorticoids and L-asparaginase.", "correct": false}, {"label": "B", "text": "Induction therapy primarily focuses on preventing CNS involvement and uses only low-intensity agents.", "correct": false}, {"label": "C", "text": "Consolidation therapy for high-risk T-cell ALL includes cyclophosphamide, cytarabine, vincristine, and anthracyclines.", "correct": true}, {"label": "D", "text": "Immunotherapy is routinely given during the induction phase to all patients with ALL.", "correct": false}], "correct_answer": "C. Consolidation therapy for high-risk T-cell ALL includes cyclophosphamide, cytarabine, vincristine, and anthracyclines.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old girl who was diagnosed with ALL complained of severe headaches, experienced nausea and vomiting, diplopia, and developed an unsteady gait a few months after the diagnosis. Which of the following would have prevented this patient's condition?", "options": [{"label": "A", "text": "Intrathecal methotrexate", "correct": true}, {"label": "B", "text": "Nilotinib", "correct": false}, {"label": "C", "text": "Blinatumomab", "correct": false}, {"label": "D", "text": "Vincristine", "correct": false}], "correct_answer": "A. Intrathecal methotrexate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is/are good prognostic markers in patients with ALL? Female gender Leukocyte count &amp;gt;100000/uL. Hyperploidy. L2 ALL.", "options": [{"label": "A", "text": "3 only", "correct": false}, {"label": "B", "text": "2 and 3", "correct": false}, {"label": "C", "text": "2,3,4", "correct": false}, {"label": "D", "text": "1,3,4", "correct": true}], "correct_answer": "D. 1,3,4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Favorable <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">Prognostic</span> factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unfavorable <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> factors </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age: 1-10 years</li>\n<li>Leucocyte count &lt; 50000/µl</li>\n<li><strong>Hyperploidy</strong></li>\n<li>t (12:21)</li>\n<li>L1 ALL</li>\n<li>Response to treatment</li>\n<li><strong>Early <span class=\"customMeta\" data-dictid=\"d80014dfb516927771962b4857d683\">Pre</span> B-cell ALL</strong></li>\n<li><strong>Female</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extreme age group: &lt;1 year or &gt;10 years</li>\n<li>Hypoploidy</li>\n<li>t(9:22) and t(4:11)</li>\n<li><strong>L2 and L3 ALL and <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> B cell ALL</strong></li>\n<li><strong>Total <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count &gt;50,000/cubic.mm</strong></li>\n<li>Black males</li>\n<li>Organomegaly</li>\n<li>CNS Leukemia</li>\n<li>Absence of CD10</li>\n</ul>\n<ul>\n<li>Remission&gt; 14 days</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old girl has been presenting to the emergency department with fatigue, pallor, and recurrent infections over the past month. On examination, she shows hepatosplenomegaly and petechiae. Laboratory tests reveal leukocytosis with a predominance of lymphoblasts, low hemoglobin, and thrombocytopenia. A bone marrow biopsy demonstrates more than 20% lymphoblasts. Cytogenetic analysis shows the presence of the Philadelphia chromosome. Based on the FAB classification, what is the most likely diagnosis?", "options": [{"label": "A", "text": "ALL-L1 (Acute Lymphoblastic Leukemia, Small Lymphoblasts)", "correct": false}, {"label": "B", "text": "ALL-L2 (Acute Lymphoblastic Leukemia, Large Lymphoblasts)", "correct": false}, {"label": "C", "text": "ALL-L3 (Acute Lymphoblastic Leukemia, Burkitt-type)", "correct": true}, {"label": "D", "text": "Acute Myeloid Leukemia (AML)", "correct": false}], "correct_answer": "C. ALL-L3 (Acute Lymphoblastic Leukemia, Burkitt-type)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YTTK48rdSAhFo8INjVFS1744710421.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CYTOLOGIC FEATURES</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cell size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small cells predominate, homogenous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large <span class=\"customMeta\" data-dictid=\"bbe1b94c491692777188fe4f85b1ce\">heterogeneous</span> in size</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large homogenous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cytoplasm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scanty</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable often moderately abundant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderately abundant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nucleoli</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One or more, often large</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One or more, prominent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nuclear shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogenous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable heterogenous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stippled homogenous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nuclear shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irregular clefts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>regular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cytoplasmic basophilia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intensely basophilic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cytoplasmic vacuolation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>prominent</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following CD markers with the corresponding type of Acute Lymphoblastic Leukemia (ALL): CD Markers Type of ALL 1. Common ALL a) CD1a 2. Pre B ALL b) CD10 3. Cortical T-ALL c) cylg, CD10 4. T lineage ALL d) CD3", "options": [{"label": "A", "text": "1-a, 2-b, 3-c, 4-d", "correct": false}, {"label": "B", "text": "1-b, 2-c, 3-d, 4-a", "correct": false}, {"label": "C", "text": "1-b, 2-c, 3-a, 4-d", "correct": true}, {"label": "D", "text": "1-a, 2-b, 3-d, 4-a", "correct": false}], "correct_answer": "C. 1-b, 2-c, 3-a, 4-d", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of ALL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mutation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>B-lineage ALL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA DR, TdT, CD19, CD79, CD22</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pro B-ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No additional markers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>t(4;11)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>t(9;22)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pre B ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>cylg, CD10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>t(1;19)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mature B-ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD10, slg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>t(8;14) t(2;8) t(8;22)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T <span class=\"customMeta\" data-dictid=\"e129d23033169277719185ba334bac\">lineage</span> ALL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD3, CD7, CD2, CD5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early Pro or <span class=\"customMeta\" data-dictid=\"d80014dfb516927771962b4857d683\">Pre</span> T-ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No additional markers</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>t(10;14) t(11;14)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortical T-ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD1a</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mature T-ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD4, CD8</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old male presents with fatigue, fever, and easy bruising. Blood tests reveal leukocytosis with a high percentage of blast cells. A bone marrow biopsy confirms the diagnosis of Acute Lymphoblastic Leukemia (ALL). Further genetic testing is performed, revealing the following mutation. What is the likely molecular weight of the BCR-ABL fusion protein associated with the Philadelphia chromosome in this patient's Acute Lymphoblastic Leukemia?", "options": [{"label": "A", "text": "190 kDa", "correct": true}, {"label": "B", "text": "210 kDa", "correct": false}, {"label": "C", "text": "230 kDa", "correct": false}, {"label": "D", "text": "250 kDa", "correct": false}], "correct_answer": "A. 190 kDa", "question_images": ["https://image.prepladder.com/notes/InUMnXvLi2DydNYyjKk21744710600.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-year-old girl was brought by her mother to the pediatrician with a history of changes in her behavior and appearance. She has become unusually pale, experiences fatigue easily, and has developed an increased frequency of bruising. Investigations reveal a high WBC count along with high lymphoblast. Even after completion of the chemotherapy treatment regimen, she presents with hematological relapse. Which of the following drugs can be used in this situation?", "options": [{"label": "A", "text": "Ponatinib", "correct": false}, {"label": "B", "text": "Methotrexate", "correct": false}, {"label": "C", "text": "Blinatumomab", "correct": true}, {"label": "D", "text": "Cytarabine", "correct": false}], "correct_answer": "C. Blinatumomab", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti CD20</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B- Precursor</p>\n<p>Burkitt Leukemia/Lymphoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rituximab</p>\n<p>Ofatumomab</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti CD22</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B- Precursor</p>\n<p>Mature B-ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inotuzumab</p>\n<p>Epratuzumab</p>\n<p>Moxetumomab Pasudotox</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti CD19</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B- Precursor</p>\n<p>Mature B-ALL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blinatumomab</p>\n<p>CAR-T cells</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 19 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 10 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 67-year-old male who previously worked in the petrochemical industry presents with complaints of generalized fatigue, fever and difficulty breathing. On examination, conjunctival pallor and petechiae over the ankle are noted. Bone marrow evaluation reveals 25% myeloblasts. Which of the following is the likely diagnosis? Complete Blood Count (CBC): Hemoglobin: 8.2 g/dL White Blood Cell Count: 1,20,000/µL Platelet Count: 30,000/µL", "options": [{"label": "A", "text": "Acute lymphoblastic leukaemia (ALL)", "correct": false}, {"label": "B", "text": "Acute myeloid leukaemia (AML)", "correct": true}, {"label": "C", "text": "Chronic myelocytic leukaemia (CML)", "correct": false}, {"label": "D", "text": "Chronic lymphocytic leukaemia (CLL)", "correct": false}], "correct_answer": "B. Acute myeloid leukaemia (AML)", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female presents with fatigue, weight loss, and easy bruising. A bone marrow aspiration is performed, and the results are shown below. Which of the following is not a cause for this condition?", "options": [{"label": "A", "text": "Idiopathic", "correct": false}, {"label": "B", "text": "Downs syndrome", "correct": false}, {"label": "C", "text": "Diamond Black Fann syndrome", "correct": false}, {"label": "D", "text": "NF-1", "correct": true}], "correct_answer": "D. NF-1", "question_images": ["https://image.prepladder.com/notes/hzCySlAfSonluHsmD7wr1744708871.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Idiopathic (25-50% cases)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(25-50% cases) (Option A)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> Failure:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fanconi Anemia</li>\n<li><strong>Diamond-Blackfan Syndrome </strong>(Option C): Diamond-Blackfan <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">Anemia</span> (DBA) is a rare inherited <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of macrocytic anaemia characterised by a failure of <span class=\"customMeta\" data-dictid=\"317dbdacdb16927771878c7860f69b\">erythropoiesis</span> in the bone marrow.</li>\n<li>Shwachman-Diamond Syndrome: An autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder involving <span class=\"customMeta\" data-dictid=\"938890efd616927771870f4a611546\">exocrine</span> pancreatic insufficiency.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Defective DNA Repair:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bloom Syndrome</li>\n<li>Ataxia Telangiectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Down Syndrome: </strong>(Option B)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>AML is associated with Down syndrome, particularly the subtype known as <strong>Acute</strong> <strong>Megakaryoblastic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (AML M7)</strong>, which involves the <strong>GATA1 gene.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exposure to Anticancer Drugs:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Alkylating agents -&gt; <span class=\"customMeta\" data-dictid=\"93e077ee021692777192666a61cfbc\">Monosomy</span> 5 &amp; 7 -&gt; <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> (After 4-6 years).</li>\n<li>Anticancer drugs (Topoisomerase 2 inhibitors) -&gt; <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">Chromosome</span> 11 involvement -&gt; <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> (After 1-3 years).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiation Exposure:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exposure to radiation, benzene, phenylbutazone, and <span class=\"customMeta\" data-dictid=\"a1b9b992ca1692777184a69772eb33\">chloramphenicol</span> may increase the risk of developing <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> and <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>t(15:17):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chromosomal <span class=\"customMeta\" data-dictid=\"8ba7332e86169277720060bd4507c8\">translocation</span> results in the PML-RARA <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene, which is associated with <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> promyelocytic leukaemia (APL), a subtype of AML.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>t(8:21):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chromosomal <span class=\"customMeta\" data-dictid=\"8ba7332e86169277720060bd4507c8\">translocation</span> (RUNX1- RUNX1T1) is associated with <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> sarcoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inversion 16 or t(16;16).</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following appropriately- 1. Acute monocytic leukemia A. M0 2. AML without maturation B. M2 3. Acute myelomonocytic Leukaemia C. M5 4. AML with minimal differentiation D. M4 E. M1", "options": [{"label": "A", "text": "1-C, 2-E,3-D,4-A", "correct": true}, {"label": "B", "text": "1-B, 2-A,3-D,4-E", "correct": false}, {"label": "C", "text": "1-D, 2-E,3-C,4-B", "correct": false}, {"label": "D", "text": "1-D, 2-E,3-A,4-B", "correct": false}], "correct_answer": "A. 1-C, 2-E,3-D,4-A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:504px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally differentiated leukaemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myeloblastic leukaemia without maturation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myeloblastic leukaemia with maturation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypergranular promyelocytic leukemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelomonocytic leukemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M4E0 (variant)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase in <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> eosinophils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M5 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"7eae8f57ab16927771922b5f3d81e4\">Monocytic</span> leukemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M6 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythroleukemia (DiGuglielmo’s disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M7 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Megakaryoblastic leukaemia</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><em>Acute <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> (AML) with <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> genetic abnormalities</em></strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>AML with t(8;21)(q22;q22); RUNX1-RUNX1T1</li>\n<li>AML with inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11</li>\n<li><strong>Acute promyelocytic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> with PML-RARA </strong></li>\n<li>AML with t(9;11)(p21.3;q23.3); MLLT3-KMT2A</li>\n<li>AML with t(6;9)(p23;q34.1); DEK-NUP214</li>\n<li>AML with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM</li>\n<li>AML (megakaryoblastic) with t(1;22)(p13.3;q13.3); RBM15-MKL1</li>\n<li>Provisional entity: <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> with BCR-ABL1</li>\n<li>AML with mutated NPM1</li>\n<li>AML with biallelic mutations of CEBPA</li>\n<li>Provisional entity: <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> with mutated RUNX1</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AML with myelodysplasia-related changes</strong></p>\n<ul>\n<li>Therapy-related <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> neoplasms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AML, not otherwise specified (NOS)</strong></p>\n<ul>\n<li>AML with minimal differentiation</li>\n<li>AML without maturation</li>\n<li>AML with maturation</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"215dafdbad1692777193dcb48ddd63\">myelomonocytic</span> leukemia</li>\n<li>Acute monoblastic/monocytic leukemia</li>\n<li>Pure <span class=\"customMeta\" data-dictid=\"892718f3e916927771871389d2e1a3\">erythroid</span> leukemia</li>\n<li>Acute megakaryoblastic leukemia</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"0bc69d6cf8169277718209818c7522\">basophilic</span> leukemia</li>\n<li>Acute panmyelosis with myelofibrosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myeloid sarcoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myeloid proliferations related to Down syndrome</strong></p>\n<ul>\n<li>Transient <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"9a34416acd16927771930416df6115\">myelopoiesis</span> (TAM)</li>\n<li>Myeloid <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> associated with Down syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old female patient presents to the clinic with fatigue, recurrent infections, and easy bruising. Laboratory tests reveal anaemia, thrombocytopenia, and an elevated white blood cell count with a high proportion of blasts. Bone marrow biopsy confirms the diagnosis of acute myeloid leukaemia (AML). Which of the following cytogenetic abnormalities is not a favourable prognosis in acute myeloid leukaemia (AML)?", "options": [{"label": "A", "text": "t (8:21)", "correct": false}, {"label": "B", "text": "Inversion of chromosome 16", "correct": false}, {"label": "C", "text": "t (16:16)", "correct": false}, {"label": "D", "text": "FLT3-ITD high", "correct": true}], "correct_answer": "D. FLT3-ITD high", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with persistent fever, epistaxis, and pallor. Lab investigations are shown below. Hb- 7.3 g/dl WBC count- 75000 cells/mm3 Blast count- 25%, positive for t (15,17) Platelet count- 48000 /cumm What is the most probable diagnosis?", "options": [{"label": "A", "text": "Acute Myeloid leukemia", "correct": true}, {"label": "B", "text": "Acute lymphoid leukemia", "correct": false}, {"label": "C", "text": "Preleukemia", "correct": false}, {"label": "D", "text": "Chronic lymphoid leukemia", "correct": false}], "correct_answer": "A. Acute Myeloid leukemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/GkIAO2Oucx1QQ7kXt3QJ1746005972.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male patient presents to the emergency department with severe fatigue, unexplained bruising, and nosebleeds. Her complete blood count reveals severe anaemia and thrombocytopenia. The peripheral blood smear image is given. Bone marrow biopsy confirms the diagnosis of acute promyelocytic leukaemia (APL). What is the first-line treatment for acute promyelocytic leukaemia (APL)?", "options": [{"label": "A", "text": "Induction chemotherapy with venetoclax", "correct": false}, {"label": "B", "text": "All-trans retinoic acid (ATRA) therapy", "correct": true}, {"label": "C", "text": "Allogeneic hematopoietic stem cell transplantation (HCT)", "correct": false}, {"label": "D", "text": "Supportive care with transfusions", "correct": false}], "correct_answer": "B. All-trans retinoic acid (ATRA) therapy", "question_images": ["https://image.prepladder.com/notes/RYvnjn2uZlVMBbMeYXko1746005854.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old female is recently diagnosed with AML. Her WBC count is 1.50 lakh/mm3. Which of the following organs is most commonly affected in symptomatic hyperleukocytosis?", "options": [{"label": "A", "text": "Liver", "correct": false}, {"label": "B", "text": "Brain", "correct": true}, {"label": "C", "text": "Kidney", "correct": false}, {"label": "D", "text": "Bowel", "correct": false}], "correct_answer": "B. Brain", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: 1. DIC A. M5- AML 2. Gingival hyperplasia B. M3- APML 3. Paraplegia and u/l proptosis C. M7- AML 4. Down syndrome D. t( 8:21)", "options": [{"label": "A", "text": "1-B, 2-A, 3-D, 4-C", "correct": true}, {"label": "B", "text": "1-D, 2-C, 3-B, 4-A", "correct": false}, {"label": "C", "text": "1-C, 2-A, 3-D, 4-B", "correct": false}, {"label": "D", "text": "1-B, 2-A, 3-C, 4-D", "correct": false}], "correct_answer": "A. 1-B, 2-A, 3-D, 4-C", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:504px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally differentiated leukaemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myeloblastic leukaemia without maturation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myeloblastic leukaemia with maturation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypergranular promyelocytic leukemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelomonocytic leukemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M4E0 (variant)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase in <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> eosinophils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M5 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"7eae8f57ab16927771922b5f3d81e4\">Monocytic</span> leukemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M6 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythroleukemia (DiGuglielmo’s disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M7 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Megakaryoblastic leukaemia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male patient came to the clinic with complaints of progressive fatigue and weight loss over the past 3 months. On physical examination, pallor and an orbital swelling leading to proptosis are seen. Bone marrow analysis showed hypercellularity with the predominance of myeloblasts and t(8,21) on FISH. All are true regarding this condition except:", "options": [{"label": "A", "text": "Caused due to extra-medullary blast proliferation", "correct": false}, {"label": "B", "text": "Swelling is very painful", "correct": true}, {"label": "C", "text": "Represents poor prognosis", "correct": false}, {"label": "D", "text": "Treatment includes anthracycline-based chemotherapy.", "correct": false}], "correct_answer": "B. Swelling is very painful", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9tfotKSEe4VCpQla90DN1744709380.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old female presents to the emergency department with complaints of sudden onset bruising, petechiae, and frequent nose bleeds. She reports increasing fatigue and shortness of breath over the past month. On examination, conjunctival pallor and multiple ecchymoses on her arms and legs are noted. A bone marrow biopsy shows hypercellularity with 27% of myeloblasts. Laboratory tests reveal: Haemoglobin: 7.5 g/dL Platelet Count: 20,000/µL White Blood Cell Count: 75,000/µL . PT: 15 seconds (normal: 11-13 seconds) PTT: 37 seconds (normal: 25-35 seconds) Fibrinogen: 100 mg/dL (low) D-dimer: Elevated (&amp;gt;10,000 ng/mL) What type of Acute Myeloid Leukemia (AML) is most commonly associated with this patient’s presentation?", "options": [{"label": "A", "text": "M3 AML", "correct": true}, {"label": "B", "text": "M2 AML", "correct": false}, {"label": "C", "text": "M5 AML", "correct": false}, {"label": "D", "text": "M7 AML", "correct": false}], "correct_answer": "A. M3 AML", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/1FCxXAN0Ex1vsgVpZtna1744709604.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:504px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally differentiated leukaemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myeloblastic leukaemia without maturation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M2 (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myeloblastic leukaemia with maturation</li>\n<li><strong>Most common type</strong> of AML</li>\n<li>Better <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> compared to other types</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypergranular promyelocytic leukemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelomonocytic leukemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M4E0 (variant)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase in <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> eosinophils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M5 (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"7eae8f57ab16927771922b5f3d81e4\">Monocytic</span> leukemia</li>\n<li>Gum infiltration</li>\n<li>Skin involvement- <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> cutis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M6 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythroleukemia (DiGuglielmo’s disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M7 (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Megakaryoblastic leukaemia</li>\n<li>Associated with Down syndrome</li>\n<li>Involves GATA1 gene</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 20 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old woman is undergoing surgery for uterine fibroids. You are preparing to transfuse whole blood preserved in Acid Citrate Dextrose (ACD). What is the maximum shelf-life of whole blood stored in ACD?", "options": [{"label": "A", "text": "21 days", "correct": true}, {"label": "B", "text": "28 days", "correct": false}, {"label": "C", "text": "35 days", "correct": false}, {"label": "D", "text": "42 days", "correct": false}], "correct_answer": "A. 21 days", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acid <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">Citrate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> (ACD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Citrate <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> (CPD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Citrate <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">Adenine</span> (CPDA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Functions:</li>\n</ul>\n<ul>\n<li><strong>Preserves <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> levels</strong>.</li>\n<li>Maintains <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">red blood cell</span> shape.</li>\n<li><strong>Prevents hemolysis.</strong></li>\n<li>Helps maintain a stable pH.</li>\n</ul>\n<ul>\n<li>Shelf-life: <strong>21 days.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Functions:\n\t\t\t\t<ul>\n<li>Decreases acidosis.</li>\n<li>Improves <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> synthesis.</li>\n</ul>\n</li>\n<li>Shelf-life: <strong>28 days</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Additional Adenine:\n\t\t\t\t<ul>\n<li>Maintains high <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> levels.</li>\n<li>Helps retain 2,3-DPG levels for 12-14 days.</li>\n</ul>\n</li>\n<li>Shelf-life: <strong>35 days</strong>.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:256px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Additives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Shelf life</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>21 days <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CPD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>28 days <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CPDA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>35 days <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SAGM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>42 days <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is incorrect regarding blood preservation?", "options": [{"label": "A", "text": "Citrate acts as an anticoagulant by binding to calcium ions, preventing clot formation.", "correct": false}, {"label": "B", "text": "Adenine is added to blood preservatives to enhance ATP production.", "correct": false}, {"label": "C", "text": "Dextrose in blood preservatives provides essential nutrients for red blood cells during storage.", "correct": false}, {"label": "D", "text": "ACD and CPD/CPDA preservatives can be used interchangeably in any volume for blood storage.", "correct": true}], "correct_answer": "D. ACD and CPD/CPDA preservatives can be used interchangeably in any volume for blood storage.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statement about Febrile Nonhemolytic Transfusion Reaction (FNHTR) is not correct?", "options": [{"label": "A", "text": "Most common reaction associated with transfusion of cellular blood components.", "correct": false}, {"label": "B", "text": "Leukocyte reduction, especially pre-storage, can reduce FNHTR occurrence.", "correct": false}, {"label": "C", "text": "Occurs during or within 4 hrs after transfusion.", "correct": false}, {"label": "D", "text": "Premedication with antipyretics is effective at preventing FNHTR", "correct": true}], "correct_answer": "D. Premedication with antipyretics is effective at preventing FNHTR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Read the following statements regarding electrolyte abnormalities following massive blood transfusion and select the correct answer: Statement 1: Hyperkalemia can occur after a massive blood transfusion, especially with prolonged storage, due to potassium release from lysed red blood cells. Statement 2: Hypocalcemia is common after massive blood transfusion due to citrate binding calcium and reducing ionized calcium levels. Statement 3: Hyperphosphatemia may develop post-transfusion, especially in renal insufficiency, leading to calcium phosphate precipitation and worsened hypocalcemia. Statement 4: Fresh blood transfusion may cause citrate toxicity, raising pH (alkalosis), which shifts potassium into cells, resulting in hypokalemia.", "options": [{"label": "A", "text": "1, 2 and 3 correct", "correct": false}, {"label": "B", "text": "Only 1 and 2 correct", "correct": false}, {"label": "C", "text": "2, 3 and 4 correct", "correct": false}, {"label": "D", "text": "All are correct", "correct": true}], "correct_answer": "D. All are correct", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman receives a transfusion of red blood cells to treat severe anemia following surgery. Within an hour of the transfusion, she develops a high fever, chills, and hypotension. The healthcare team suspects a transfusion-related infection. Which of the following is false about the precautions taken to prevent this?", "options": [{"label": "A", "text": "Blood donations are tested for infectious agents", "correct": false}, {"label": "B", "text": "Active surveillance programs are essential for identifying new infectious risks", "correct": false}, {"label": "C", "text": "Donor reports of fever lead to quarantine of the blood products collected", "correct": false}, {"label": "D", "text": "All bacterial spores and viruses are removed by the pathogen-mitigating processes", "correct": true}], "correct_answer": "D. All bacterial spores and viruses are removed by the pathogen-mitigating processes", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:353px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Bacteria </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pyogenic bacteria</li>\n<li>Treponema pallidum(syphilis)</li>\n<li>Yersinia (even at 4℃)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Virus </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HIV-1/2</li>\n<li>HBV</li>\n<li>HCV</li>\n<li>HTLV-1/2</li>\n<li>HEVCMV</li>\n<li>Parvovirus B-19</li>\n<li>West Nile virus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Parasite </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Plasmodium (malaria)<br/>\n\t\t\t\tBabesia</li>\n<li>Trypanosoma cruzi (Chagas disease)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old female receives a blood transfusion for anemia. 12 hours after the transfusion, she develops dyspnea, hypoxia, and following findings on chest X-ray (see image below). Her vitals , ABG and BNP are as follows: Vitals Blood pressure: 160/90 mmHg Heart rate: 98 bpm Respiratory rate: 22 bpm Temperature: 37.2°C Oxygen saturation: 88% on room air ABG pH: 7.38 pCO2: 32 mmHg pO2: 65 mmHg HCO3: 24 mEq/L BNP 1,100 pg/mL What preventive measure could have avoided this complication?", "options": [{"label": "A", "text": "Using leukoreduced blood products", "correct": false}, {"label": "B", "text": "Pre-transfusion administration of antihistamines", "correct": false}, {"label": "C", "text": "Administering diuretics and slowing the transfusion rate", "correct": true}, {"label": "D", "text": "Ensuring HLA-matching for future transfusions", "correct": false}], "correct_answer": "C. Administering diuretics and slowing the transfusion rate", "question_images": ["https://image.prepladder.com/notes/hNznOp0YQ1qRwH45u0M71744708451.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:730px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Transfusion Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Transfusion-Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury (TRALI)</strong><strong> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Transfusion-associated <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> (TACO)</strong><strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by the onset or worsening of <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> and noncardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema.</li>\n<li>Occurs during or within 6 hours after transfusion.</li>\n<li>Delayed cases can happen up to 72 hours later.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occur after <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> of red blood cells or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> products in 1% to 8.9% of transfusions.</li>\n<li>Has become the leading cause of transfusion-related deaths</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes/Risk Factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transfusion of donor <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> containing:\n\t\t\t\t<ul>\n<li>Anti-HLA class II antibodies</li>\n<li>Anti-HLA class I antibodies</li>\n<li>Anti-human <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">neutrophil</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (HNA) antibodies</li>\n</ul>\n</li>\n<li>Can also occur through mechanisms involving cytokines and chemokines without HLA-mediated interaction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Older age</li>\n<li>Renal failure</li>\n<li>Preexisting fluid overload</li>\n<li>Cardiac dysfunction</li>\n<li>Administration of a large volume of blood components</li>\n<li>Excessive <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> rate beyond the patient's <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> tolerance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oxygen <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> &lt;90% or PaO2/FiO2 ≤ 300 mmHg</li>\n<li>Chest X-ray: <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> infiltrates</li>\n<li>No signs of <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> overload</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypoxia, dyspnea</li>\n<li>Systolic hypertension</li>\n<li>Left heart failure</li>\n<li>Pulmonary edema</li>\n<li>Increased central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"76ae7252af169277718371dee6d3cf\">brain <span class=\"customMeta\" data-dictid=\"bd16654d3e169277719371077d7a8c\">natriuretic</span> peptide</span> (BNP)</li>\n<li>Chest X-ray: <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> alveolar infiltrates</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transfusion of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> and <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> concentrate from:</p>\n<ul>\n<li>Male donors or <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> females.</li>\n<li>Parous female donors without anti-HLA antibodies.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Identify at-risk patients.</li>\n<li>Close monitoring and slow <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> rates, 1 <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> concentrate over 3-4 hours.</li>\n<li>Diuretics for hemodynamically stable patients with a history of TACO.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supportive measures such as oxygen or <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> support for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> and hypoxia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stopping the transfusion</li>\n<li>Administering oxygen</li>\n<li>Diuretics</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with a history of acute myeloid leukemia undergoes an allogeneic hematopoietic stem cell transplant. Ten days after receiving a transfusion of red blood cells from a related donor, he develops a fever and following finding.Laboratory tests show a WBC count of 2,000/µL, and platelets of 40,000/µL. Liver function tests reveal AST (120 U/L), ALT (110 U/L), and total bilirubin (4.0 mg/dL). Based on these findings, the most likely diagnosis is:", "options": [{"label": "A", "text": "Acute hemolytic transfusion reaction", "correct": false}, {"label": "B", "text": "Graft-versus-host disease (GVHD)", "correct": true}, {"label": "C", "text": "Transfusion-associated circulatory overload (TACO)", "correct": false}, {"label": "D", "text": "Allergic transfusion reaction", "correct": false}], "correct_answer": "B. Graft-versus-host disease (GVHD)", "question_images": ["https://image.prepladder.com/notes/wktzaGD2lYkdD2bMkcG01744707995.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with chronic anemia receives a blood transfusion. After 12 hours of transfusion, he develops fever, chills, chest pain, and dark urine. On examination BP 90/60 mmHg, heart rate 120 bpm, and temperature 101°F. Lab tests reveal hemoglobinemia, elevated LDH, and a positive direct antiglobulin test. What is the most likely diagnosis for this patient’s condition?", "options": [{"label": "A", "text": "Anaphylactic transfusion reaction", "correct": false}, {"label": "B", "text": "Delayed hemolytic transfusion reaction", "correct": false}, {"label": "C", "text": "Acute hemolytic transfusion reaction", "correct": true}, {"label": "D", "text": "Transfusion-associated circulatory overload", "correct": false}], "correct_answer": "C. Acute hemolytic transfusion reaction", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman with no prior transfusion history receives fresh frozen plasma. Within minutes of starting the transfusion, she develops acute bronchospasm, hypotension, and severe respiratory distress. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hemolytic Transfusion Reaction", "correct": false}, {"label": "B", "text": "Anaphylactic Transfusion Reaction", "correct": true}, {"label": "C", "text": "Transfusion-Related Acute Lung Injury", "correct": false}, {"label": "D", "text": "Febrile Nonhemolytic Transfusion Reaction", "correct": false}], "correct_answer": "B. Anaphylactic Transfusion Reaction", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male patient presents with severe trauma following a road traffic accident. He was transfused with 5 units of packed red blood cells (PRBCs) within an hour as part of the resuscitation efforts. A few hours later, he develops the following sign when a blood pressure cuff is inflated. His ECG showed QT prolongation. What is the most likely cause of his symptoms?", "options": [{"label": "A", "text": "Coagulopathy", "correct": false}, {"label": "B", "text": "Hyperkalemia", "correct": false}, {"label": "C", "text": "Citrate toxicity", "correct": true}, {"label": "D", "text": "Metabolic alkalosis", "correct": false}], "correct_answer": "C. Citrate toxicity", "question_images": ["https://image.prepladder.com/notes/Qw0fGDfTJz5kI5Rgeo4o1744707593.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:765px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prevention/ Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypothermia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transfusion of <strong>cold blood </strong>(stored at 4°C).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Body temperature drops, leading to impaired <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> mechanisms <strong>(coagulopathy), worsening bleeding.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Warm blood products before transfusion</li>\n<li><strong>Use external warming methods</strong> (e.g., warming blankets).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coagulopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilution of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors and platelets due to transfusion; consumption of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors by ongoing hemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired blood clotting, prolonged <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> time, increased risk of continued bleeding.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Administer <span class=\"customMeta\" data-dictid=\"0339123c621692777203964a9056bb\">fresh frozen plasma</span> (FFP), platelets, cryoprecipitate.</strong></li>\n<li>For massive BT, blood products should be administered in 1:1:1 ratio.</li>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors (e.g., PT, aPTT).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Citrate Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Large volumes of transfused blood contain citrate</strong>, which binds to calcium.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypocalcemia</strong>, leading to muscle cramps, seizures, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administer <strong>calcium <span class=\"customMeta\" data-dictid=\"ff3235f97616927771884121a800e7\">gluconate</span> or <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> chloride</strong> prophylactically.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potassium leaks from stored red blood cells into <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels (hyperkalemia) can cause<strong> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, potentially leading to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels.</li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> to stabilize the myocardium.</li>\n<li>Insulin with <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> to shift <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> intracellularly if needed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypokalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potassium may shift intracellularly once transfused red blood cells are metabolically revived.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypokalemia, causing muscle weakness, paralysis, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitor <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels and provide <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> supplements as necessary.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rapid <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> into bicarbonate.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased pH (alkalosis)</strong> can lead to muscle twitching, irritability, and impaired oxygen release from hemoglobin.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gases (ABG)</li>\n<li>Adjust <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> speed and, if necessary, reduce <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> levels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inadequate tissue <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> leading to <strong>lactic acid accumulation.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lowered blood pH (acidosis)</strong> leads to confusion, fatigue, rapid breathing, and worsened <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Correct underlying cause (e.g., improve perfusion).</li>\n<li>Administer sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> in severe cases of acidosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transfusion Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury (TRALI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibodies in transfused blood <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> recipient's immune response,</strong> causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fluid buildup in the lungs.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema,</strong> presenting as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> with <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> within 6 hours of transfusion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate cessation of transfusion.</li>\n<li>Oxygen therapy and <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">mechanical ventilation</span> if necessary.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transfusion Associated <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">Circulatory</span> <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (TACO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Volume of transfused blood exceeds the patient’s capacity to manage, leading to <strong>fluid overload.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary edema</strong>, shortness of breath, hypertension, and signs of heart failure.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer diuretics (e.g., furosemide).</li>\n<li>Slow the rate of transfusion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iron Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Repeated transfusions</strong> lead to excessive accumulation of iron.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iron deposits in organs</strong> (e.g., liver, heart, pancreas), leading to organ damage and <strong>failure over time.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administer iron chelators <strong>(e.g., deferoxamine, deferasirox).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemolytic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ABO or Rh incompatibility.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rapid destruction of red blood cells (hemolysis),</strong> causing fever, chills, hemoglobinuria, and potentially <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure or shock.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immediate cessation of transfusion.</strong></li>\n<li>Supportive care with IV fluids.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Allergic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reaction to proteins</strong> in transfused blood products.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms range from mild itching, rash, or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> to severe <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">anaphylaxis</span> (airway constriction, low blood pressure, shock).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer <strong>antihistamines</strong> for mild reactions.</li>\n<li><strong>Corticosteroids and <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> </strong>for severe reactions like anaphylaxis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bacterial Contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood products contaminated during collection or storage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sepsis, characterized by fever, chills, low blood pressure, and possibly <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate cessation of transfusion.</li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the right sequence of platelet-rich plasma method?", "options": [{"label": "A", "text": "Whole blood ➞ Light spin ➞ RBC concentrate + PRP ➞ Heavy spin ➞ Platelets + Plasma", "correct": true}, {"label": "B", "text": "Whole blood ➞ Heavy spin ➞ RBC concentrate + PRP ➞ Light spin ➞ Platelets + Plasma", "correct": false}, {"label": "C", "text": "Whole blood ➞ Heavy spin ➞ PRBC + Plasma + Buffy coat ➞ Light spin ➞ Platelets", "correct": false}, {"label": "D", "text": "Whole blood ➞ Light spin ➞ PRBC + Plasma + Buffy coat ➞ Heavy spin ➞ Platelets", "correct": false}], "correct_answer": "A. Whole blood ➞ Light spin ➞ RBC concentrate + PRP ➞ Heavy spin ➞ Platelets + Plasma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/WwTtGVyeMea9gAiuGGYR1744706477.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>PRP method </strong><strong>(vs Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Buffy coat method </strong><strong>(Option C &amp; D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Whole blood</p>\n<p><strong>￬</strong></p>\n<p>Light spin</p>\n<p><strong>￬</strong></p>\n<p>RBC concentrate + PRP</p>\n<p><strong>￬</strong></p>\n<p>Heavy spin</p>\n<p><strong>￬</strong></p>\n<p><strong>Platelets + <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Whole blood</p>\n<p><strong>￬</strong></p>\n<p>Heavy spin</p>\n<p><strong>￬</strong></p>\n<p>PRBC + <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> + <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">Buffy</span> coat (platelets, WBC)</p>\n<p><strong>￬</strong></p>\n<p>Light spin</p>\n<p><strong>￬</strong></p>\n<p><strong>Platelets </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a study of ABO blood groups, researchers focus on the enzyme activities associated with the A and B phenotypes. Which of the following statements is true regarding the enzymes involved in the ABO blood group system?", "options": [{"label": "A", "text": "Both A-transferase and B-transferase are encoded by the O allele.", "correct": false}, {"label": "B", "text": "A-transferase adds N-acetylgalactosamine to the H antigen, while B-transferase adds galactose.", "correct": true}, {"label": "C", "text": "The H antigen is produced by the O allele alone.", "correct": false}, {"label": "D", "text": "The Bombay phenotype is characterized by active A-transferase and B-transferase enzymes.", "correct": false}], "correct_answer": "B. A-transferase adds N-acetylgalactosamine to the H antigen, while B-transferase adds galactose.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phenotype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antigen Present</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Transferase Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sugar Added</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>H <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">Antigen</span> Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Genotype</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A-transferase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N-acetylgalactosamine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (modified)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AA or AO</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B-transferase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Galactose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (modified)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BB or BO</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A &amp; B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both A &amp; B -transferase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N-acetylgalactosamine &amp; Galactose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (modified)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>O</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>inactive enzyme</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>H <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> remains unmodified</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (unmodified)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>OO</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Protein Blood Groups</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rh System:</strong></p>\n<ul>\n<li>The Rh system (formerly \"Rhesus\") is specific to humans, meaning <span class=\"customMeta\" data-dictid=\"f5f07a3262169277718915163d31e3\">immunization</span> occurs only through <span class=\"customMeta\" data-dictid=\"812d0ddedb1692777181aaf62743b1\">allogeneic</span> exposure (e.g., <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> or pregnancy).\n\t\t\t\t<ul>\n<li>Abs produced in response to Rh antigens are termed \"immune\" or \"irregular,\" as their production is variable.</li>\n<li>The Rh system has 56 antigens, with the most <span class=\"customMeta\" data-dictid=\"b3c8b5ea2e169277718969e2c05fae\">immunogenic</span> being<strong> RhD (RH1)</strong>. <strong>RhD <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> </strong>presence<strong> indicates Rh-positive</strong> status, while its absence denotes Rh-negative.</li>\n<li>The RhD gene (RH<em>D) and RhCE gene (RH</em>CE) located on <strong>chromosome 1 </strong>determine eight main haplotypes (e.g., DCe, Dce).</li>\n<li>Identifying weak or partial RhD expression is crucial, especially in women of childbearing age and heavily transfused patients.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kell System:</strong></p>\n<ul>\n<li>Kell includes the<strong> K <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (KEL1)</strong>, whose absence leads to the <strong>McLeod phenotype</strong>, associated with acanthocytosis, muscle dystrophy, and shortened <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> survival.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duffy System:</strong></p>\n<ul>\n<li>The Duffy system has five antigens, with<strong> Fya (FY1) </strong>and<strong> Fyb (FY2)</strong> being routinely tested.</li>\n<li>The<strong> Fy(a–b–) phenotype</strong>, common in individuals of African ancestry, is associated with <strong>resistance</strong> to <strong>Plasmodium vivax malaria</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Others:</strong></p>\n<ul>\n<li><strong>Kidd System</strong></li>\n<li><strong>MNS System</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female who recently underwent a solid organ transplant is about to receive a red blood cell transfusion. She is at high risk for transfusion-transmitted cytomegalovirus (CMV) infection. Which of the following measures can reduce her risk of CMV transmission during transfusion?", "options": [{"label": "A", "text": "Blood irradiation", "correct": false}, {"label": "B", "text": "Use of a diversion pouch", "correct": false}, {"label": "C", "text": "Use of leukoreduction filter", "correct": true}, {"label": "D", "text": "Using washed red blood cells", "correct": false}], "correct_answer": "C. Use of leukoreduction filter", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YprKRhVI94y5qaKNv4Gf1744707178.png", "https://image.prepladder.com/notes/XjsOLd71mXiVypcExGc31745645356.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Leukocyte filter </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Leukocyte filter labelled\" data-author=\"\" data-hash=\"10366\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"406\" src=\"https://image.prepladder.com/notes/YprKRhVI94y5qaKNv4Gf1744707178.png\" width=\"406\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Leukoreduction is a process in which the WBCs are intentionally <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by almost 99.99% in <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> concentrates.</li>\n<li>Decrease the WBCs to &lt; 1-5×106.</li>\n<li><strong>Filtration Mechanisms</strong>:\n\t\t\t\t<ul>\n<li><strong>Mechanical <span class=\"customMeta\" data-dictid=\"025e317c8116927771870f34a94b56\">Entrapment</span> (Sieving)</strong>: Based on <span class=\"customMeta\" data-dictid=\"7cff82458316927771965eba1af4db\">pore</span> size and cell deformability.</li>\n<li><strong>Physical-Chemical <span class=\"customMeta\" data-dictid=\"025e317c8116927771870f34a94b56\">Entrapment</span> (Adhesion)</strong>: Involves <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">adherence</span> of cells to the filter surface.</li>\n</ul>\n</li>\n<li><strong>Uses of <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">Leukocyte</span> Removal Filters</strong></li>\n</ul>\n<p>It <strong>reduces complications</strong> associated with transfused white blood cells that are contained in units of red blood cells and platelets.</p>\n<ul>\n<li>These complications include:\n\t\t\t\t<ul>\n<li>Nonhemolytic <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">Febrile</span> <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">Transfusion</span> Reactions <strong>(NHFTRs)</strong>.</li>\n<li><strong>Alloimmunization</strong> and <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> refractoriness.</li>\n<li>Transfusion-transmitted infections, such as <strong>cytomegalovirus</strong> (CMV). <strong>(Option C)</strong></li>\n<li><strong>Immunomodulation </strong>risks from transfusions.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diversion <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> is attached to a primary collection bag, <strong>diverting the first 10–30 mL of blood</strong> into the pouch.</li>\n<li>This prevents the initial <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> from entering the primary bag, which can<strong> reduce the risk of bacterial contamination</strong>.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"Diversion pouch\" data-author=\"\" data-hash=\"11330\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/XjsOLd71mXiVypcExGc31745645356.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman undergoing chemotherapy is found to have neutropenia with an absolute neutrophil count of 50 cells/μL and has developed a severe bacterial infection. What is the most appropriate component therapy for her?", "options": [{"label": "A", "text": "Whole Blood", "correct": false}, {"label": "B", "text": "Granulocyte Concentrates", "correct": true}, {"label": "C", "text": "Donor Mononuclear Cells", "correct": false}, {"label": "D", "text": "Cryoprecipitate", "correct": false}], "correct_answer": "B. Granulocyte Concentrates", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:735px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dosage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Therapeutic Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Efficacy Evaluation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Whole Blood </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repeated per clinical status</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute hypovolemic <span class=\"customMeta\" data-dictid=\"09376c06ef16927771848108fd8f70\">coagulopathy</span> requiring massive transfusion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normovolemia, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> resolution.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multicomponent (RBCC, PC, Plasma)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 RBCC/1 plasma/0.25 PC ratio, repeated as needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute hypovolemic <span class=\"customMeta\" data-dictid=\"09376c06ef16927771848108fd8f70\">coagulopathy</span> requiring massive transfusion.</li>\n<li><strong>RBCC:Plasma: Platelets = 1:1:0.25</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normovolemia; <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> resolution.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulocyte Concentrates </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1–2 × 10¹⁰, repeated per clinical status</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> bacterial or fungal infection with<strong> neutropenia</strong> <strong>&lt;100 cells/μL </strong>.</li>\n<li>Dysfunctional granulocytes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection resolution or <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> until recovery from neutropenia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Donor <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">Mononuclear</span> Cells </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10⁵–10⁷ T lymphocytes/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relapse of <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"954a8c7cbb1692777188d27052b230\">hemopathy</span> after <span class=\"customMeta\" data-dictid=\"812d0ddedb1692777181aaf62743b1\">allogeneic</span> <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> cell transplantation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disease-specific <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> achieved.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryoprecipitate </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10–15 mL/unit, pool of 4–5 units</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> coagulopathy.</li>\n<li>Type II or <span class=\"customMeta\" data-dictid=\"adcadb82091692777201d084ed114c\">type III</span> von Willebrand disease.</li>\n<li>Hemophilia A (when <span class=\"customMeta\" data-dictid=\"65dc2273b5169277720208ba704b7f\">factor VIII</span> concentrates are unavailable).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">fibrinogen</span> (0.3–1 g/L).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman with a history of thrombocytopenia due to Thrombotic Thrombocytopenic Purpura (TTP) presents with severe bleeding. She has a platelet count of 10,000/μL. What is the best approach for managing her condition?", "options": [{"label": "A", "text": "Administer Platelet Concentrates immediately.", "correct": false}, {"label": "B", "text": "Initiate plasma exchange therapy.", "correct": true}, {"label": "C", "text": "Transfuse RBCC to manage hypoxia.", "correct": false}, {"label": "D", "text": "Administer Fresh Frozen Plasma (FFP).", "correct": false}], "correct_answer": "B. Initiate plasma exchange therapy.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:748px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dosage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Therapeutic Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Efficacy Evaluation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red Blood Cell Concentrate (RBCC) </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 unit (250–350 mL), repeated as needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For treating and preventing <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> and tissue ischemia.</li>\n<li>Hb thresholds are<strong> &lt; 7 g/dL</strong> for stable patients</li>\n<li>Orthopedic and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> surgery (Hb &lt; 8 g/dL)</li>\n<li>Preexisting <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease (Hb &lt; 8 g/dL)</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> disease patients (Hb &lt; 9-10 g/dL)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hb increase (+1 g/dL) and <span class=\"customMeta\" data-dictid=\"2e114d4cdc169277718882a0a01076\">hematocrit</span> (+3%)</li>\n<li>Reduction in anemia-related symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBC Exchange</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>25–30 mL/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anemia/sickle cell crisis in hemoglobinopathies (sickle cell disease, thalassemia).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced percentage of <span class=\"customMeta\" data-dictid=\"81bb02697216927771887f2fffc386\">HbS</span> in sickle cell disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Platelet Concentrates (PCs) </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5–0.7 × 10¹⁰ platelets/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thrombocytopenia-related <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders.</li>\n<li>Platelet count ≤5000/μL in the absence of fever or infection.</li>\n<li>≤10,000/μL - 20,000/μL in presence of fever or infection.</li>\n<li>≤50,000/μL if surgery, DIC, endoscopy, <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> procedures;</li>\n<li>≤80,000/μL if <span class=\"customMeta\" data-dictid=\"51854cacc3169277719381fc218b05\">neurosurgery</span> or eye surgery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention &amp; resolution of bleeding.</li>\n<li>Count <span class=\"customMeta\" data-dictid=\"a9838acc3316927771903ae9e67514\">increment</span> ≥10 × 10⁹/L within 1 hour.</li>\n<li>≥7.5 × 10⁹/L within 24 hours after transfusion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma (Thawed Frozen) </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10–15 mL/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coagulation factor-related <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders; <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> hypovolemic coagulopathy;</li>\n<li>Infectious disease treatment (e.g., <span class=\"customMeta\" data-dictid=\"f61d3f005e1692777185603561c35e\">convalescent</span> plasma).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorder.</li>\n<li>Infection resolution.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma Exchange </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>45–60 mL/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Removal of <span class=\"customMeta\" data-dictid=\"aab99c76cb16927771946daf9e4dbf\">pathogenic</span> antibodies and <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> supplementation. Ex: <strong>TTP, GBS.</strong></li>\n<li>Anti-HLA <span class=\"customMeta\" data-dictid=\"c087dfa48f1692777180b90ca2237f\">Ab</span> removal prior to <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplantation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Improved disease-specific symptomatology.</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"c087dfa48f1692777180b90ca2237f\">Ab</span> levels prior to transplantation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female patient with severe COVID-19 is admitted to the ICU. To help manage her condition, the medical team decides to administer convalescent plasma from a recovered patient with high levels of antibodies. The plasma is collected using a method that selectively collects plasma while returning other blood components to the donor. Which technique was used to collect the plasma?", "options": [{"label": "A", "text": "Hemodialysis", "correct": false}, {"label": "B", "text": "Apheresis", "correct": true}, {"label": "C", "text": "Hemofiltration", "correct": false}, {"label": "D", "text": "Therapeutic phlebotomy", "correct": false}], "correct_answer": "B. Apheresis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/sYKXUvFaLi96YDDPIRVB1744706968.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indications for Separation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plasmapheresis, treatment of <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases (e.g., <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">myasthenia</span> gravis, lupus) and <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> proteins (e.g., <span class=\"customMeta\" data-dictid=\"e8716e1e311692777189738429bab5\">hyperviscosity</span> syndrome).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Platelets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collection for transfusion, especially in patients with low <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> counts (e.g., leukemia, chemotherapy).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red Blood Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythrocytapheresis for conditions like sickle cell disease and management of <span class=\"customMeta\" data-dictid=\"7fd466a9c016927771962d5b061b0f\">polycythemia</span> vera.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>White Blood Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leukapheresis to reduce high <span class=\"customMeta\" data-dictid=\"57176262ed169277720233ee0ceb2a\">white blood cell</span> counts in leukemias or <span class=\"customMeta\" data-dictid=\"42937950901692777191ff3611c9ae\">lymphoproliferative</span> disorders.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient with a history of bacterial sepsis receives granulocyte concentrate transfusion as part of their treatment. Shortly after the transfusion, the patient develops fever, skin rash and jaundice consistent with graft-versus-host disease (GVHD). Which of the following procedures during the preparation of the granulocyte concentrate was most likely compromised?", "options": [{"label": "A", "text": "Leukoreduction", "correct": false}, {"label": "B", "text": "Pathoreduction", "correct": false}, {"label": "C", "text": "Apheresis", "correct": false}, {"label": "D", "text": "Irradiation", "correct": true}], "correct_answer": "D. Irradiation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Collection of <span class=\"customMeta\" data-dictid=\"60d609888b169277720258496ef45a\">Whole Blood</span> or Apheresis (Option C ruled out)</strong><br/>\n\t\t\tGranulocyte concentrates can be obtained either through <span class=\"customMeta\" data-dictid=\"60d609888b169277720258496ef45a\">whole blood</span> collection or by apheresis.</p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"3f66b7db761692777181a352f4ddda\">apheresis</span> method selectively extracts granulocytes, enhancing the yield and quality of the concentrate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Speed <span class=\"customMeta\" data-dictid=\"af7c8043d01692777184863feb6c5f\">Centrifugation</span> (Hard Spin)</strong><br/>\n\t\t\tThe collected blood is subjected to high-speed centrifugation, which separates it into three distinct layers based on density:</p>\n<ul>\n<li><strong>Packed Red Blood Cells (RBCs): </strong>This forms the bottom layer.</li>\n<li><strong>Plasma: </strong>The top layer contains proteins, electrolytes, and waste products.</li>\n<li><strong>Buffy Coat:</strong> The middle layer, rich in leukocytes, including granulocytes, is collected for further processing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isolation of the <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">Buffy</span> Coat </strong><br/>\n\t\t\tThe <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">buffy</span> coat is carefully extracted, which contains the concentrated <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> population, primarily granulocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Buffy Coat High-Speed Centrifugation</strong><br/>\n\t\t\tThe isolated <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">buffy</span> coat undergoes a second round of high-speed centrifugation. This step further concentrates the granulocytes and separates them from other leukocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Irradiation </strong><strong>(Mandatory) (Option D)</strong><br/>\n\t\t\tThe <span class=\"customMeta\" data-dictid=\"012606e9991692777188e51bdaf9fd\">granulocyte</span> concentrate is then irradiated at a dose of 25-35 Gy. This step is essential to prevent transfusion-associated graft-versus-host disease (TA-GVHD).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leukoreduction (Option A ruled out)</strong><br/>\n\t\t\tFinally, <span class=\"customMeta\" data-dictid=\"9fdd74890516927771914df0cd3fa7\">leukoreduction</span> is performed on the <span class=\"customMeta\" data-dictid=\"012606e9991692777188e51bdaf9fd\">granulocyte</span> concentrate to minimize the risk of <span class=\"customMeta\" data-dictid=\"6eec2212b91692777189b54f3d9066\">immunological</span> complications in the recipient.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogen Reduction (Optional) (Option B ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following Blood products with its shelf life? Blood products Shelf life a) Whole Blood 1) 35-42 days b) Red Blood Cells (RBCs) 2) 5-7 days c) Platelets 3) 21-35 days d) Fresh Frozen Plasma (FFP) 4) 1 year", "options": [{"label": "A", "text": "a-1; b-2; c-3; d-4", "correct": false}, {"label": "B", "text": "a-4; b-2; c-3; d-1", "correct": false}, {"label": "C", "text": "a-3; b-1; c-2; d-4", "correct": true}, {"label": "D", "text": "a-2; b-3; c-4; d-1", "correct": false}], "correct_answer": "C. a-3; b-1; c-2; d-4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blood Product</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Storage Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Shelf Life</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Whole Blood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-6°C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>21-35 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Red Blood Cells (RBCs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-6°C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preservative used:</p>\n<p>SAGM - 42 days</p>\n<p>CPDA - 35 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Platelets</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-24°C (with agitation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-7 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fresh Frozen <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> (FFP)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-18°C or lower</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 year</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cryoprecipitate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-18°C or lower</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 year</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Granulocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-24°C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prothrombin Complex Concentrate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-8°C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Factor VIII Concentrate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-8°C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-2 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Albumin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-30°C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 years</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Collection of Whole Blood</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Speed <span class=\"customMeta\" data-dictid=\"af7c8043d01692777184863feb6c5f\">Centrifugation</span> (Hard Spin)</strong></p>\n<p>Separates it into three distinct layers based on density:</p>\n<ul>\n<li><strong>Packed Red Blood Cells (RBCs)</strong> (bottom layer)</li>\n<li><strong>Plasma (top layer):</strong> Contains proteins, electrolytes, and waste products.</li>\n<li><strong>Buffy Coat </strong>(middle layer)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Collection of Plasma</strong></p>\n<p>The top layer (plasma) is extracted with minimal <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> from the <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">buffy</span> coat and packed RBCs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryopreservation</strong></p>\n<p>Plasma is typically frozen at -18°C or colder to maintain its stability and extend its shelf life. This process is often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as <span class=\"customMeta\" data-dictid=\"0339123c621692777203964a9056bb\">fresh frozen plasma</span> (FFP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deleucocytation (Optional)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogen Reduction (Optional)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After high-speed centrifugation of whole blood, from which layer can platelets be extracted?", "options": [{"label": "A", "text": "Upper layer", "correct": false}, {"label": "B", "text": "Middle layer", "correct": true}, {"label": "C", "text": "Bottom layer", "correct": false}, {"label": "D", "text": "Superficial floating layer", "correct": false}], "correct_answer": "B. Middle layer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Collection of Whole Blood</strong></p>\n<p>Blood is drawn into <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> bags with anticoagulants to prevent clotting. Each unit contains 450-500 mL.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Speed <span class=\"customMeta\" data-dictid=\"af7c8043d01692777184863feb6c5f\">Centrifugation</span> (Hard Spin)</strong></p>\n<p>Separates the blood into three distinct layers based on density:</p>\n<ul>\n<li><strong>Packed Red Blood Cells (RBCs) </strong>(bottom layer): Contains the majority of erythrocytes.</li>\n<li><strong>Plasma</strong> (top layer): Contains proteins, electrolytes, and waste products.</li>\n<li><strong>Buffy Coat</strong> (middle layer): Contains platelets and white blood cells (WBCs).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isolation of the <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">Buffy</span> Coat</strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">buffy</span> coat, rich in platelets and leukocytes, is carefully extracted to minimize <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> from the packed RBCs and plasma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Slow-Speed Centrifugation</strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">buffy</span> coat undergoes slow-speed <span class=\"customMeta\" data-dictid=\"af7c8043d01692777184863feb6c5f\">centrifugation</span> to separate the platelets from other blood components. This step allows for the concentration of platelets, which can be pooled from 4 to 6 ABO-identical units or obtained through apheresis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suspension in <span class=\"customMeta\" data-dictid=\"8fabe131a916927771802a448a329c\">Additive</span> Solution</strong></p>\n<p>The platelets are diluted in an <span class=\"customMeta\" data-dictid=\"8fabe131a916927771802a448a329c\">additive</span> solution to reduce the chances of post-transfusion fever, a common reaction associated with <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> transfusions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leukoreduction/Deleucocytation</strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count is <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> to less than 1-5 x 10⁶ leukocytes/unit.</p>\n<p><strong>Purpose:</strong></p>\n<ul>\n<li>Reduces the risk of post-transfusion fever.</li>\n<li>Minimizes the presence of <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> pathogens.</li>\n<li>Lowers the risk of alloimmunization.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogen Reduction</strong></p>\n<p><strong>Methods:</strong></p>\n<ul>\n<li>UV Illumination</li>\n<li>Nucleic Acid Cross-Linker</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a recognized benefit of the procedure depicted in the image?", "options": [{"label": "A", "text": "Reduces febrile non-hemolytic transfusion reaction.", "correct": false}, {"label": "B", "text": "Minimizes the presence of cytomegalovirus.", "correct": false}, {"label": "C", "text": "Minimizes alloimmunization.", "correct": false}, {"label": "D", "text": "Extends shelf life.", "correct": true}], "correct_answer": "D. Extends shelf life.", "question_images": ["https://image.prepladder.com/notes/EWELlJwX6Rp2hcq3OAGd1744706703.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:671px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Whole Blood Collection</strong></p>\n<p>Blood is drawn into <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> bags with anticoagulants to prevent clotting. Each unit contains 450-500 mL. (First 20-30 ml is discarded due to skin <span class=\"customMeta\" data-dictid=\"0af84af4761692777202fbf6914573\">flora</span> contamination)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Slow Speed <span class=\"customMeta\" data-dictid=\"af7c8043d01692777184863feb6c5f\">Centrifugation</span> (Soft Spin)</strong></p>\n<p>Separates <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">Red Blood Cell</span> Concentrate (RBCC) at the bottom and Platelet-Rich <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> (PRP) at the top, with the <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">buffy</span> coat (white blood cells) in between.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBCC Processing and <span class=\"customMeta\" data-dictid=\"8fabe131a916927771802a448a329c\">Additive</span> Solutions</strong></p>\n<p>After removing <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> and <span class=\"customMeta\" data-dictid=\"353a9bd0c61692777183ec2414d977\">buffy</span> coat, <span class=\"customMeta\" data-dictid=\"8fabe131a916927771802a448a329c\">additive</span> solutions like SAGM (Saline, Adenine, Glucose, Mannitol) or <span class=\"customMeta\" data-dictid=\"ff21381a7a1692777185cb873396da\">CPD</span> are added to preserve cell <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> and extend shelf life.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leukoreduction/ Deleucocytation</strong></p>\n<p>Achieved by filtering RBCC to remove &gt;99.9% of white blood cells.</p>\n<p><strong>Purpose:</strong></p>\n<ul>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> non-hemolytic <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reactions (FNHTR).</li>\n<li>Minimizes the presence of <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> pathogens [eg. <span class=\"customMeta\" data-dictid=\"ee831318721692777185479e65655e\">cytomegalovirus</span> (CMV)]</li>\n<li>Minimizes alloimmunization.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>Post-reduction <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> content: &lt;1–5 x 10⁶ leukocytes/unit.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Irradiation (Optional)</strong></p>\n<p>RBCC is irradiated with <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> or <span class=\"customMeta\" data-dictid=\"49be0416121692777188dc8944b7bc\">gamma</span> rays (25–35 Gy).</p>\n<p><strong>Purpose: </strong>Prevents graft-versus-host disease (GVHD) by inactivating donor lymphocytes.</p>\n<p><strong>Use:</strong> RBCC must be transfused within 24 hours post-irradiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma Reduction (Optional)</strong></p>\n<p>Plasma proteins are removed to prevent allergic or anaphylactic reactions.</p>\n<p><strong>Purpose: </strong>Useful for patients with a history of allergic <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reactions, reducing post-transfusion <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">anaphylaxis</span> risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryopreservation (Optional)</strong></p>\n<p>RBCC is cryopreserved at -80°C, mainly for rare blood types.</p>\n<p><strong>Purpose: </strong>Extends shelf life up to 30 years, increasing availability of rare blood groups.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 13 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Match the haematological malignancies with their predominant age group. 1. Acute Myeloid Leukemia a. Children 2. Acute Lymphoblastic Leukaemia b. Adolescent to middle-aged 3. Chronic Lymphocytic Leukaemia c. Middle age to elderly 4. Chronic Myeloid Leukaemia d. Elderly", "options": [{"label": "A", "text": "1-b, 2-a, 3-d, 4-c", "correct": true}, {"label": "B", "text": "1-a, 2-b, 3-c, 4-d", "correct": false}, {"label": "C", "text": "1-b, 2-a, 3-c, 4-d", "correct": false}, {"label": "D", "text": "1-a, 2-b, 3-d, 4-c", "correct": false}], "correct_answer": "A. 1-b, 2-a, 3-d, 4-c", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematological malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predominant age group</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">Myeloid</span> <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (AML)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adolescent to middle-aged</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute Lymphoblastic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (ALL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Children</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic Lymphocytic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (CLL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">Myeloid</span> <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (CML)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Middle age to elderly</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man presents with complaints of fatigue, weight loss, and generalized lymphadenopathy and splenomegaly. The patient gives a history of working in a factory with exposure to ionizing radiation 20 years ago. Laboratory tests reveal lymphocytosis, anemia, and thrombocytopenia. Which of the following haematological malignancies is least likely to be associated with his prior radiation exposure?", "options": [{"label": "A", "text": "Acute Myeloid Leukemia", "correct": false}, {"label": "B", "text": "Acute Lymphoblastic Leukemia", "correct": false}, {"label": "C", "text": "Chronic Lymphocytic Leukemia", "correct": true}, {"label": "D", "text": "Chronic Myeloid Leukemia", "correct": false}], "correct_answer": "C. Chronic Lymphocytic Leukemia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68 year old male presents with fatigue and unintentional weight loss. Physical examination reveals cervical lymphadenopathy and mild splenomegaly. Blood investigations show a white blood cell count of 75,000/µL with marked lymphocytosis. A peripheral blood smear reveals the following picture. Which of the following genetic alterations is frequently observed in this condition?", "options": [{"label": "A", "text": "Deletion of chromosome 13q14", "correct": true}, {"label": "B", "text": "A translocation involving chromosomes 9 and 22", "correct": false}, {"label": "C", "text": "A translocation involving chromosomes 8 and 14", "correct": false}, {"label": "D", "text": "Inversion of chromosome 16", "correct": false}], "correct_answer": "A. Deletion of chromosome 13q14", "question_images": ["https://image.prepladder.com/notes/X3RMlb3auaUBFQ2B0IIk1744401397.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cytogenetic abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gene mutations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overexpression</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Deletion of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 13q14</strong></li>\n<li><strong>Trisomy 12 </strong></li>\n<li><strong>Deletion of 11q </strong>(associated with aggressive disease in young patients)</li>\n<li><strong>Deletion of 17p</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>SF3B1</li>\n<li>NOTCH1</li>\n<li>MYD88</li>\n<li>ATM</li>\n<li>TP53</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>ZAP - 70</strong>\n<ul>\n<li>Intracellular Tyrosine kinase.</li>\n<li>Present usually inside the T cell.</li>\n<li>Aberrant expression in <span class=\"customMeta\" data-dictid=\"f8109755621692777184ae2847c580\">CLL</span> (B cells).</li>\n<li>ZAP-70 positive → Early treatment is recommended.</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>BCL 2</strong>\n<ul>\n<li>It inhibits apoptosis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following microRNAs is most commonly associated with the pathophysiology of chronic lymphocytic leukemia (CLL)?", "options": [{"label": "A", "text": "miR-34a", "correct": false}, {"label": "B", "text": "miR-21", "correct": false}, {"label": "C", "text": "miR-146a", "correct": false}, {"label": "D", "text": "miR15A/miR16A", "correct": true}], "correct_answer": "D. miR15A/miR16A", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 year old female presents with complaints of fatigue and recurrent infections over the past several months. On examination, there is generalized lymphadenopathy and mild splenomegaly. Blood tests revealed lymphocytosis and flow cytometry of peripheral blood showed the following findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Mantle Cell Lymphoma", "correct": false}, {"label": "B", "text": "Marginal Zone Lymphoma", "correct": false}, {"label": "C", "text": "Hodgkin’s Lymphoma", "correct": false}, {"label": "D", "text": "Chronic Lymphocytic Leukemia", "correct": true}], "correct_answer": "D. Chronic Lymphocytic Leukemia", "question_images": ["https://image.prepladder.com/notes/9EpRXIK9xFRBrXJwQBTi1744401845.png", "https://image.prepladder.com/notes/eK0b2iuxMcljDkyHYtmd1744401875.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD10</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD19</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD20</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD23</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cyclin D1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surface Ig</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CLL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ (dim)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ (dim)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mantle cell lymphoma</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Marginal zone lymphoma</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follicular lymphoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which staging system primarily assesses Chronic Lymphocytic Leukemia (CLL) based on the extent of lymphocytosis and the presence of lymphadenopathy, splenomegaly, and hepatomegaly?", "options": [{"label": "A", "text": "Binet Staging System", "correct": false}, {"label": "B", "text": "Rai Staging System", "correct": true}, {"label": "C", "text": "International Staging System", "correct": false}, {"label": "D", "text": "WHO Staging System", "correct": false}], "correct_answer": "B. Rai Staging System", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Involves</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only Lymphocytosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I/II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytosis with enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, with or without <span class=\"customMeta\" data-dictid=\"b3eb52fe3b1692777199de8465eea8\">splenomegaly</span> or hepatomegaly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>III/IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytosis along with anaemia or <span class=\"customMeta\" data-dictid=\"fc28c74bb716927772003aee4aa43c\">thrombocytopenia</span> due to <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> involvement.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:543px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Involves</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;3 areas of lymphadenopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥3 areas of lymphadenopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemoglobin ≤10 g/dL and/or platelets &lt;100,000/μL</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 67-year-old male with a history of chronic lymphocytic leukemia presents with sudden worsening of night sweats and unintentional weight loss. Laboratory investigations reveal elevated lactate dehydrogenase (LDH) levels and thrombocytopenia associated with a marked increase in lymphadenopathy. What is the most appropriate next step in management for this patient?", "options": [{"label": "A", "text": "Initiate treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen", "correct": false}, {"label": "B", "text": "Obtain an FDG-PET scan to guide further diagnostic workup.", "correct": true}, {"label": "C", "text": "Begin treatment with fludarabine, cyclophosphamide, and rituximab (FCR) regimen.", "correct": false}, {"label": "D", "text": "Start targeted therapy with ibrutinib for CLL", "correct": false}], "correct_answer": "B. Obtain an FDG-PET scan to guide further diagnostic workup.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Richter’s transformation refers to the <strong>transformation of <span class=\"customMeta\" data-dictid=\"f8109755621692777184ae2847c580\">CLL</span> into an aggressive lymphoma,</strong> most commonly <strong>Diffuse Large B-cell <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> (DLBCL),</strong> and can rarely include Hodgkin <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">Lymphoma</span> (HL).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bulky lymphadenopathy</li>\n<li>NOTCH1 mutations</li>\n<li>Del(17)(p13.1)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of adenopathy, often localized.</li>\n<li>Constitutional symptoms: fatigue, night sweats, fever, weight loss.</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> levels are common.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>18FDG-PET/CT</strong> scan is the first step to localize areas for biopsy.</li>\n<li><strong>Excisional biopsy</strong> is preferred; fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> is discouraged.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treatment decisions should be based on confirmed diagnosis and staging.</li>\n<li>DLBCL Richter’s transformation is usually treated with combination chemoimmunotherapy (e.g., <strong>R-CHOP</strong> or <strong>dose-adjusted EPOCH-R</strong>).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old female presents to the clinic with a history of easy bruising, petechiae, and recurrent episodes of mucosal bleeding. She reports feeling fatigued and weak for the past few weeks. Laboratory investigations reveal severe thrombocytopenia and hemolytic anaemia. Peripheral smear shows multiple spherocytes but no schistocytes. The direct antiglobulin test is positive. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Evans syndrome", "correct": true}, {"label": "B", "text": "Thrombotic thrombocytopenic purpura", "correct": false}, {"label": "C", "text": "HIV-related cytopenias", "correct": false}, {"label": "D", "text": "Occult malignancy", "correct": false}], "correct_answer": "A. Evans syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Evans syndrome</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thrombotic thrombocytopenic <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">purpura</span> (TTP)</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HIV-related cytopenias</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Occult malignancy</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patho-</strong></p>\n<p><strong>physiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune <strong>destruction of RBCs and platelets.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of <strong>platelet-rich thrombi</strong> in small blood vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various mechanisms include<strong> <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> suppression</strong>, <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <strong>destruction, or infections</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occult <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> is a less common cause of <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anaemia and thrombocytopenia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemolytic anaemia and thrombocytopenia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microangiopathic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anaemia, thrombocytopenia, <span class=\"customMeta\" data-dictid=\"c36bccf76e169277718712a7cc339f\">end-organ</span> damage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anaemia and/or <span class=\"customMeta\" data-dictid=\"fc28c74bb716927772003aee4aa43c\">thrombocytopenia</span> secondary to <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemolytic anaemia and <span class=\"customMeta\" data-dictid=\"fc28c74bb716927772003aee4aa43c\">thrombocytopenia</span> are less common presentations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coombs-positive <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anaemia</strong>, low <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count, f<strong>ragmented RBCs</strong> (schistocytes).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HIV serology.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occult <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> may have additional features suggestive of cancer, such as weight loss and lymphadenopathy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucocorticoids,</strong> <strong>rituximab</strong>, and <strong>mycophenolate mofetil</strong> are used.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma exchange, corticosteroids, rituximab.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management directed at <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection with <strong>antiretroviral therapy (ART) </strong>and supportive care.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment is directed at underlying malignancy, chemotherapy, and radiation therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male presents with fatigue, night sweats, and unintentional weight loss. On examination, generalized lymphadenopathy and hepatosplenomegaly are noted. Blood tests reveal a white blood cell count of 90,000/µL. Chronic lymphocytic leukemia (CLL) is suspected. Which of the following sets of findings is most likely to support the diagnosis?", "options": [{"label": "A", "text": "Lymphocytosis, thrombocytopenia, and bone marrow showing diffuse infiltration by small mature lymphocytes with expression of CD5 and CD19", "correct": true}, {"label": "B", "text": "Pancytopenia, blast cells on peripheral smear, and lymph node biopsy showing Reed-Sternberg cells", "correct": false}, {"label": "C", "text": "Thrombocytosis, neutrophilia, and bone marrow showing hypercellularity with increased myeloid precursors", "correct": false}, {"label": "D", "text": "Eosinophilia, basophilia, and bone marrow showing increased plasma cells with M protein spike", "correct": false}], "correct_answer": "A. Lymphocytosis, thrombocytopenia, and bone marrow showing diffuse infiltration by small mature lymphocytes with expression of CD5 and CD19", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete blood count</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Total <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count is elevated</li>\n<li>Decreased levels of hemoglobin</li>\n<li>Thrombocytopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral smear</strong></p>\n<figure class=\"caption_element\"><img alt=\"Peripheral &lt;span class=\" custommeta\"=\"\" data-dictid=\"6777533153169277719804fcbbf2d1\"/>smear CLL \" data-author=\"Prof. Erhabor Osaro\" data-hash=\"9706\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Chronic_Lymphocytic_Leukaemia_%28lymphocytosis_and_smear_cells%29.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1m6uChHS1j0TBhPPjMOK1744402364.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small lymphocytes with condensed <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> and <strong>scant cytoplasm</strong>.</li>\n<li>These <strong>mature-looking lymphocytes</strong> are highly fragile and can get disrupted in the process of making smears, known as <strong>smudge cells</strong>.</li>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia: Presence of <strong>spherocytes</strong>, to identify:\n\t\t\t\t<ul>\n<li>Normal RBC: Central pallor</li>\n<li>Spherocyte RBC: Central <span class=\"customMeta\" data-dictid=\"dd5d862f051692777194647422e1c9\">pallor</span> is absent (small)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> biopsy</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Diffuse <span class=\"customMeta\" data-dictid=\"dc0035cd191692777187b9b8b2af69\">effacement</span> of nodal architecture</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Flow <span class=\"customMeta\" data-dictid=\"551a62b1ec169277718587f847e627\">cytometry</span> (IOC)</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CD 19 positive</li>\n<li>CD 20 (dim) positive</li>\n<li>CD 23 positive</li>\n<li>CD 5 positive (It is a B cell tumor expressing the T cell marker)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man presents with fatigue, enlarged lymph nodes, and recurrent infections. Peripheral blood smear reveals lymphocytosis with smudge cells. Flow cytometry confirms the diagnosis of chronic lymphocytic leukaemia (CLL). As you assess his prognosis, which of the following factors would you consider as good prognostic indicators for CLL?", "options": [{"label": "A", "text": "Deletion of 13q14 chromosome", "correct": true}, {"label": "B", "text": "Unmutated Ig heavy chain", "correct": false}, {"label": "C", "text": "ZAP-70", "correct": false}, {"label": "D", "text": "Deletion of 17p chromosome", "correct": false}], "correct_answer": "A. Deletion of 13q14 chromosome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognostic Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Good Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bad Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cytogenetic Abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deletion of 13q14</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Deletion of 17p</strong> (poorest prognosis) <strong>(Option D ruled out)</strong></li>\n<li>Deletion of 11q</li>\n<li>NOTCH1 mutations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunoglobulin Heavy Chain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypermutated IGHV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unmutated IGHV (Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LDH Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Biomarkers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low β2-microglobulin levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High β2-microglobulin levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD38 expression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ZAP-70 (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>+</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old male presents with fatigue, unintentional weight loss, and enlarged lymph nodes. The patient is a known case of T2 DM under control with medications. Laboratory tests reveal lymphocytosis with a high percentage of mature lymphocytes. Flow cytometry confirms the presence of CD5, CD19, CD20, and CD23 positive B cells. What is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Fludarabine + Cyclophosphamide + Rituximab", "correct": false}, {"label": "B", "text": "Rituximab monotherapy", "correct": false}, {"label": "C", "text": "Ibrutinib + venetoclax + idelalisib", "correct": false}, {"label": "D", "text": "Chlorambucil + Obinutuzumab", "correct": true}], "correct_answer": "D. Chlorambucil + Obinutuzumab", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;65 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No comorbidities</li>\n<li>Chemotherapeutic drugs include <strong>FCR (Option A ruled out)</strong>.</li>\n<li>In older editions, it includes <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> (Pentostatin, Cyclophosphamide, and Rituximab)\n\t\t\t\t<ul>\n<li><strong>F: Fludarabine </strong>(DOC for Chronic lymphocytic leukemia)</li>\n<li><strong>C: Cyclophosphamide</strong></li>\n<li><strong>R: Rituximab</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt;65 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Comorbidities are present (Hypertension or DM, but HbA1C is well controlled)</li>\n<li>Chemotherapeutic drugs\n\t\t\t\t<ul>\n<li><strong>Chlorambucil</strong></li>\n<li><strong>Obinutuzumab</strong></li>\n</ul>\n</li>\n<li>Alternative drugs\n\t\t\t\t<ul>\n<li><strong>Bendamustine with Rituximab</strong></li>\n</ul>\n</li>\n<li>Antiapoptotic drug\n\t\t\t\t<ul>\n<li><strong>Venetoclax</strong></li>\n</ul>\n</li>\n<li>B cell drugs that act directly on B cell tumors</li>\n<li>B <span class=\"customMeta\" data-dictid=\"1713c93fa616927771845ec7ead9f9\">cell signaling</span> inhibitors specifically affect the cells of Chronic lymphocytic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> but don't cause damage to the adjacent cells present in the bone marrow</li>\n<li>Drugs include\n\t\t\t\t<ul>\n<li><strong>Ibrutinib</strong> (Bruton tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitor)</li>\n<li><strong>Idelalisib</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes the mechanism of action of alemtuzumab used in treating Chronic Lymphocytic Leukemia?", "options": [{"label": "A", "text": "Targets the CD20 antigen on B cells, leading to cell lysis.", "correct": false}, {"label": "B", "text": "Inhibits BCL-2, preventing apoptosis of CLL cells.", "correct": false}, {"label": "C", "text": "Binds to the CD52 antigen on lymphocytes, leading to complement-mediated cell lysis and antibody-dependent cytotoxicity.", "correct": true}, {"label": "D", "text": "Blocks the BTK signaling pathway, inhibiting B cell proliferation.", "correct": false}], "correct_answer": "C. Binds to the CD52 antigen on lymphocytes, leading to complement-mediated cell lysis and antibody-dependent cytotoxicity.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man with chronic lymphocytic leukemia presents with progressive fatigue, night sweats, and weight loss. Despite initiating appropriate treatment, the patient develops fever and respiratory distress. A CT scan of the chest shows bilateral infiltrates. His condition deteriorates rapidly, and he requires intensive care. Which of the following mechanisms most likely contributes to the leading cause of death in patients with CLL?", "options": [{"label": "A", "text": "T-cell dysfunction causing viral infections", "correct": false}, {"label": "B", "text": "Hypogammaglobulinemia increasing bacterial infections", "correct": true}, {"label": "C", "text": "Autoimmune hemolytic anemia causing organ failure", "correct": false}, {"label": "D", "text": "Richter transformation to aggressive lymphoma", "correct": false}], "correct_answer": "B. Hypogammaglobulinemia increasing bacterial infections", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 11 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 60-year-old male patient presents to his family physician with complaints of fatigue, malaise, and unintentional weight loss for the past 6 months. On examination, the patient appears pale, and there is splenomegaly. The blood picture reveals anaemia, leukocytosis, and basophilia. Upon suspicion, genetic testing was done, and a diagnosis was made. Which of the following is the underlying genetic defect in this condition?", "options": [{"label": "A", "text": "Translocation between chromosomes 12 and 21", "correct": false}, {"label": "B", "text": "Unbalanced translocation between the long arm of chromosomes 9 and 22", "correct": false}, {"label": "C", "text": "Deletion of chromosomes 11q, 13q, 17p", "correct": false}, {"label": "D", "text": "Balanced translocation between the long arms of chromosomes 9 and 22", "correct": true}], "correct_answer": "D. Balanced translocation between the long arms of chromosomes 9 and 22", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ubjfUdjgnTMSWByZT6yM1744697921.png", "https://image.prepladder.com/notes/Tu46dTeOSzd38UJYk3I81744698080.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding the genetic basis of Chronic Myeloid Leukemia (CML) is most accurate?", "options": [{"label": "A", "text": "The BCR-ABL fusion gene in CML results from a translocation involving chromosomes 15 and 17.", "correct": false}, {"label": "B", "text": "CML patients who progress to blast crisis often acquire mutations in the TP53 gene, leading to genomic instability.", "correct": true}, {"label": "C", "text": "The BCR-ABL fusion protein activates the JAK-STAT signalling pathway, contributing to leukemic cell proliferation in CML.", "correct": false}, {"label": "D", "text": "Resistance to tyrosine kinase inhibitors (TKIs) in CML is commonly associated with mutations in the BCR gene.", "correct": false}], "correct_answer": "B. CML patients who progress to blast crisis often acquire mutations in the TP53 gene, leading to genomic instability.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:743px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Genetic Abnormality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p><strong>Philadelphia <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">Chromosome</span> (Ph)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p>A <strong>reciprocal <span class=\"customMeta\" data-dictid=\"8ba7332e86169277720060bd4507c8\">translocation</span> between chromosomes 9 and 22 [t(9;22)]</strong>, resulting in the <strong>fusion of the BCR gene </strong>on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 22 with the<strong> ABL gene </strong>on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 9 <strong>(Option A ruled out).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p><strong>BCR-ABL <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">Fusion</span> Gene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p>The <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of BCR and ABL genes leads to a constitutively active tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (BCR-ABL) that promotes uncontrolled cell <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> and survival in CML.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p><strong>ABL <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> Domain Mutations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p>Mutations within the ABL <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> domain, particularly T315I, are associated with <strong>resistance to tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (TKIs)</strong> used in <span class=\"customMeta\" data-dictid=\"32c39405871692777184d06d6c01ab\">CML</span> treatment. <strong>(Option D ruled out).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p><strong>JAK-STAT <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">Signaling</span> Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p>Although not directly activated by BCR-ABL, <strong>JAK-STAT <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> dysregulation</strong> may contribute to <span class=\"customMeta\" data-dictid=\"32c39405871692777184d06d6c01ab\">CML</span> pathogenesis, including disease <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> and resistance. <strong>(Option C ruled out).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p><strong>TP53 Mutations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:middle\">\n<p><strong>Acquired mutations in TP53</strong>, common in <span class=\"customMeta\" data-dictid=\"c961b3ec6516927771831836e7f351\">blast crisis</span> CML, lead to genomic instability, <span class=\"customMeta\" data-dictid=\"5173f9c96716927771843cbe0c7611\">cell cycle</span> dysregulation, and aggressive disease behaviour.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with fatigue, weight loss and abdominal discomfort. On physical examination, the spleen is palpable 5 cm below the left costal margin, and there is mild tenderness in the left upper quadrant. Blood investigations reveal anaemia, leukocytosis, and basophilia. Which of the following features is not associated with this condition?", "options": [{"label": "A", "text": "Pruritus", "correct": false}, {"label": "B", "text": "Diarrhea", "correct": false}, {"label": "C", "text": "Increased NAP score", "correct": true}, {"label": "D", "text": "Left shift in differential count", "correct": false}], "correct_answer": "C. Increased NAP score", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age group </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>55-65 years or older.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fatigue, malaise, weight loss (10% in 6 months).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Splenomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early satiety, left upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain/mass.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thrombotic or hyperviscosity-related symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Priapism</li>\n<li>Cardiovascular complications</li>\n<li>Visual disturbances</li>\n<li>Dyspnea</li>\n<li>Pulmonary insufficiency</li>\n<li>Cerebrovascular complications</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding diathesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Retinal hemorrhage</li>\n<li>Gastrointestinal hemorrhage</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progression to accelerated or blast phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unexplained significant weight loss</li>\n<li>Severe fatigue</li>\n<li>Bone and joint pain</li>\n<li>Bleeding and thrombotic events</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basophilia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes excessive <span class=\"customMeta\" data-dictid=\"b5d4ddbfe71692777189a12acd5502\">histamine</span> production, leading to:</p>\n<ul>\n<li><strong>Pruritus </strong><strong>(Option A)</strong></li>\n<li><strong>Diarrhea </strong><strong>(Option B)</strong></li>\n<li>Flushing</li>\n<li>Gastrointestinal ulcers</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased <span class=\"customMeta\" data-dictid=\"dd4fbf70c41692777193f9cc6697e6\">NAP</span> score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"dd4fbf70c41692777193f9cc6697e6\">NAP</span> score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> <span class=\"customMeta\" data-dictid=\"ddeb334a351692777188795bb090ef\">hemoglobinuria</span> (PNH)</li>\n<li>Myelodysplastic syndrome</li>\n<li><strong>CML</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stress</li>\n<li>Infection</li>\n<li>Leukemoid reaction</li>\n<li>Pregnancy</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"8dd789d7d1169277719303d4744837\">myeloproliferative</span> disorders except CML</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with fatigue, malaise, weight loss, and swelling in the left upper quadrant of the abdomen. On evaluation, he was diagnosed with chronic myeloid leukaemia. Which of the following peripheral smears will be seen in this patient?", "options": [{"label": "A", "text": "No options available", "correct": true}], "correct_answer": "A. No options available", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/tMaEkozF09i4mVr2ZejF1744699736.png", "https://image.prepladder.com/notes/xO9bBDiLD6HaR3SOYTAG1744699860.png", "https://image.prepladder.com/notes/ED4K81uoq9nfgEIMFitY1744699964.png", "https://image.prepladder.com/notes/ozMPSWKh38SHq30wD11q1744700045.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cell </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myeloblast</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large cells with a round or <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> with dark <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> and no granules.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Segmented neutrophil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Has a <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> with 2-5 lobes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelocyte</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> and eccentrically placed.(D-shaped nuclei)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metamyelocyte</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Has a <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> bean-shaped nucleus.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male is diagnosed with chronic myeloid leukemia (CML). The oncologist is planning to monitor the patient’s response to treatment and check for the presence of the Philadelphia chromosome. What is the investigation of choice for confirming the diagnosis of CML and detecting the Philadelphia chromosome?", "options": [{"label": "A", "text": "Bone marrow examination", "correct": false}, {"label": "B", "text": "FISH (Fluorescence In Situ Hybridization)", "correct": true}, {"label": "C", "text": "Cytogenetic analysis (karyotyping)", "correct": false}, {"label": "D", "text": "PCR (Polymerase Chain Reaction)", "correct": false}], "correct_answer": "B. FISH (Fluorescence In Situ Hybridization)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/VOpY4sGjrbPzoudkiYq51744700705.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CBC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normal <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> + Elevated <span class=\"customMeta\" data-dictid=\"15d4ce5bf21692777200543fdf4d2f\">TLC</span> + Elevated platelets</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Left shift with predominant segmented neutrophils, myelocytes, and metamyelocytes.</li>\n<li>College girl/garden party appearance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> aspirate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Increased</strong> Myeloid:Erythroid ratio.</li>\n<li><strong>Dwarf megakaryocytes.</strong></li>\n<li><strong>Sea blue histiocytes</strong> (blue-coloured cytoplasm)</li>\n<li><strong>Pseudo Gaucher cells</strong></li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Bone &lt;span class=\" custommeta\"=\"\" data-dictid=\"c8a8c935a41692777191610f6aacb4\"/>marrow <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> CML\" data-author=\"Gören Şahin D, Üsküdar Teke H, Karagülle M, Andıç N, Gündüz E, Işıksoy S, Balić M, Akay OM \" data-hash=\"10358\" data-license=\"CC BY 2.5\" data-source=\"https://openi.nlm.nih.gov/detailedresult?img=PMC4454064_TJH-31-428-g1&amp;query=pseudo%20gaucher%20cells&amp;it=xg&amp;req=4&amp;npos=1\" data-tags=\"April2025\" height=\"324\" src=\"https://image.prepladder.com/notes/Ldg2zFJjiBGhBKJNCQu41744700618.png\" width=\"394\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>The image shows Pseudo-Gaucher cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NAP/LAP score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decreased</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FISH (IOC) </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Confirms t(9:22) translocation</li>\n<li>Analysis to quantify Philadelphia chromosome-positive cells</li>\n<li>Estimates the tumor load</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"FISH CML\" data-author=\"Asif M, Jamal MS, Khan AR, Naseer MI, Hussain A, Choudhry H, Malik A, Khan SA, Mahmoud MM, Ali A, Iram S, Kamran K, Iqbal A, Abduljaleel Z, Pushparaj PN, Rasool M\" data-hash=\"10359\" data-license=\"CC BY 4.0\" data-source=\"https://openi.nlm.nih.gov/detailedresult?img=PMC4885335_fonc-06-00124-g002&amp;query=bcr%20abl%20fusion%20gene&amp;it=xg&amp;lic=by&amp;req=4&amp;npos=74\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/VOpY4sGjrbPzoudkiYq51744700705.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n<p>The image shows BCR-ABL gene <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (red + green) in <span class=\"customMeta\" data-dictid=\"da0e2a00fa1692777202d6e2054b26\">fluorescence</span> in-situ <span class=\"customMeta\" data-dictid=\"7ac003b8c41692777189e14eda8f2d\">hybridization</span> (FISH; the ABL gene is red and the BCR gene is green).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PCR </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>To quantify BCR-ABL-1</li>\n<li>It can be a false negative or false positive</li>\n<li>False negative: Early part of the disease</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with a history of chronic myeloid leukemia (CML), diagnosed two years ago and currently on imatinib therapy, presents with worsening fatigue, abdominal discomfort, and early satiety. On examination, he has splenomegaly and mild pallor. Lab tests show hemoglobin 9.5 g/dL, platelet count 90,000/µL, white blood cell count 50,000/µL, and 12% blasts on peripheral smear. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Blast crisis of CML", "correct": false}, {"label": "B", "text": "Transformation to acute myeloid leukaemia (AML)", "correct": false}, {"label": "C", "text": "Accelerated phase of CML", "correct": true}, {"label": "D", "text": "Chronic phase of CML", "correct": false}], "correct_answer": "C. Accelerated phase of CML", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:70%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic phase (M/C) </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Accelerated phase (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blast phase </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Leukocytosis: <span class=\"customMeta\" data-dictid=\"98bbe8f3ce1692777183eb722de38e\">Bimodal</span> distribution with a higher proportion of <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> segmented neutrophils and myelocytes.</li>\n<li>Blast cells <strong>&lt;10%.</strong></li>\n<li>Increased basophils and eosinophils.</li>\n<li>Monocytosis &lt;3%.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs in 50% of the patients who present with increasing anaemia, thrombocytopenia, and splenomegaly.</li>\n<li>Blast count: <strong>10-19%</strong>.</li>\n<li>Basophilia &gt;20%.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CML transforming into <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> <strong>(Option B)</strong></li>\n<li>Occurs in an average of 3 years after the diagnosis of CML.</li>\n<li>Blasts on the <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> <strong>&gt;20%.</strong></li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> <span class=\"customMeta\" data-dictid=\"42eb51d31e1692777183d170489ba8\">blastic</span> infiltrates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male with chronic myeloid leukemia (CML) was diagnosed six months ago and is currently on 400 mg of imatinib daily. His laboratory studies show a quantitative polymerase chain reaction (qPCR) for a BCR-ABL transcript level of 0.02% on the International Scale (IS). What is the most appropriate next step in managing this patient?", "options": [{"label": "A", "text": "Increase the dose of imatinib to 600 mg daily", "correct": false}, {"label": "B", "text": "Obtain a bone marrow biopsy and cytogenetic analysis", "correct": false}, {"label": "C", "text": "Continue the current dose of imatinib and monitor qPCR every 3 months", "correct": true}, {"label": "D", "text": "Switch to a second-generation tyrosine kinase inhibitor (TKI) such as dasatinib or nilotinib", "correct": false}], "correct_answer": "C. Continue the current dose of imatinib and monitor qPCR every 3 months", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/8tDEB4XAZqt9Fdnn7zy91744700968.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes the mechanism of action of imatinib in the treatment of chronic myeloid leukaemia (CML)?", "options": [{"label": "A", "text": "Inhibition of BCL-2, leading to apoptosis of leukemic cells", "correct": false}, {"label": "B", "text": "Inhibition of BCL-2, leading to apoptosis of leukemic cells", "correct": false}, {"label": "C", "text": "Blockade of aberrant tyrosine kinase signaling", "correct": true}, {"label": "D", "text": "Stimulation of DNA repair mechanisms, enhancing leukemic cell survival", "correct": false}], "correct_answer": "C. Blockade of aberrant tyrosine kinase signaling", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9Wj6Pp1dMmUdZmIQuoOe1744701149.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old male with chronic myeloid leukemia (CML) presents to the emergency department with severe weakness, nausea, and decreased urine output for the past 24 hours, following a new chemotherapy regimen. Lab studies show: Potassium - 6.2 mmol/L, Phosphorus - 7.8 mg/dL, Calcium - 6.5 mg/dL, uric acid - 12 mg/dL, and Creatinine - 2.2 mg/dL. What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Intravenous hydration and diuretics", "correct": false}, {"label": "B", "text": "Intravenous hydration, rasburicase, and diuretics", "correct": true}, {"label": "C", "text": "Intravenous hydration and calcium gluconate", "correct": false}, {"label": "D", "text": "Intravenous hydration, loop diuretics, and sodium bicarbonate", "correct": false}], "correct_answer": "B. Intravenous hydration, rasburicase, and diuretics", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male with Chronic Myeloid Leukemia (CML) presents with disease progression while on first-line therapy with imatinib. Molecular testing reveals the presence of the T315I mutation within the ABL kinase domain. What is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Continue imatinib therapy at a higher dose.", "correct": false}, {"label": "B", "text": "Switch to a second-generation tyrosine kinase inhibitor (TKI) such as dasatinib or nilotinib.", "correct": false}, {"label": "C", "text": "Consider allogeneic hematopoietic stem cell transplantation (allo-HSCT)", "correct": false}, {"label": "D", "text": "Initiate treatment with ponatinib.", "correct": true}], "correct_answer": "D. Initiate treatment with ponatinib.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer:D) Initiate treatment with ponatinib</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:704px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>AGENT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>APPROVED INDICATIONS </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>NOTABLE TOXICITIES</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imatinib (Gleevec)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All phases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluid retention, weight gain, nausea, diarrhea, skin rashes, <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> edema, bone or muscle aches and fatigue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dasatinib </strong>(2nd generation)<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All phases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelosuppression, pleural and <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusions , <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nilotinib </strong>(2nd generation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All phases except <span class=\"customMeta\" data-dictid=\"42eb51d31e1692777183d170489ba8\">blastic</span> phase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diabetes , arterio-occlusive disease , pancreatitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bosutinib</strong> (2nd generation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All phases</p>\n<p>Most effective in case of imatinib-resistant CML</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhea , liver <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> , <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> dysfunction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ponatinib </strong>(3rd generation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Optimal TKI if T315I mutation</p>\n<p>Failure of ≥ 2 TKI’s</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin rashes, pancreatitis, arterio-occlusive disease, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Omacetaxine mepesuccinate</strong> (3rd generation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Failure of ≥ 2 TKI’s</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelosuppression</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 57-year-old male is diagnosed with chronic myeloid leukemia (CML) after presenting with fatigue, night sweats, and splenomegaly. His initial laboratory tests show a white blood cell count of 85,000/µL, hemoglobin of 10.5 g/dL, and a platelet count of 600,000/µL. The oncologist decides to evaluate his prognosis to guide treatment decisions. Which of the following diagnostic tools is most appropriate for assessing the prognosis of this patient with CML?", "options": [{"label": "A", "text": "Karnofsky's performance status", "correct": false}, {"label": "B", "text": "Sokal risk score", "correct": true}, {"label": "C", "text": "Ann Arbor staging classification", "correct": false}, {"label": "D", "text": "Rai classification", "correct": false}], "correct_answer": "B. Sokal risk score", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:469px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sokal score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.8</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.8-1.2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;1.2</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hasford score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>European Treatment and Outcome Study (EUTOS) Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modification of Sokal score takes into addition two more values:</p>\n<ul>\n<li>Eosinophil count.</li>\n<li>Basophil count.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two parameters:</p>\n<ul>\n<li>Spleen size.</li>\n<li>Basophil count.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 18 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 58-year-old male presents to the clinic with significant fatigue, lymphadenopathy, and unintentional weight loss over the past few months. He has a history of HIV and is currently on antiretroviral therapy. A biopsy of the enlarged lymph nodes reveals aggressive B-cell neoplasm. Which of the following types of non-Hodgkin’s lymphoma is most likely associated with his condition?", "options": [{"label": "A", "text": "Diffuse large B-cell lymphoma", "correct": true}, {"label": "B", "text": "Gastric MALT lymphoma", "correct": false}, {"label": "C", "text": "Multicentric Castleman’s disease", "correct": false}, {"label": "D", "text": "Primary CNS diffuse large B-cell lymphoma", "correct": false}], "correct_answer": "A. Diffuse large B-cell lymphoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:565px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Infectious agent </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lymphoid malignancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epstein-Barr virus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Burkitt’s lymphoma</p>\n<p>Post-organ transplant lymphoma</p>\n<p>Primary <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> large B-cell <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> <strong>(Option D ruled out)</strong></p>\n<p>Hodgkin’s lymphoma</p>\n<p>Extranodal NK/T-cell lymphoma, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> type</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HTLV-1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adult T-cell leukaemia/lymphoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HIV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse large B-cell lymphoma</strong></p>\n<p>Burkitt’s lymphoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatitis C virus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphoplasmacytic lymphoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helicobacter pylori</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastric <span class=\"customMeta\" data-dictid=\"62de0ec43c16927771912c01f6f373\">MALT</span> <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Human <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> virus 8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> lymphoma</p>\n<p>Multicentric Castleman’s disease <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>High-grade NHL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Low-grade NHL</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This type has a high rate of proliferation.</li>\n<li>Rapidly produces symptoms.</li>\n<li>It is fatal if not treated. However, it is curable.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It has a low <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> rate.</li>\n<li>It may stay <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> for months or years.</li>\n<li>It has a slow course of disease.</li>\n<li>It is not curable with conventional treatments.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over ⅔ rds of the NHL in the world are either</p>\n<ul>\n<li>Diffuse large B-cell NHL, which is <span class=\"customMeta\" data-dictid=\"ffb779b5ad1692777189091a0aef76\">high-grade</span> NHL or</li>\n<li>Follicular NHL, which is a <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> NHL.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with cervical lymphadenopathy, fever, night sweats, and unintentional weight loss. A lymph node biopsy reveals cells, as shown in the image below. Which of the following statements is consistent with this diagnosis?", "options": [{"label": "A", "text": "Bone marrow involvement is often present.", "correct": false}, {"label": "B", "text": "Frequently associated with Epstein-Barr virus", "correct": true}, {"label": "C", "text": "Gastrointestinal involvement is commonly observed", "correct": false}, {"label": "D", "text": "Associated with non-contiguous lymph nodes spread.", "correct": false}], "correct_answer": "B. Frequently associated with Epstein-Barr virus", "question_images": ["https://image.prepladder.com/notes/CMAgO9CAgxEYBnMozimz1744696957.png"], "explanation_images": ["https://image.prepladder.com/notes/Mha7smaKcd13iHEEelHc1744697218.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hodgkin <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">Lymphoma</span> (HL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Hodgkin <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">Lymphoma</span> (NHL)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 new cases per 1 lakh population per year</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 new cases per 1 lakh population per year</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Median age 31 years;</p>\n<p><strong>First peak </strong>at 20-35 years and <strong>second</strong> at 50-70 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Median <strong>age 65-70 years</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contiguous <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> enlargement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-contiguous spread <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage at diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mostly localized</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Commonly widespread</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nodal; supradiaphragmatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nodal or extranodal; any site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epstein-Barr virus (EBV) involvement </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequently <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less commonly </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cellular Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reed-Sternberg cells present</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No Reed-Sternberg cells; various <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> types</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Constitutional symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alter prognosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Do not affect prognosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central nervous system involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurrence increases with AIDS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mediastinal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common with<strong> <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">nodular</span> <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> HL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common with <strong>lymphoblastic lymphoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdominal nodal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be small or large, mesenteric rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually enlarged, mesenteric common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Marrow involvement </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>70-80% cure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly variable by type; mostly incurable</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old patient presents with chronic eczematous lesions on his thighs for 6 years. He had visited a dermatologist previously, and a biopsy of the lesion and histopathological examination was done as treatment was not effective and he was referred to the physician. The HPE report shows Pautrier microabscesses. What is the most probable diagnosis in this case?", "options": [{"label": "A", "text": "Sezary syndrome", "correct": false}, {"label": "B", "text": "Adult T-cell lymphoma", "correct": false}, {"label": "C", "text": "Subcutaneous panniculitis-like T-cell lymphoma", "correct": false}, {"label": "D", "text": "Mycosis fungoides", "correct": true}], "correct_answer": "D. Mycosis fungoides", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/HFZGB2xBRi2f9OQp0HuZ1744695923.png", "https://image.prepladder.com/notes/wg49KTKQ6wvkQyswkhjp1744696149.png", "https://image.prepladder.com/notes/X0Ui5rGQkECL9Sbatvqs1744696218.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:730px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mycosis fungoides</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sezary syndrome </strong><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This is the <strong>most common <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> T-cell</strong> <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> that mimics <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> skin diseases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This condition slowly develops from <span class=\"customMeta\" data-dictid=\"a1e130c1691692777192c7da13c523\">mycosis</span> fungoides and is an <strong>aggressive </strong>form.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It usually presents with <strong>chronic <span class=\"customMeta\" data-dictid=\"6cc26a38ff1692777186dfa1267cfa\">eczematous</span> lesions</strong><strong>.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is an <strong>erythrodermic <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> T-cell</strong> <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> with a <strong>leukemic </strong>component.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The skin lesions are thin <strong>erythematous plaques</strong> or <strong>flat patches</strong>.</li>\n<li>They are single or multiple lesions in the <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> region/thighs.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Skin lesions are <strong>intense</strong>, widespread <strong>pruritic erythroderma</strong>.</li>\n<li>It involves ~80% of the total body surface area.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>On histopathology, <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> cells are seen as aggregates in the <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> layer, forming <strong>Pautrier microabscesses</strong>.</li>\n<li>Epidermotropism of <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> cells is seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pautrier microabscesses may or may not be present.</li>\n<li>Sparse <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> is seen and may lack epidermotropism.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> circulating lymphocytes are called <strong>Sezary cells </strong>having<strong> <span class=\"customMeta\" data-dictid=\"19b43840a41692777184d27ec15616\">cerebriform</span> nuclei</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The treatment goal is mainly <strong>palliative, </strong>with the usage of <strong>topical/systemic</strong> <strong>steroids </strong>for pruritis and other symptoms.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Mycosis fungoides Skin lesion\" data-author=\"Bobjgalindo\" data-hash=\"10343\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Mycosis_fungoides_knee.JPG\" data-tags=\"April2025\" height=\"285\" src=\"https://image.prepladder.com/notes/HFZGB2xBRi2f9OQp0HuZ1744695923.png\" width=\"342\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Sezary syndrome\" data-author=\"James Heilman, MD\" data-hash=\"10344\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Sezery2.jpg\" data-tags=\"April2025\" height=\"357\" src=\"https://image.prepladder.com/notes/wg49KTKQ6wvkQyswkhjp1744696149.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pautrier Microabscesses\" data-author=\"Casey Schukow; Aadil Ahmed.\" data-hash=\"10345\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.ncbi.nlm.nih.gov/books/NBK589703/figure/article-150159.image.f3/\" data-tags=\"April2025\" height=\"372\" src=\"https://image.prepladder.com/notes/X0Ui5rGQkECL9Sbatvqs1744696218.png\" width=\"592\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old male presents with a rapidly enlarging jaw mass and facial swelling. Imaging reveals extensive extranodal involvement. Biopsy shows a starry sky appearance, and immunohistochemistry is positive for CD19, CD20, and CD10 but negative for BCL2. EBV testing is positive. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Burkitt's Lymphoma", "correct": true}, {"label": "B", "text": "Follicular Lymphoma", "correct": false}, {"label": "C", "text": "Mantle Cell Lymphoma", "correct": false}, {"label": "D", "text": "Diffuse Large B-cell lymphoma", "correct": false}], "correct_answer": "A. Burkitt's Lymphoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/SWdSZKdGxpPYPTKE5VAo1744688533.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 67-year-old male presents with a rapidly growing abdominal mass, fever, night sweats, and weight loss. His lab results show elevated LDH levels and a biopsy reveals large atypical lymphocytes expressing CD19 and CD20 with negative Cyclin D1. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Follicular Lymphoma", "correct": false}, {"label": "B", "text": "Mantle Cell Lymphoma", "correct": false}, {"label": "C", "text": "Classical Hodgkin's Lymphoma", "correct": false}, {"label": "D", "text": "Diffuse Large B-cell lymphoma", "correct": true}], "correct_answer": "D. Diffuse Large B-cell lymphoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are true regarding marginal zone lymphoma except?", "options": [{"label": "A", "text": "It can affect the stomach", "correct": false}, {"label": "B", "text": "It can be associated with Sjögren's syndrome", "correct": false}, {"label": "C", "text": "It originates from small B lymphocytes", "correct": false}, {"label": "D", "text": "R-CHOP regimen is the first-line treatment", "correct": true}], "correct_answer": "D. R-CHOP regimen is the first-line treatment", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/vTNw8CUU0n0ftwBeH3Lz1744687438.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with painless lymphadenopathy. A biopsy of the lymph node reveals the presence of \"buttock cells\". Flow cytometry shows a clonal population of B-cells expressing CD10, CD19, and BCL-2. Based on these findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Follicular lymphoma", "correct": true}, {"label": "B", "text": "Mantle cell lymphoma", "correct": false}, {"label": "C", "text": "Burkitt lymphoma", "correct": false}, {"label": "D", "text": "Small lymphocytic lymphoma", "correct": false}], "correct_answer": "A. Follicular lymphoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive Markers:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Negative Markers:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD19: A pan-B-cell marker.</p>\n<p>CD20: Commonly expressed in B-cells.</p>\n<p>Bcl-2: (Anti-apoptotic protein)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD5</p>\n<p>CD23</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with lymphadenopathy and splenomegaly. Biopsy findings reveal a diffuse proliferation of small to medium-sized lymphoid cells with irregular nuclei. Which of the following immunohistochemical (IHC) markers is definitive for diagnosing mantle cell lymphoma?", "options": [{"label": "A", "text": "CD5", "correct": false}, {"label": "B", "text": "BCL-2", "correct": false}, {"label": "C", "text": "CD23", "correct": false}, {"label": "D", "text": "Cyclin D1", "correct": true}], "correct_answer": "D. Cyclin D1", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding non-Hodgkin lymphoma is incorrect?", "options": [{"label": "A", "text": "B-symptoms are mostly seen in advanced disease.", "correct": false}, {"label": "B", "text": "Extranodal involvement is very common", "correct": false}, {"label": "C", "text": "It frequently presents at advanced stages (I or II) in the Ann Arbor staging system", "correct": true}, {"label": "D", "text": "B-cell subtypes are more common", "correct": false}], "correct_answer": "C. It frequently presents at advanced stages (I or II) in the Ann Arbor staging system", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ZleiiXF7WHorUbtqV7BZ1744685876.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:641px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of a single <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> region</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of two or more <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> regions on the same side of the diaphragm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> regions on both sides of the diaphragm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disseminated disease involving one or more <span class=\"customMeta\" data-dictid=\"7fa42cc96416927771877d60e9fae2\">extranodal</span> sites, including bone marrow, liver, or other organs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "NF-κB activation is a common event in classical Hodgkin Lymphoma (cHL) and promotes the growth and survival of Reed-Sternberg cells. Which of the following mechanisms is associated with NF-κB activation in EBV-positive tumours?", "options": [{"label": "A", "text": "Loss-of-function mutations in IκB", "correct": false}, {"label": "B", "text": "Expression of latent membrane protein-1 (LMP-1).", "correct": true}, {"label": "C", "text": "Activation of the TNF-α–induced protein 3", "correct": false}, {"label": "D", "text": "Decreased levels of cytokine production", "correct": false}], "correct_answer": "B. Expression of latent membrane protein-1 (LMP-1).", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology &amp; <span class=\"customMeta\" data-dictid=\"715b4caf0316927771943797627d8d\">Pathogenesis</span> of Hodgkin <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">Lymphoma</span> (HL)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hodgkin Lymphoma</strong> is a <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> B-cell tumour.</li>\n<li>More common in whites &amp; Males.</li>\n<li>Bimodal age distribution with peaks in the 20s and 80s.</li>\n<li>It is not a part of AIDS-defining lymphoma.</li>\n<li><strong>Risk Factors</strong>:\n\t\t\t\t<ul>\n<li>HIV infection is a major risk factor.</li>\n<li>Epstein-Barr virus (EBV).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reed-Sternberg (HRS) Cells</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HRS cells are derived from the <span class=\"customMeta\" data-dictid=\"a0e5fdc156169277718879843a6ede\">germinal</span> <span class=\"customMeta\" data-dictid=\"1feb2a0a3016927771847db9449f75\">centre</span> or post-germinal <span class=\"customMeta\" data-dictid=\"1feb2a0a3016927771847db9449f75\">centre</span> B cells (mature B cells in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes) as revealed by clonal IGH gene rearrangements and <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> hypermutation.</li>\n<li>Diagnostic of HL.</li>\n<li>Large, with abundant cytoplasm, bilobed or multinucleated.</li>\n<li>Typically positive for<strong> PAX-5, CD15, and CD30.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NF-κB Activation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common in cHL, promoting RS cell growth and survival.</li>\n<li><strong>EBV+ Tumors</strong>: Express <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> protein-1 <strong>(LMP-1)</strong>, which activates <strong>NF-κB</strong>. <strong>(Option B)</strong></li>\n<li><strong>EBV− Tumors</strong>: NF-κB <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> may result from <strong>loss-of-function mutations in IκB</strong> or l<strong>oss-of-function <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> of TNF-α–induced protein 3</strong>, both of which normally <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> NF-κB. <strong>(Options A &amp; C)</strong></li>\n<li>NF-κB <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> may rescue \"crippled\" B cells that can't express Ig,<strong> preventing</strong> <strong>apoptosis </strong>and enabling further mutations that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> RS cells.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Microenvironment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>RS cells <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> cytokines (e.g., IL-5, IL-10) and chemokines (e.g., eotaxin) that attract <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> cells (e.g., eosinophils, T cells). <strong>(Option D)</strong></li>\n<li>These <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> cells support tumour growth and modify the immune response, with ligands activating RS cell receptors (e.g., CD30, CD40), further upregulating NF-κB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immune Evasion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>97% of <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">HRS</span> cells have genetic abnormalities at the<strong> PD-L1 locus</strong> on <strong>chromosome 9p24.1</strong>, leading to PD-L1 overexpression, which helps the tumour evade immune detection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viral Oncogenesis</strong>: <span class=\"customMeta\" data-dictid=\"e4f6b2922d16927771865030175a86\">EBV</span> involvement is stronger in HIV-associated HL, where nearly all cases show <span class=\"customMeta\" data-dictid=\"e4f6b2922d16927771865030175a86\">EBV</span> expression.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with rapid-onset weight loss, fatigue, and an enlarging mass in the abdomen. Laboratory tests reveal elevated lactate dehydrogenase (LDH), and a biopsy confirms the presence of a fast-growing malignancy. Immunohistochemical staining shows that the tumour cells are CD19, CD20 and CD79 +ve. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Mycosis fungoides", "correct": false}, {"label": "B", "text": "Burkitt’s lymphoma", "correct": true}, {"label": "C", "text": "Sezary syndrome", "correct": false}, {"label": "D", "text": "Anaplastic large cell lymphoma", "correct": false}], "correct_answer": "B. Burkitt’s lymphoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>B-cell origin (90%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T-cell origin (10%) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These are <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> (peripheral) B-cell neoplasms</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These are <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> (peripheral) T-cell neoplasms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hairy cell leukemia</li>\n<li>Waldenstorm macroglobulinemia</li>\n<li>Follicular lymphoma</li>\n<li>Mantle cell lymphoma</li>\n<li>Diffuse large B-cell <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> and subtypes</li>\n<li>Splenic marginal zone B-cell lymphoma</li>\n<li>Extranodal marginal B-cell lymphoma</li>\n<li>High-grade B-cell <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> NOS</li>\n<li><strong>Burkitt’s lymphoma/Burkitt’s cell leukaemia</strong></li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> large B-cell lymphoma</li>\n<li>HHV8+ DCLBL NOS</li>\n<li>Plasmablastic lymphoma</li>\n<li>Intravascular large B-cell leukaemia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>T-cell <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> lymphocytic leukemia</li>\n<li>Adult T-cell lymphoma/leukaemia</li>\n<li>Extranodal NK/T-cell lymphoma, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> type</li>\n<li>Enteropathy-associated T-cell lymphoma</li>\n<li>Hepatosplenic T-cell lymphoma</li>\n<li>Subcutaneous panniculitis-like T-cell lymphoma</li>\n<li>Mycosis fungoides <strong>(Option A)</strong></li>\n<li>Sezary syndrome <strong>(Option C) </strong></li>\n<li>Peripheral T-cell <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> NOS</li>\n<li>Angioimmunoblastic T-cell lymphoma</li>\n<li>Anaplastic large-cell lymphoma, ALK+ <strong>(Option D)</strong></li>\n<li>Anaplastic large-cell lymphoma, ALK-</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mycosis fungoides (MF) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cutaneous T-cell lymphoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sezary syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leukaemia <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of MF that spreads via a <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> route</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male is diagnosed with Hodgkin lymphoma. His survival chances are assessed using the International Prognostic Index. Which of the following is not a criterion for this index?", "options": [{"label": "A", "text": "Age &amp;gt;45 years", "correct": false}, {"label": "B", "text": "Presence of B symptoms", "correct": true}, {"label": "C", "text": "Serum albumin &amp;lt;4 g/dL", "correct": false}, {"label": "D", "text": "Lymphocyte count &amp;lt;600/mm³", "correct": false}], "correct_answer": "B. Presence of B symptoms", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male presents with fever, night sweats, and significant weight loss over the past few months. A lymph node biopsy confirms advanced-stage classical Hodgkin lymphoma. Imaging reveals bulky mediastinal lymphadenopathy. What is the most appropriate treatment for this patient?", "options": [{"label": "A", "text": "6 cycles of ABVD regimen alone", "correct": true}, {"label": "B", "text": "Brentuximab combined with nivolumab", "correct": false}, {"label": "C", "text": "4 cycles of ABVD followed by field radiation", "correct": false}, {"label": "D", "text": "Combination of ABVD and R-CHOP regimens", "correct": false}], "correct_answer": "A. 6 cycles of ABVD regimen alone", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with painless cervical lymphadenopathy with no extranodal involvement. Immunohistochemistry reveals cells positive for CD20, CD19, and CD45 but negative for CD30 and CD15. He has a history of chronic, relapsing symptoms. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Follicular Lymphoma", "correct": false}, {"label": "B", "text": "Diffuse Large B-cell lymphoma", "correct": false}, {"label": "C", "text": "Classical Hodgkin's Lymphoma", "correct": false}, {"label": "D", "text": "Nodular Lymphocyte-Predominant Hodgkin's Lymphoma", "correct": true}], "correct_answer": "D. Nodular Lymphocyte-Predominant Hodgkin's Lymphoma", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with unexplained fever, night sweats, and a 12% weight loss over 6 months. A physical exam reveals palpable lymph nodes in the neck and axilla. PET/CT shows lymph node involvement on both sides of the diaphragm and splenic enlargement without extranodal disease. Based on the Ann Arbor Staging System, what is the correct stage for this patient’s disease?", "options": [{"label": "A", "text": "Stage IIB", "correct": false}, {"label": "B", "text": "Stage III1B", "correct": true}, {"label": "C", "text": "Stage III2A", "correct": false}, {"label": "D", "text": "Stage IVB", "correct": false}], "correct_answer": "B. Stage III1B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Ann <span class=\"customMeta\" data-dictid=\"be003ab8e216927771824f1270479c\">Arbor</span> Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of a single <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> region or <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> structure (e.g., spleen, thymus, Waldeyer’s ring).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of 2 or more <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> regions on the same side of the diaphragm.</p>\n<p>Mediastinum counts as one site; hilar <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes are considered \"lateralized,\" and if both sides are involved, it is stage II disease. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> regions or <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> structures on both sides of the diaphragm.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>III1</strong> <span class=\"customMeta\" data-dictid=\"06b00dab1c169277719971e483826b\">Subdiaphragmatic</span> involvement is limited to the spleen, splenic hilar nodes, <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> nodes, or <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> nodes. <strong>(Option B)</strong></li>\n<li><strong>III2</strong> <span class=\"customMeta\" data-dictid=\"06b00dab1c169277719971e483826b\">Subdiaphragmatic</span> involvement includes paraaortic, iliac, or mesenteric nodes plus structures from III1. <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of <span class=\"customMeta\" data-dictid=\"7fa42cc96416927771877d60e9fae2\">extranodal</span> sites beyond “E” designation, more than one <span class=\"customMeta\" data-dictid=\"7fa42cc96416927771877d60e9fae2\">extranodal</span> deposit at any location, or involvement of the liver or bone marrow. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A </strong>- No <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n<p><strong>B </strong>- Unexplained weight loss &gt;10% in 6 months, persistent or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> fever &gt;38°C, or</p>\n<p>recurrent <span class=\"customMeta\" data-dictid=\"a696a8e86016927771939c84736fbb\">night sweats</span> in the past months.</p>\n<p><strong>E</strong> - <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> involvement of extra <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> tissue, excluding liver and bone marrow.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents with cervical lymphadenopathy and constitutional symptoms, including unexplained weight loss and night sweats. Imaging studies suggest the presence of a mediastinal mass. An excisional biopsy of a cervical lymph node is given below. Which of the following findings is most likely to be present in this patient?", "options": [{"label": "A", "text": "Positive for CD15 and CD30", "correct": true}, {"label": "B", "text": "High expression of CD20 and BCL6", "correct": false}, {"label": "C", "text": "Negative for PAX-5", "correct": false}, {"label": "D", "text": "Positive for CD19", "correct": false}], "correct_answer": "A. Positive for CD15 and CD30", "question_images": ["https://image.prepladder.com/notes/zTahRaucBupHPTfxRrlk1744684825.png"], "explanation_images": ["https://image.prepladder.com/notes/zTahRaucBupHPTfxRrlk1744684825.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Workup of Hodgkin's Lymphoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Comprehensive <strong>history and physical examination</strong>, with attention to <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, liver, spleen, and B symptoms.</li>\n<li><strong>Chest radiograph</strong> if there is a <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> mass to evaluate for bulky disease.</li>\n<li><strong>Imaging</strong>: PET/CT scan (imaging <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> of choice) <strong>for staging</strong>, which is more accurate than <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> due to patchy <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> involvement in cHL.</li>\n<li><strong>Complete <span class=\"customMeta\" data-dictid=\"57525e6f6416927771835d0fb0bee5\">blood count</span> (CBC)</strong>, <strong>ESR</strong>.</li>\n<li><strong>Liver function tests</strong> (alkaline phosphatase, <strong>lactate dehydrogenase</strong>, albumin, bilirubin).</li>\n<li><strong>Kidney function tests</strong>: BUN, creatinine.</li>\n<li><strong>Thyroid function tests</strong> if neck <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> is considered.</li>\n<li><strong>Pregnancy test</strong> for women of childbearing age.</li>\n</ul>\n<ul>\n<li><strong>Echocardiogram</strong> or <span class=\"customMeta\" data-dictid=\"72cf96e6ab16927771970405c5066c\">radionuclide</span> study for <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> fraction if <span class=\"customMeta\" data-dictid=\"4564eec6dd16927771815772bbe47e\">anthracycline</span> <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> is planned.</li>\n<li><strong>Pulmonary function tests</strong> with <span class=\"customMeta\" data-dictid=\"68325001361692777186184e298e9d\">diffusing capacity</span> if bleomycin-containing <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> is to be used.</li>\n<li>Infection panel for HIV, Hepatitis, EBV.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Investigation of choice: <strong>Excision <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> biopsy, </strong>which shows <strong>Reed-Sternberg (HRS) Cells.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Reed-Sternberg cells\" data-author=\"Ed Uthman, MD\" data-hash=\"10333\" data-license=\"CC BY SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hodgkin_Disease,_Reed-Sternberg_Cell.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/zTahRaucBupHPTfxRrlk1744684825.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p>HRS cells are large with <strong>abundant cytoplasm</strong> and<strong> bilobed</strong> or <span class=\"customMeta\" data-dictid=\"aa085932ce1692777193be7e5198bf\">multinucleated</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (Owleye appearance), making them characteristic of classical Hodgkin <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> (cHL).</p>\n<p>Flow cytometry:</p>\n<ul>\n<li><strong>CD15 </strong>and<strong> CD30 +ve</strong> in <strong>classical Hodgkin lymphoma</strong>. <strong>(Option A)</strong></li>\n<li><strong>L&amp;H (NLPHL) </strong> variants show <strong>CD20</strong> and<strong> BCL6 +ve</strong> <strong>(Option B) </strong>and are usually negative for CD15 and CD30.</li>\n<li>Low or<strong> absent </strong>expression of B-cell markers <strong>CD19</strong><strong> </strong><strong>(Option D)</strong><strong> </strong>and<strong> CD20</strong>.</li>\n<li>Positive for PAX-5. <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classical HL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NLPHL </strong></p>\n<p><strong>(Nodular <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> predominant Hodgkin lymphoma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Young age group</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Old age group</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>R-S cells</strong> in Histopathological examination. (HPE)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HPE shows L and H variants (lymphocytic and histiocytic cells) aka <strong>popcorn cells</strong>: small cells with hyperlobulated nuclei.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Markers: CD 15 and CD 30 +ve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD 20, BCL6 and CD 45 aka LCA(Leukocyte common antigen) +ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"e4f6b2922d16927771865030175a86\">EBV</span> virus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male presents with jaundice, pruritus, and fatigue. He reports experiencing night sweats, fever, and unintentional weight loss over the past month. Laboratory tests reveal elevated alkaline phosphatase and bilirubin levels. A liver biopsy shows loss of intrahepatic bile ducts. Further evaluation shows enlarged lymph nodes in the cervical region. What is the most likely underlying diagnosis?", "options": [{"label": "A", "text": "Primary biliary cholangitis", "correct": false}, {"label": "B", "text": "Classical Hodgkin Lymphoma", "correct": true}, {"label": "C", "text": "Hepatitis C infection", "correct": false}, {"label": "D", "text": "Alcoholic liver disease", "correct": false}], "correct_answer": "B. Classical Hodgkin Lymphoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paraneoplastic Findings in Classical Hodgkin <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">Lymphoma</span> (cHL)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rare <span class=\"customMeta\" data-dictid=\"42825d622516927771943152da2670\">paraneoplastic</span> syndromes have been observed at the time of <span class=\"customMeta\" data-dictid=\"2b8e87cc481692777184e49d44fc10\">cHL</span> diagnosis.</li>\n<li>Syndromes include:\n\t\t\t\t<ul>\n<li><strong>Vanishing <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> syndrome </strong><strong>(Option B)</strong> and <strong>idiopathic cholangitis</strong> with clinical jaundice.</li>\n<li><strong>Nephrotic syndrome </strong>(membranous glomerulopathy) with anasarca.</li>\n<li><strong>Autoimmune hematologic disorders</strong> such as <span class=\"customMeta\" data-dictid=\"e04dfc010f169277718982f09083af\">immune thrombocytopenia</span> or <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anaemia.</li>\n<li>Various <strong>neurologic signs</strong> and symptoms.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>While direct <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> or meningeal involvement in <span class=\"customMeta\" data-dictid=\"2b8e87cc481692777184e49d44fc10\">cHL</span> is rare, neurological <span class=\"customMeta\" data-dictid=\"42825d622516927771943152da2670\">paraneoplastic</span> syndromes include:\n\t\t\t\t<ul>\n<li><strong>Subacute cerebellar degeneration</strong>.</li>\n<li>Myelopathy.</li>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> encephalopathy.</li>\n<li>Limbic encephalitis.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypercalcemia</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presents with a 3-month history of painless, enlarged cervical lymph nodes that are nontender and \"rubbery\" in consistency. He reports fever, night sweats, and unintentional weight loss of about 10% over the last six months. Additionally, he experiences pain in the lymph nodes after consuming alcohol. There are no complaints of cough or dyspnea, and his complete blood count is unremarkable. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Non-Hodgkin lymphoma", "correct": false}, {"label": "B", "text": "Hodgkin lymphoma", "correct": true}, {"label": "C", "text": "Tuberculosis", "correct": false}, {"label": "D", "text": "Sarcoidosis", "correct": false}], "correct_answer": "B. Hodgkin lymphoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation of Hodgkin lymphoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphadenopathy (Swollen <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Nodes)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common presentation: ~60-70% in cervical/supraclavicular nodes, 15-20% in axillary nodes.</li>\n<li><strong>Non-tender</strong>, <strong>\"rubbery\" </strong>lymph nodes.</li>\n<li>Over half have <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> adenopathy, sometimes the first sign.</li>\n<li>Subdiaphragmatic involvement is rare and more common in older males.</li>\n<li><strong>Pain</strong> in <strong>lymph nodes</strong> after<strong> alcohol consumption</strong>. Seen in &lt;10% of patients but highly <strong>specific to cHL</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>B Symptoms (Constitutional Symptoms)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Present in ~30% of cases.</li>\n<li>Includes fever &gt;38°C, night sweats, and unexplained weight loss (&gt;10% in 6 months).</li>\n<li>Fever is often <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> and irregular.</li>\n<li>Rarely,<strong> Pel-Ebstein fever</strong>: <span class=\"customMeta\" data-dictid=\"1d84248e9f16927771850f8b75c26a\">cyclic</span> high fevers (1-2 weeks) <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> with <span class=\"customMeta\" data-dictid=\"5b4680fc9b169277718092403965d7\">afebrile</span> periods.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Symptoms (Intrathoracic Disease)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cough, chest pain, difficulty breathing (dyspnea), and rarely, coughing up blood (hemoptysis).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone Pain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occasional, sometimes with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> symptoms like back pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> compression</strong>: <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> swelling, neck <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> engorgement.</li>\n<li>Rare signs: pleural effusion, hepatosplenomegaly, or <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> masses.</li>\n<li>Generalized<strong> itching</strong>, sometimes severe with <span class=\"customMeta\" data-dictid=\"c69e43907e1692777187901f8d665f\">excoriation</span> and skin disorders (e.g., <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> nodosum, <span class=\"customMeta\" data-dictid=\"b2ae46fdc1169277718976f2230722\">ichthyosiform</span> atrophy).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hodgkin lymphoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Hodgkin lymphoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>40%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reed-Sternberg cells (owl eye cells) - B cells - induce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fibrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphoid cells - many subtypes - most are B cells than T cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mass composition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammatory cells and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (reactive cells)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphoid cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Painless lymphadenopathy</p>\n<p>- <strong>B symptoms</strong></p>\n<p>- Bimodal: classically seen in <strong>young adults and &gt;55 yrs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Painless <span class=\"customMeta\" data-dictid=\"344bcb4e391692777191307c1e0074\">lymphadenopathy</span> - - Classically seen in<strong> late adults</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spread</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contiguous (touching); rarely extranodal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse; often extranodal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Staging</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Guides therapy</p>\n<p>- Radiation mainstay treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited importance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leukemic phase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Doesn't occur</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prognosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Much better <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> than non-Hodgkins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 28 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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She has been experiencing fatigue and increased thirst for the past month. Laboratory tests reveal: Serum calcium : 13 mg/dL Serum creatinine : 150 μmol/L (1.7 mg/dL) Hemoglobin : 8.5 g/dL Alkaline phosphatase (ALP) : 70 U/L (normal range) Serum phosphate : 3.5 mg/dL (normal) Imaging reveals findings as shown: Based on this clinical presentation, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteoporosis", "correct": false}, {"label": "B", "text": "Paget’s disease of bone", "correct": false}, {"label": "C", "text": "Multiple Myeloma", "correct": true}, {"label": "D", "text": "Renal osteodystrophy", "correct": false}], "correct_answer": "C. Multiple Myeloma", "question_images": ["https://image.prepladder.com/notes/RlvkJWbK7KovOFTCcnVf1744403914.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Diagnostic Criteria for Multiple Myeloma</strong><strong> (Option C)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of clonal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells or biopsy-proven bony/extramedullary <span class=\"customMeta\" data-dictid=\"d5111b80db16927771958b92f25b19\">plasmacytoma</span> and anyone or more of the following myeloma-defining events:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evidence of one or more indicators of <strong>end-organ damage</strong> attributed to the <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cell disorder, specifically: <strong>(CRAB)</strong></p>\n<ul>\n<li><strong>Hypercalcemia</strong>: <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> &gt;0.25 mmol/L above the upper limit of normal or &gt;2.75 mmol/L<strong> (&gt;11 mg/dL)</strong>.</li>\n<li><strong>Renal Insufficiency</strong>: <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">Creatinine</span> <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> &lt;40 mL/min or <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> &gt;177 μmol/L <strong>(&gt;2 mg/dL)</strong>.</li>\n<li><strong>Anemia</strong>: <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">Hemoglobin</span> &gt;20 g/L below the lower limit of normal or haemoglobin <strong>&lt;100 g/L or &lt;10g/100ml</strong>.</li>\n<li><strong>Bone Lesions</strong>: One or more <strong>osteolytic lesions </strong>identified on skeletal radiography, CT, or PET-CT.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biomarkers of Malignancy</strong> <strong>(any one of the following)</strong>:</p>\n<ul>\n<li>Clonal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells ≥60%.</li>\n<li>Involved: uninvolved serum-free <span class=\"customMeta\" data-dictid=\"578fe8d7dd16927771913c847ed254\">light chain</span> ratio ≥100.</li>\n<li>1 <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> studies.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male presents with fatigue, bone pain, and an elevated serum protein level. Bone marrow biopsy reveals 40% plasma cells. Cytogenetic studies show the following abnormalities: t(4;14), del 17p, and gain of 1q. Based on the mSMART 3.0 classification, which of the following best describes the patient’s risk stratification?", "options": [{"label": "A", "text": "Standard-risk myeloma", "correct": false}, {"label": "B", "text": "Double-hit myeloma", "correct": false}, {"label": "C", "text": "High-risk myeloma", "correct": false}, {"label": "D", "text": "Triple-hit myeloma", "correct": true}], "correct_answer": "D. Triple-hit myeloma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:524px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>mSMART 3.0: <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Active MM</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Risk </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Standard-Risk </strong><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High-risk genetic Abnormalities:</li>\n</ul>\n<ul>\n<li><strong>t(4;14)</strong></li>\n<li>t(14;16)</li>\n<li>t(14;20)</li>\n<li><strong>Del 17p</strong></li>\n<li>p53 mutation</li>\n<li><strong>Gain 1q </strong></li>\n</ul>\n<ul>\n<li>RISS Stage 3</li>\n<li>High <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> Cell S-phase</li>\n<li>GEP: High-risk signature</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All others, including:</p>\n<ul>\n<li>Trisomies</li>\n<li>t(11;14)</li>\n<li>t(6;14)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Double Hit Myeloma</strong>: Any 2 high-risk genetic abnormalities. <strong>(Option B)</strong></li>\n<li><strong>Triple Hit Myeloma</strong>: 3 or more high-risk genetic abnormalities. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In multiple myeloma, osteoblast suppression is primarily associated with which of the following factors?", "options": [{"label": "A", "text": "Increased expression of RANKL by osteoblasts.", "correct": false}, {"label": "B", "text": "Enhanced production of macrophage inflammatory protein-1 alpha (MIP-1alpha).", "correct": false}, {"label": "C", "text": "Elevated levels of Dickkopf 1 (DKK1) blocking Wnt signaling.", "correct": true}, {"label": "D", "text": "Decreased levels of IL-3 and IL-7.", "correct": false}], "correct_answer": "C. Elevated levels of Dickkopf 1 (DKK1) blocking Wnt signaling.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/RgbED5B63s30dSTHpPSV1746520196.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> activity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This is driven by elevated<strong> <span class=\"customMeta\" data-dictid=\"cebebc510416927771979a104a1d7b\">RANKL</span> </strong>expression <strong>(Option A ruled out)</strong> from osteoblasts and possibly <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells, along with <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> levels of its decoy receptor, <strong>osteoprotegerin (OPG)</strong>.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"2cc844bc9c1692777189739abf1dc5\">imbalance</span> (high RANKL/OPG ratio) promotes <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> and bone resorption.</li>\n<li>Additionally, <strong>macrophage <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> protein-1 <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> (MIP-1alpha) </strong><strong>(Option B ruled out)</strong>, IL-3, IL-6, and stromal-derived factor 1 <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> (SDF-1alpha) contribute to <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> overactivity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteoblast suppression</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Suppression is <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to increased levels of IL-3, IL-7, and Dickkopf 1 (DKK1), which inhibits <span class=\"customMeta\" data-dictid=\"8e55f8d71d1692777194a10c3d3d9d\">osteoblast</span> differentiation.</li>\n<li>DKK1, secreted by MM cells, blocks Wnt <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> and is associated with the presence of bone lesions. <strong>(Option C)</strong></li>\n<li>Elevated levels of IL-3 and IL-7 further <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> <span class=\"customMeta\" data-dictid=\"8e55f8d71d1692777194a10c3d3d9d\">osteoblast</span> function. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with severe back pain, fatigue, confusion, and lethargy. Imaging reveals multiple osteolytic lesions; lab tests show elevated calcium and anemia, and serum protein electrophoresis identifies a monoclonal spike. Given this presentation, which complication is most likely contributing to his neurologic symptoms?", "options": [{"label": "A", "text": "Spinal cord compression from vertebral collapse", "correct": false}, {"label": "B", "text": "Hyperviscosity syndrome from increased serum proteins", "correct": false}, {"label": "C", "text": "Hypercalcemia from bone destruction", "correct": true}, {"label": "D", "text": "Peripheral neuropathy due to plasma cell infiltration", "correct": false}], "correct_answer": "C. Hypercalcemia from bone destruction", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone manifestation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone pain </strong>is the<strong> most common symptom</strong>, affecting ~70% of patients. Persistent pain often indicates a <span class=\"customMeta\" data-dictid=\"e32252a2c41692777194fe542b3e35\">pathologic</span> fracture.</p>\n<ul>\n<li>Caused by tumour cell proliferation, <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> activation, and <span class=\"customMeta\" data-dictid=\"8e55f8d71d1692777194a10c3d3d9d\">osteoblast</span> suppression.</li>\n<li>Osteoclast <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> is driven by cytokines like IL-1, VEGF, RANK ligand, and TNF, leading to bone destruction and <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> lesions.</li>\n<li>Osteoblast <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> is mediated by DKK-1, resulting in minimal new bone formation.</li>\n</ul>\n<p><strong>Hypercalcemia</strong>: Results from bone destruction, causing both <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> and chronic complications. Vertebral collapse may lead to <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord compression.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infections</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>2nd most common clinical issue</li>\n<li>Frequent pathogens include <em>S. pneumoniae, S. aureus,</em> and <em>K. pneumoniae</em> in the lungs, and <em>E. coli</em> in the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tract.</li>\n<li><strong>Immune dysfunction</strong> is caused by<strong> hypogammaglobulinemia</strong>, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> T-cell function (reduced TH1, increased TH17), and impaired <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> activity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Manifestation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common causes include<strong> hypercalcemia</strong> (most common), <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> deposits, hyperuricemia, infections, NSAIDs, iodinated contrast, bisphosphonates, and <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> cell infiltration.</p>\n<ul>\n<li><strong>Light Chain Damage</strong>: Excessive light chains in tubules cause damage, leading to adult<strong> Fanconi's syndrome </strong>(proximal <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis) with loss of glucose, <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids, and impaired <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function.</li>\n<li><strong>Proteinuria</strong>: Mainly <span class=\"customMeta\" data-dictid=\"578fe8d7dd16927771913c847ed254\">light chain</span> proteinuria, minimal <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> unless <span class=\"customMeta\" data-dictid=\"c9bd75ce5f1692777188f7fe800061\">glomeruli</span> are involved.</li>\n<li><strong>Decreased <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap </strong>due to cationic M component causing <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> retention. <strong>Pseudohyponatremia</strong> may occur due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> water content from increased proteins (Increased proteins retain water, leading to falsely low sodium levels)</li>\n<li>Patients are <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, especially if dehydrated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anemia</strong>: Normocytic, normochromic anaemia occurs in ~80% of patients due to <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> replacement, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> production, and therapy effects. Some may develop megaloblastic anaemia due to <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> or B12 deficiency.</li>\n<li><strong>Clotting Abnormalities</strong>: Dysfunctional antibody-coated platelets and interactions between the M component and <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors can lead to <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> issues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperviscosity Syndrome</strong>: Caused by high <span class=\"customMeta\" data-dictid=\"4eacb958f416927771942c6b96a705\">paraprotein</span> concentrations (especially IgM, IgG3, IgA), leading to increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> viscosity. Symptoms include headache, visual disturbances, fatigue, and coma. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurologic Symptoms</strong>: Causes include <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> (lethargy, confusion) <strong>(Option C)</strong>, <span class=\"customMeta\" data-dictid=\"e8716e1e311692777189738429bab5\">hyperviscosity</span> (ataxia, coma), and bony damage (cord compression, <span class=\"customMeta\" data-dictid=\"02f52172cf1692777197fe1be2e386\">radicular</span> pain). Peripheral nerve <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> by <strong>amyloid</strong> can cause neuropathy. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumor Expansion</strong>: Although <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells spread widely, tumour expansion predominantly occurs within bone and bone marrow, with minimal involvement of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, spleen, or gut-associated <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> tissue.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old woman presents to the clinic with increasing fatigue and bone pain. Laboratory tests reveal normocytic anemia, a high serum calcium level, and a serum protein electrophoresis that shows a significant monoclonal spike. Which cytokine is likely contributing to her anemia by inhibiting iron release?", "options": [{"label": "A", "text": "Interleukin-1 (IL-1)", "correct": false}, {"label": "B", "text": "Interleukin-6 (IL-6)", "correct": true}, {"label": "C", "text": "Interleukin-5 (IL-5)", "correct": false}, {"label": "D", "text": "Vascular endothelial growth factor (VEGF)", "correct": false}], "correct_answer": "B. Interleukin-6 (IL-6)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Hematologic Abnormalities in Myeloma</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anemia</strong>:</li>\n</ul>\n<p>Normocytic and normochromic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> affects ~80% of <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> patients.</p>\n<p>Caused by:</p>\n<ul>\n<li>Replacement of normal <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> by tumor cells.</li>\n<li>Tumor-induced <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of hematopoiesis.</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> production from the kidneys.</li>\n<li>Long-term therapy effects.</li>\n</ul>\n<ul>\n<li><strong>IL-6 Overproduction</strong>: Produced by <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> and <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> cells, contributing to <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> by increasing <span class=\"customMeta\" data-dictid=\"8b891dde731692777188b56c9cb5f3\">hepcidin</span> levels, which inhibits iron release from macrophages and reduces intestinal iron absorption.</li>\n<li><strong>Clotting Abnormalities</strong>:</li>\n</ul>\n<ul>\n<li>Result from dysfunctional antibody-coated platelets or interactions with <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors.</li>\n<li>Amyloid damage to endothelial cells may contribute.</li>\n</ul>\n<ul>\n<li><strong>Hypercoagulable States</strong>: Result from <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> structure and <span class=\"customMeta\" data-dictid=\"efd9265c421692777202931bbcc4be\">fibrinolysis</span> due to elevated <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> levels, <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> protein C resistance, and increased <span class=\"customMeta\" data-dictid=\"5719f0acf416927771967e59e7c469\">proinflammatory</span> cytokines.</li>\n<li><strong>Bleeding Complications</strong>: Generally uncommon but more frequent with <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> paraproteins, high <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> levels, and increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> viscosity. <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">Acquired</span> von Willebrand factor <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> may occur.</li>\n<li><strong>Raynaud’s phenomenon</strong> and impaired <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> can occur if the <span class=\"customMeta\" data-dictid=\"6bbbc1011e1692777191fe359176fa\">M component</span> forms cryoglobulins.</li>\n<li><strong>Thrombocytopenia</strong>: Rare in the early stages of myeloma, even with significant <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> involvement.</li>\n<li><strong>Thrombocytosis</strong>: May indicate <span class=\"customMeta\" data-dictid=\"77d120b4501692777189604740c430\">hyposplenism</span> due to <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> deposition in the spleen.</li>\n<li><strong>Lupus anticoagulants</strong>: Have been observed in some <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> patients.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male presents with fatigue, bone pain, anemia, hypercalcemia, and elevated creatinine. Imaging reveals multiple lytic bone lesions, and serum electrophoresis shows an M spike. Bone marrow biopsy reveals 15% clonal plasma cells. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Multiple myeloma", "correct": true}, {"label": "B", "text": "Solitary plasmacytoma", "correct": false}, {"label": "C", "text": "Smouldering multiple myeloma", "correct": false}, {"label": "D", "text": "Monoclonal Gammopathy of Undetermined Significance", "correct": false}], "correct_answer": "A. Multiple myeloma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with fatigue, bone pain, and recurrent infections. Laboratory tests show anemia, elevated serum creatinine, and hypercalcemia. An X-ray of the skull reveals findings as shown in the image. Which of the following findings is not consistent with a diagnosis in this patient?", "options": [{"label": "A", "text": "Biopsy shows increased plasma cells in the bone marrow &amp;gt;30% cellularity.", "correct": false}, {"label": "B", "text": "Immunofixation identifies heavy or light chain isotypes of abnormal proteins.", "correct": false}, {"label": "C", "text": "Biopsy shows the presence of Russell and Dutcher bodies in the bone marrow.", "correct": false}, {"label": "D", "text": "Serum electrophoresis reveals a broad, plateau-like peak in the beta region.", "correct": true}], "correct_answer": "D. Serum electrophoresis reveals a broad, plateau-like peak in the beta region.", "question_images": ["https://image.prepladder.com/notes/q0TZpjlJSBR0BoU3a6v71744406103.png"], "explanation_images": ["https://image.prepladder.com/notes/BcZziBk1xynVlWlzHrpX1744406557.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following conditions with the respective criteria used for their diagnosis . Condition Criteria 1. Plasma Cell Leukemia a) Clonal bone marrow plasma cells ≥60% 2. Multiple Myeloma b) Serum monoclonal protein (lgG or IgA) &amp;gt;30 g/L 3. Monoclonal Gammopathy of Undetermined Significance c) Plasma cell count &amp;gt;2000 plasma cells/μL 4. Smouldering Multiple Myeloma d) Clonal bone marrow plasma cells&amp;lt;10%", "options": [{"label": "A", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}, {"label": "B", "text": "1-a, 2-d, 3-b, 4-c", "correct": false}, {"label": "C", "text": "1-d, 2-b, 3-c, 4-a", "correct": false}, {"label": "D", "text": "1-b, 2-c, 3-a, 4-d", "correct": false}], "correct_answer": "A. 1-c, 2-a, 3-d, 4-b", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male presents with persistent back pain, fatigue, and recurrent minor fractures. Laboratory tests show anemia, elevated serum creatinine, and hypercalcemia. An X-ray of the skull is taken, which is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Metastasis", "correct": false}, {"label": "B", "text": "Multiple myeloma", "correct": true}, {"label": "C", "text": "Eosinophilic granuloma", "correct": false}, {"label": "D", "text": "Hyperparathyroidism", "correct": false}], "correct_answer": "B. Multiple myeloma", "question_images": ["https://image.prepladder.com/notes/q0TZpjlJSBR0BoU3a6v71744406103.png"], "explanation_images": ["https://image.prepladder.com/notes/q0TZpjlJSBR0BoU3a6v71744406103.png", "https://image.prepladder.com/notes/s71vUEcePHGJi9w5NGzA1744406927.png", "https://image.prepladder.com/notes/PXsr7U1ibV2YXXURVZDF1744407623.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male presents with fatigue, bone pain, and recurrent infections. Lab tests show elevated β2-microglobulin and low albumin levels. Which of the following drugs is not part of his initial therapy for transplant-eligible patients?", "options": [{"label": "A", "text": "Bortezomib", "correct": false}, {"label": "B", "text": "Lenalidomide", "correct": false}, {"label": "C", "text": "Cyclophosphamide", "correct": true}, {"label": "D", "text": "Dexamethasone", "correct": false}], "correct_answer": "C. Cyclophosphamide", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ZmglFNqtyGLKSDDkz5Mo1744407953.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 64-year-old man presents with fever, fatigue, and recurrent infections. On further evaluation, his serum IgM level is 5g/dl. Which of the following is least likely to be associated with this condition?", "options": [{"label": "A", "text": "Peripheral neuropathy", "correct": false}, {"label": "B", "text": "Bone pain", "correct": true}, {"label": "C", "text": "Retinal vessel segmentation", "correct": false}, {"label": "D", "text": "Recurrent infections", "correct": false}], "correct_answer": "B. Bone pain", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following components does not characterise POEMS syndrome?", "options": [{"label": "A", "text": "Peripheral edema", "correct": true}, {"label": "B", "text": "Skin changes", "correct": false}, {"label": "C", "text": "Endocrine manifestations", "correct": false}, {"label": "D", "text": "Organomegaly", "correct": false}], "correct_answer": "A. Peripheral edema", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:764px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P</strong>olyneuropathy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>O</strong>rganomegaly <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>E</strong>ndocrine <strong>M</strong>anifestations <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>S</strong>kin changes</p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patients typically experience severe, progressive <span class=\"customMeta\" data-dictid=\"068d6642471692777198d89a1be687\">sensorimotor</span> <span class=\"customMeta\" data-dictid=\"04863b50b516927771967b59757561\">polyneuropathy</span> <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> bone lesions associated with myeloma.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatomegaly</li>\n<li>Lymphadenopathy</li>\n<li>Splenomegaly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Women may experience amenorrhea.</li>\n<li>Males may have <span class=\"customMeta\" data-dictid=\"960bd9fb3d1692777189abb8d8f4cf\">impotence</span> and gynecomastia.</li>\n<li>Hyperprolactinemia is also seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperpigmentation</li>\n<li>Hypertrichosis</li>\n<li>Skin thickening,</li>\n<li>Digital clubbing.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 22 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 23 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old woman presents with fatigue, pallor, and mild jaundice. Blood tests reveal a macrocytic anaemia with a mean cell volume (MCV) of 110 fL. Further testing showed elevated bilirubin and high lactate dehydrogenase (LDH), and peripheral blood smear showed the following: What is the most likely cause of her anaemia?", "options": [{"label": "A", "text": "Myelodysplasia", "correct": false}, {"label": "B", "text": "Vitamin B12 deficiency", "correct": true}, {"label": "C", "text": "Alcohol-induced liver disease", "correct": false}, {"label": "D", "text": "Reticulocytosis", "correct": false}], "correct_answer": "B. Vitamin B12 deficiency", "question_images": ["https://image.prepladder.com/notes/8zXsssC9NBpM9J5mpDqF1744419354.png"], "explanation_images": ["https://image.prepladder.com/notes/8zXsssC9NBpM9J5mpDqF1744419354.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: a. Bernard soulier syndrome 1. antibodies to, the metalloprotease ADAMTS13 b. Glanzmann’s thrombasthenia 2. absence of the platelet Gp Ib-IX-V receptor c. Hemolytic uremic syndrome 3. absence of the platelet Gp IIb/IIIa receptor d. Thrombotic Thrombocytopenic Purpura 4. Escherichia coli O157:H7", "options": [{"label": "A", "text": "a-1, b-2, c-3, d-4", "correct": false}, {"label": "B", "text": "a-2, b-3, c-4, d-1", "correct": true}, {"label": "C", "text": "a-3, b-4, c-1, d-2", "correct": false}, {"label": "D", "text": "a-4, b-1, c-2, d-3", "correct": false}], "correct_answer": "B. a-2, b-3, c-4, d-1", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/z479TkEbUHj1mtKNKdY51744426322.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>a. Bernard soulier syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. absence of the <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> Gp Ib-IX-V receptor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>b. Glanzmann’s thrombasthenia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. absence of the <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> Gp IIb/IIIa receptor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>c. <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> <span class=\"customMeta\" data-dictid=\"7b92610b86169277720111ae27d1d8\">uremic</span> syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. <span class=\"customMeta\" data-dictid=\"c2ea0d4bf01692777187d486aa6385\">Escherichia</span> <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> O157:H7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>d. Thrombotic Thrombocytopenic Purpura</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. antibodies to, the metalloprotease ADAMTS13</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: a) Hemophilia A 1. Factor IX deficiency b) Von-Willebrand disease 2. Factor XIII deficiency c) Osler weber rendu disease 3. Factor VIII deficiency d) Laki lorand factor 4. Arteriovenous malformations e) Hemophilia B 5. Von willebrand factor deficiency", "options": [{"label": "A", "text": "a-2, b-5, c-1, d-3, e-4", "correct": false}, {"label": "B", "text": "a-1, b-5, c-2, d-4, e-3", "correct": false}, {"label": "C", "text": "a-4 , b-5, c-3, d-1, e-2", "correct": false}, {"label": "D", "text": "a-3, b-5, c-4, d-2, e-1", "correct": true}], "correct_answer": "D. a-3, b-5, c-4, d-2, e-1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Hemophilia A</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. <span class=\"customMeta\" data-dictid=\"65dc2273b5169277720208ba704b7f\">Factor VIII</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Von-Willebrand disease</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. Von willebrand factor deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Osler <span class=\"customMeta\" data-dictid=\"0495fb4f8216927772029622eabcaa\">weber</span> rendu disease</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">Arteriovenous</span> malformations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Laki lorand factor</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. <span class=\"customMeta\" data-dictid=\"dbf5db7ad1169277720292b2d2e956\">Factor XIII</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Hemophilia B</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"f8846c9a0516927772020622977113\">Factor IX</span> deficiency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male is being treated for tuberculosis with rifampin, isoniazid, and pyrazinamide. He has been on this regimen for the past 4 weeks. Over the last few days, he has noticed easy bruising, petechiae on his legs, and gum bleeding. He denies any history of trauma and he does not have any signs of active bleeding. On examination, he has petechiae on his extremities and ecchymosis. Laboratory tests show: Platelet count: 45,000/µL (normal range: 150,000–450,000/µL) Hemoglobin: 13.5 g/dL (normal) White blood cell count: Normal Peripheral blood smear: No signs of platelet clumping, but reduced platelet count Which of the following is the most likely cause of this patient's condition?", "options": [{"label": "A", "text": "Heparin-induced thrombocytopenia (HIT)", "correct": false}, {"label": "B", "text": "Drug-induced thrombocytopenia due to rifampin", "correct": true}, {"label": "C", "text": "Immune thrombocytopenic purpura (ITP)", "correct": false}, {"label": "D", "text": "Disseminated intravascular coagulation (DIC)", "correct": false}], "correct_answer": "B. Drug-induced thrombocytopenia due to rifampin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a correct combination of PBF cells?", "options": [{"label": "A", "text": "1) Monocyte, 2) Basophil, 3) Lymphocyte, 4) Eosinophil, 5) Neutrophil", "correct": true}, {"label": "B", "text": "1) Lymphocyte, 2) Eosinophil, 3) Basophil, 4) Neutrophil, 5) Monocyte", "correct": false}, {"label": "C", "text": "1) Eosinophil, 2) Basophil, 3) Monocyte, 4) Lymphocyte, 5) Neutrophil", "correct": false}, {"label": "D", "text": "1) Neutrophil, 2) Monocyte, 3) Lymphocyte, 4) Basophil, 5) Eosinophil", "correct": false}], "correct_answer": "A. 1) Monocyte, 2) Basophil, 3) Lymphocyte, 4) Eosinophil, 5) Neutrophil", "question_images": ["https://image.prepladder.com/notes/ginFLS1RlapThwRXNjkv1744424230.png"], "explanation_images": ["https://image.prepladder.com/notes/uIchhHN83CHbUubfIWF51744424744.png", "https://image.prepladder.com/notes/G3L6UOnt43DVwViMpmC81744425615.png", "https://image.prepladder.com/notes/ylRZeQdjq2w9IHSYumC01745645178.png", "https://image.prepladder.com/notes/mEk5zAZwoGOdUH34uhkd1744425692.png", "https://image.prepladder.com/notes/tCLlvKM9zMTeIKqId9jj1744425885.png", "https://image.prepladder.com/notes/SCUVCnv1HR825naFeuyq1744426005.png", "https://image.prepladder.com/notes/qSQ2jXAqnVzumkZUtAgv1744426089.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Slide </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Red Blood Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Round, <span class=\"customMeta\" data-dictid=\"896c5b0b3616927771836c801b78c2\">biconcave</span> shape</li>\n<li>Stain deeply with eosin</li>\n<li>Diameter: 6.0–8.5 μm</li>\n<li>Mostly uniform; small percentage may appear <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> or <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> (schistocytes &lt;0.1%)</li>\n<li>Size: 6.0–8.5 μm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<figure class=\"caption_element\"><img alt=\"Red Blood Cells\" data-author=\"Keith Chambers\" data-hash=\"9772\" data-license=\"CC BY SA 3.0 \" data-source=\"https://en.wikipedia.org/wiki/File:Normal_Adult_Blood_Smear.JPG\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/uIchhHN83CHbUubfIWF51744424744.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>WBC’s</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Neutrophils</strong></p>\n<p><strong>(Image 5)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Segmented <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> (3–5 lobes)</li>\n<li>Pink/orange <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> due to granules</li>\n<li>Diameter: ~13 μm</li>\n<li>Size: ~13 μm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<figure class=\"caption_element\"><img alt=\"Neutrophil\" data-author=\"Ajay Kumar Chaurasiya\" data-hash=\"9773\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:WBC_%28neutrophil%29_at_centre,_numerous_erythrocytes_and_platelets_%28dot_like_bodies%29_in_Wright%27s_stained_peripheral_blood_smear_%28PBS%29_microscopy.jpg#/media/File:WBC_(neutrophil)_at_centre,_numerous_erythrocytes_and_platelets_(dot_like_bodies)_in_Wright's_stained_peripheral_blood_smear_(PBS)_microscopy.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/G3L6UOnt43DVwViMpmC81744425615.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Eosinophils</strong></p>\n<p><strong>(Image 4)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Two lobed nucleus</li>\n<li>Packed with gold/orange granules</li>\n<li>Diameter: 12–17 μm</li>\n<li>Size: 12–17 μm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Eosinophil\" data-author=\"Michael Dennis Weaver 1,*,†,Bianca Glass 2,†ORCID,Chance Aplanalp 2,Gauri Patel 2,Jeshrine Mazhil 2,Isabella Wang 2 andSamir Dalia 3\" data-hash=\"11329\" data-license=\"CC BY\" data-source=\"https://www.mdpi.com/2673-6357/5/1/8\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ylRZeQdjq2w9IHSYumC01745645178.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Basophils</strong></li>\n</ul>\n<p><strong>(Image 2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Compact, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> nucleus</li>\n<li>Large purple granules</li>\n<li>Rare (&lt;1% of leukocytes)</li>\n<li>Size: Variable (typically 12–15 μm)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<figure class=\"caption_element\"><img alt=\"Basophil\" data-author=\"El*Falaf\" data-hash=\"9774\" data-license=\"CC BY SA 3.0 \" data-source=\"https://en.wikipedia.org/wiki/Basophilia#/media/File:Hem1Basophile.jpg\" data-tags=\"April2025\" height=\"263\" src=\"https://image.prepladder.com/notes/mEk5zAZwoGOdUH34uhkd1744425692.png\" width=\"261\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Monocytes</strong></li>\n</ul>\n<p><strong>(Image 1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Largest leukocytes</li>\n<li>Horseshoe-shaped nucleus</li>\n<li>Bluish-grey <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> with fine granules</li>\n<li>Diameter: 15–18 μm</li>\n<li>Size:15–18 μm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<figure class=\"caption_element\"><img alt=\"Monocyte \" data-author=\" Furqan Rustam 1,2ORCID,Naila Aslam 3,Isabel De La Torre Díez 4,*ORCID,Yaser Daanial Khan 3ORCID,Juan Luis Vidal Mazón 5,6,7ORCID,Carmen Lili Rodríguez 5,8 andImran Ashraf 9,*ORCID\" data-hash=\"9775\" data-license=\"CC BY\" data-source=\"https://www.mdpi.com/2227-9032/10/11/2230\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/tCLlvKM9zMTeIKqId9jj1744425885.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Lymphocytes </strong><strong>(Image 3)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Small cells with a thin rim of cytoplasm</li>\n<li>Uniform <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (~9 μm in diameter)</li>\n<li>About 85% are T cells or NK cells</li>\n<li>Size: ~9 μm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<figure class=\"caption_element\"><img alt=\"Lymphocyte \" data-author=\" Furqan Rustam 1,2ORCID,Naila Aslam 3,Isabel De La Torre Díez 4,*ORCID,Yaser Daanial Khan 3ORCID,Juan Luis Vidal Mazón 5,6,7ORCID,Carmen Lili Rodríguez 5,8 andImran Ashraf 9,*ORCID\" data-hash=\"9776\" data-license=\"CC BY\" data-source=\"https://www.mdpi.com/2227-9032/10/11/2230\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/SCUVCnv1HR825naFeuyq1744426005.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Platelets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Irregular outline with fine red granules</li>\n<li>Diameter: 1–3 μm (some larger platelets up to 5 μm may be present)</li>\n<li>Size: 1–3 μm (up to 5 μm)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<figure class=\"caption_element\"><img alt=\"Platelets \" data-author=\"Dr Graham Beards\" data-hash=\"9777\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Platelet#/media/File:Platelets2.JPG\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/qSQ2jXAqnVzumkZUtAgv1744426089.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy presents with severe pain in his right elbow, which has persisted for the past two days. His mother reports that the pain is sharp and debilitating, causing him to wake up at night. On examination, he is pale and tachycardic, with a heart rate of 120 bpm. The right elbow shows swelling, tenderness, and warmth. A peripheral blood smear is performed as shown. Which of the following statements is incorrect for this condition?", "options": [{"label": "A", "text": "Decrease reticulocytes in aplastic crisis", "correct": false}, {"label": "B", "text": "Howell-Jolly bodies may be present", "correct": false}, {"label": "C", "text": "Newborns are symptomatic", "correct": true}, {"label": "D", "text": "Hydration may relieve symptoms", "correct": false}], "correct_answer": "C. Newborns are symptomatic", "question_images": ["https://image.prepladder.com/notes/hfgA3ZQGYzPtlPNkIpf91746006139.png"], "explanation_images": ["https://image.prepladder.com/notes/CJPBJDCVaK5QKzOJ5Juy1744422575.png", "https://image.prepladder.com/notes/qRqmXjFB3AXSDx4LrSfi1744422823.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder; <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in β-globin chain (Glu → Val); results in <span class=\"customMeta\" data-dictid=\"81bb02697216927771887f2fffc386\">HbS</span> instead of HbA.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Homozygote (HbSS): Sickle cell anemia</li>\n<li>Heterozygote (HbAS): <span class=\"customMeta\" data-dictid=\"eae0e23ef41692777198f15774290f\">Sickle cell trait</span> (asymptomatic, protects against malaria).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> survival;HbS polymerises to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> sticky stiff Hb precipitates- causes <span class=\"customMeta\" data-dictid=\"a4f67f90fa169277719829965d14e9\">sickling</span> ; sickled cells cause vaso-occlusion, especially during <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">dehydration</span> or deoxygenation.</p>\n<p>Factors increasing sickling- Acidosis, hypoxia, dehydration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Classic Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Sudden severe pain (chest, back, thigh); may include fever.</li>\n<li><strong>Acute chest syndrome: </strong>\n<ul>\n<li>Chest pain, fever, wheezing, cough, tachypnea</li>\n<li>Common infections (S. pneumoniae, Mycoplasma, etc.)</li>\n</ul>\n</li>\n<li>Other Vaso-occlusive crises: (triggered by infection, hypoxia, dehydration, cold)\n\t\t\t\t<ul>\n<li>Dactylitis</li>\n<li>Mesenteric ischemia</li>\n<li>CNS <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (stroke)</li>\n<li>Priapism</li>\n<li>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> (AVN)</li>\n</ul>\n</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> necrosis: decreased ability to concentrate urine; may present as polyuria/nocturia</li>\n<li>Anemia, jaundice, <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> cholelithiasis</li>\n<li>Osteomyelitis (S. aureus, Salmonella).</li>\n<li>Aplastic crisis (transient arrest of <span class=\"customMeta\" data-dictid=\"317dbdacdb16927771878c7860f69b\">erythropoiesis</span> due to <span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\">parvovirus</span> B19)<strong> (Option A)</strong></li>\n<li>Autosplenectomy (<strong>Howell-Jolly bodies</strong>) increases the risk of infection by <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> organisms (eg, S pneumoniae)<strong> (Option B)</strong></li>\n<li>CHF, delayed growth</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Best initial test: <span class=\"customMeta\" data-dictid=\"4feca1220c16927771832d229ba003\">CBC</span> (↑ reticulocytes, ↑ <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> bilirubin) with <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> showing sickle cells</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Sickle- cell anemia\" data-author=\"Dr Graham beards\" data-hash=\"9769\" data-license=\"CC BY SA 3.0 \" data-source=\"https://en.wikipedia.org/wiki/Sickle_cell_trait#/media/File:Sickle_cells.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/CJPBJDCVaK5QKzOJ5Juy1744422575.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n\t\t\t \n\n\t\t\t<ul>\n<li>Screening: <span class=\"customMeta\" data-dictid=\"a4f67f90fa169277719829965d14e9\">sickling</span> test (creating artificial <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> with 2% Na-metabisulphite)</li>\n<li>High-performance liquid <span class=\"customMeta\" data-dictid=\"fdf5ab514d1692777184d9fe915cba\">chromatography</span> (HPLC) is the investigation of choice.</li>\n<li>X-ray:\n\t\t\t\t<ul>\n<li><strong>Crew cut</strong> on skull <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">x-ray</span> due to marrow</li>\n<li>Due to expansion from increased <span class=\"customMeta\" data-dictid=\"317dbdacdb16927771878c7860f69b\">erythropoiesis</span> (also seen in thalassemias).</li>\n</ul>\n</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Crew cut appearance\" data-author=\"Weerakkody Y, Niknejad M, Skalski M,\" data-hash=\"9770\" data-license=\"\" data-source=\"https://radiopaedia.org/articles/hair-on-end-sign-mnemonic\" data-tags=\"April2025\" height=\"309\" src=\"https://image.prepladder.com/notes/qRqmXjFB3AXSDx4LrSfi1744422823.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management of Chronic Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hydroxyurea\n\t\t\t\t<ul>\n<li>Increases <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> hemoglobin</li>\n<li>Monitor WBCs.</li>\n</ul>\n</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> therapy\n\t\t\t\t<ul>\n<li>Risk of iron overload.</li>\n</ul>\n</li>\n<li>Folic acid supplementation\n\t\t\t\t<ul>\n<li>Prevents macrocytic anemia.</li>\n<li>HSCT (TOC)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management of Crises</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Pain management</li>\n<li>O2 therapy</li>\n<li>IV fluid rehydration<strong> (Option D)</strong></li>\n<li>Antibiotics if infection suspected.</li>\n<li>For VOCs progressing to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> chest syndrome\n\t\t\t\t<ul>\n<li>Aggressive hydration, antibiotics, incentive spirometry, transfusions if needed.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prophylaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Prophylactic pneumococcal <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> and antibiotics for patients with auto splenectomy</li>\n<li>Cholecystectomy for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> cholelithiasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sickle Cell Trait (HbAS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Generally benign</li>\n<li>Complications include hematuria, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> concentrating defect, and increased <span class=\"customMeta\" data-dictid=\"210e94f8861692777201a0d6de4b0e\">UTI</span> risk.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male presents with fatigue, weight loss, numbness in his fingers, and episodes of cold-induced color changes. A bone marrow biopsy shows greater than 10% small lymphocytes and a finding as shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Multiple myeloma", "correct": false}, {"label": "B", "text": "Waldenström macroglobulinemia", "correct": true}, {"label": "C", "text": "Monoclonal gammopathy of undetermined significance", "correct": false}, {"label": "D", "text": "Chronic lymphocytic leukemia", "correct": false}], "correct_answer": "B. Waldenström macroglobulinemia", "question_images": ["https://image.prepladder.com/notes/vq7zujwuInlBMu1deBkv1746006246.png"], "explanation_images": ["https://image.prepladder.com/notes/HFE8w0Hjc5Rk9d7p7s7V1744421516.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Key features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>B cell malignancy</li>\n<li>MYD88 mutation</li>\n<li>Increased levels of <strong>IgM</strong> <strong>(Vs increase <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">igA</span> &amp; <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">igG</span> in MM)</strong></li>\n<li>MGUS is the <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> just as in multiple myeloma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lethargy, weight loss, raynaud phenomenon, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy</li>\n<li>Hyperviscosity syndrome: Headache, blurry vision, <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages</li>\n<li>No <span class=\"customMeta\" data-dictid=\"a3792999e71692777185880d431114\">CRAB</span> symptoms (hyper<u>C</u>alcemia, <u>r</u>enal involvement,<u> a</u>nemia, <u>b</u>one <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> lesions) <strong>Vs MM has <span class=\"customMeta\" data-dictid=\"a3792999e71692777185880d431114\">CRAB</span> symptoms</strong><strong> (Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Thrombosis</li>\n<li>Organomegaly and dysfunction</li>\n<li>Cryoglobulinemia</li>\n<li>Cold <span class=\"customMeta\" data-dictid=\"793dda05ac1692777180345347d49c\">agglutinin</span> disease (AIHA)</li>\n<li>Amyloidosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> and <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> <strong>(most accurate)</strong>\n<ul>\n<li>&gt; 10% small lymphocytes</li>\n<li>Intranuclear cytoplasmic pseudo-inclusions<strong> (Dutcher bodies)</strong></li>\n<li>Dutcher bodies (PAS-positive <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> deposits)</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Waldenstrom macroglobulinemia- Dutcher body\" data-author=\"Anubha Bajaj\" data-hash=\"9768\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/WM-intra-nuclear-inclusions-known-as-Dutchers-body-Courtesy-Image-bank-haematology_fig12_333373260\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/HFE8w0Hjc5Rk9d7p7s7V1744421516.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Serum and <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> protein electrophoresis</li>\n<li>Immunofixation, increased ESR, <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid, LDH, <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> (nonspecific)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Rituximab</li>\n<li>Chemotherapy</li>\n<li>Plasmapheresis (for <span class=\"customMeta\" data-dictid=\"e8716e1e311692777189738429bab5\">hyperviscosity</span> symptoms)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding the PBF shown is incorrect?", "options": [{"label": "A", "text": "It is associated with an autoimmune condition", "correct": false}, {"label": "B", "text": "It is associated with a hereditary condition", "correct": false}, {"label": "C", "text": "Cells show an increase in surface area-to-volume ratio", "correct": true}, {"label": "D", "text": "Mycoplasma pneumonia may be a cause", "correct": false}], "correct_answer": "C. Cells show an increase in surface area-to-volume ratio", "question_images": ["https://image.prepladder.com/notes/qFBMX7jUNUjVylzNOWGn1746006430.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Small, spherical cells without central pallor.</li>\n<li><strong>Surface area-to-volume ratio: decreased</strong> due to loss of <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> surface area. <strong>(Option C)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Spherocytosis- &lt;span class=\" custommeta\"=\"\" data-dictid=\"255674f3271692777195c172d86daf\"/>Peripheral smear\" data-author=\"Paulo Henrique Orlandi Mourao\" data-hash=\"9767\" data-license=\"CC BY SA 3.0 \" data-source=\"https://en.wikipedia.org/wiki/Spherocytosis#/media/File:Hereditary_Spherocytosis_smear_2010-03-17.JPG\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/jzarLBgTUY72HcDwlQcR1744420900.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hereditary <span class=\"customMeta\" data-dictid=\"d30f4533661692777199385959bd9f\">Spherocytosis</span> <strong>(Option A)</strong></li>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">Anemia</span> (AIHA) <strong>(Option B)</strong><strong>, </strong>G6PD <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> , burns , BT reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Key tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Both conditions can present with spherocytes and positive osmotic <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> tests.</li>\n<li>Only <span class=\"customMeta\" data-dictid=\"3b4c3c13fb169277718004f65ca0b1\">AIHA</span> will have a positive direct Coombs’s test.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hereditary Spherocytosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">Anemia</span> (AIHA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Autosomal dominant <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> proteins (ankyrin&gt;&gt;spectrin) leading to spherical RBCs.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Autoantibodies against <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> causing <span class=\"customMeta\" data-dictid=\"26e1dbfb921692777187208a4ff0e9\">extravascular</span> hemolysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Extravascular <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia, splenomegaly, jaundice; risk of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"180ce1a7c416927771844825c616f4\">cholecystitis</span> from <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> gallstones.</p>\n<p>Aplastic crisis: <span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\">Parvovirus</span> B19</p>\n<p>Hemolytic crisis: EBV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hemolytic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Best Initial Test: <span class=\"customMeta\" data-dictid=\"4feca1220c16927771832d229ba003\">CBC</span> (normal to low MCV, ↑ MCHC, ⊖ Coombs test)</li>\n<li>Blood Smear: Shows spherocytes</li>\n<li>Most Accurate Test: Eosin-5 maleimide flow cytometry, acidified <span class=\"customMeta\" data-dictid=\"124462cc291692777188e1a9cce583\">glycerol</span> <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> test.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Direct Coombs Test: <strong>Positive</strong> in warm AIHA</li>\n<li>Cold <span class=\"customMeta\" data-dictid=\"793dda05ac1692777180345347d49c\">Agglutinin</span> Test: Effective in cold AIHA.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Splenectomy (stops <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> but spherocytes remain)</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> replacement (assists <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> production).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Mild AIHA: No treatment necessary</li>\n<li>Warm AIHA: Steroids; <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> episodes</li>\n<li>Severe, non-responsive hemolysis: IVIG</li>\n<li>Severe cold AIHA: Keep warm, ± rituximab.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>N/A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Warm AIHA: IgG, associated with SLE, CLL, lymphoma, some drugs.</li>\n<li>Cold AIHA: IgM, associated with <span class=\"customMeta\" data-dictid=\"28c0a387c916927771930b5215e045\">Mycoplasma</span> pneumonia, EBV, Waldenström <span class=\"customMeta\" data-dictid=\"d2e790fd63169277719172fdcca409\">macroglobulinemia</span> <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which condition is most likely associated with the cell marked with an arrow in the blood film?", "options": [{"label": "A", "text": "A) Aortic Stenosis", "correct": false}, {"label": "B", "text": "HELLP Syndrome", "correct": false}, {"label": "C", "text": "C) DIC", "correct": false}, {"label": "D", "text": "D) All of the above", "correct": true}], "correct_answer": "D. D) All of the above", "question_images": ["https://image.prepladder.com/notes/2HaodncrVORWSZTMMrW91744420560.png"], "explanation_images": ["https://image.prepladder.com/notes/2HaodncrVORWSZTMMrW91744420560.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Condition Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> \n\t\t\t<p><strong>Microangiopathic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> Anemias</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Red blood cells (RBCs) are damaged as they pass through obstructed or narrowed blood vessels.</li>\n<li>Causes <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> due to <span class=\"customMeta\" data-dictid=\"1a9e83a309169277719859946ca445\">shear</span> stress and mechanical damage.</li>\n<li><strong>Causes:</strong>\n<ul>\n<li>Disseminated <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">Intravascular</span> <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">Coagulation</span> (DIC)</li>\n<li>Thrombotic Thrombocytopenic <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">Purpura</span> (TTP) / <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> <span class=\"customMeta\" data-dictid=\"7b92610b86169277720111ae27d1d8\">Uremic</span> Syndrome (HUS)</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Erythematosus (SLE)</li>\n<li>HELLP Syndrome</li>\n<li>Hypertensive Emergency</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Macroangiopathic</strong></p>\n<p><strong>hemolytic anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>A type of <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> caused by mechanical destruction of red blood cells (RBCs).</li>\n<li>Causes:\n\t\t\t\t<ul>\n<li><strong>Prosthetic Heart Valves</strong>:\n\t\t\t\t\t<ul>\n<li>Leads to turbulent <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and <span class=\"customMeta\" data-dictid=\"1a9e83a309169277719859946ca445\">shear</span> stress on RBCs, resulting in their destruction.</li>\n</ul>\n</li>\n<li><strong>Aortic Stenosis</strong>:\n\t\t\t\t\t<ul>\n<li>Narrowing of the <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> leads to mechanical destruction of RBCs as they pass through the constricted area.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old man presents to the emergency department with fatigue, jaundice, and dark urine. A blood film reveals: The patient has a history of dapsone use for the management of a skin condition.Which of the following is the most likely underlying cause of the bite cell formation in this patient?", "options": [{"label": "A", "text": "Sickle cell disease", "correct": false}, {"label": "B", "text": "Vitamin B12 deficiency", "correct": false}, {"label": "C", "text": "Glucose-6-phosphate dehydrogenase (G6PD) deficiency", "correct": true}, {"label": "D", "text": "Iron deficiency anaemia", "correct": false}], "correct_answer": "C. Glucose-6-phosphate dehydrogenase (G6PD) deficiency", "question_images": ["https://image.prepladder.com/notes/pWDnaeI5o0SCUYomDkvq1744420218.png"], "explanation_images": ["https://image.prepladder.com/notes/pWDnaeI5o0SCUYomDkvq1744420218.png", "https://image.prepladder.com/notes/uXWtKaqbEiDZwCrJU3WR1744420365.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man with non-Hodgkin lymphoma (NHL) is undergoing evaluation for his treatment response. His healthcare provider orders a scan. Which of the following statements best describes the role of the above scan in the management of NHL?", "options": [{"label": "A", "text": "Bone scans are primarily used for initial diagnosis and do not provide information on treatment response.", "correct": false}, {"label": "B", "text": "PET scans can assess metabolic activity to help stage the disease and monitor treatment effectiveness.", "correct": true}, {"label": "C", "text": "Gallium-67 scans are useful for detecting recurrence of lymphoma.", "correct": false}, {"label": "D", "text": "Tc-99m tilmanocept scans require preparation and cannot be performed immediately after a meal.", "correct": false}], "correct_answer": "B. PET scans can assess metabolic activity to help stage the disease and monitor treatment effectiveness.", "question_images": ["https://image.prepladder.com/notes/3H7jRHLWY44QTgNQfOXc1744419841.png"], "explanation_images": ["https://image.prepladder.com/notes/3H7jRHLWY44QTgNQfOXc1744419841.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess disease spread by identifying areas of increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity indicating cancer.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Differentiate between active cancer cells and <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue after treatment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Detection of Recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitor for potential <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> recurrence, guiding further management.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Safety</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small radiation exposure; benefits in NHL diagnosis and management typically outweigh risks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Discuss concerns with healthcare providers before the procedure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most likely complication associated with the above intravenous access system?", "options": [{"label": "A", "text": "Thrombosis", "correct": false}, {"label": "B", "text": "Bloodstream infection", "correct": true}, {"label": "C", "text": "Device fracture", "correct": false}, {"label": "D", "text": "Air embolism", "correct": false}], "correct_answer": "B. Bloodstream infection", "question_images": ["https://image.prepladder.com/notes/3IMPVmwH22oPugrZN1FV1744419611.png"], "explanation_images": ["https://image.prepladder.com/notes/3IMPVmwH22oPugrZN1FV1744419611.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man diagnosed with chronic ITP 6 months ago presents with recurrent oral mucosal bleeding despite treatment with prednisolone. His platelet count is 45,000/µL. He is not a candidate for splenectomy. Which of the following is the most appropriate next-line therapy?", "options": [{"label": "A", "text": "Eltrombopag", "correct": true}, {"label": "B", "text": "Intravenous immunoglobulin (IVIgG)", "correct": false}, {"label": "C", "text": "Platelet transfusion", "correct": false}, {"label": "D", "text": "High-dose prednisolone", "correct": false}], "correct_answer": "A. Eltrombopag", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman presents with localised bone pain and swelling in her left femur. A biopsy confirms the presence of abnormal plasma cells. Based on this presentation, which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Multiple myeloma", "correct": false}, {"label": "B", "text": "Solitary plasmacytoma of bone", "correct": true}, {"label": "C", "text": "Extramedullary plasmacytoma", "correct": false}, {"label": "D", "text": "Osteosarcoma", "correct": false}], "correct_answer": "B. Solitary plasmacytoma of bone", "question_images": ["https://image.prepladder.com/notes/TsDmHBZxZThF74GU1jW71744418776.png", "https://image.prepladder.com/notes/52hp0s3wDL67D0DMCZUn1744418950.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:524px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiation Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary treatment for <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> plasmacytomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Considered if risk of <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to multiple myeloma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Intervention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be indicated for tumour removal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old male presents with lymphadenopathy, fatigue, and weight loss. A peripheral blood smear reveals atypical lymphocytes with cleaved, lobulated nuclei resembling as shown below. Based on the histological findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Chronic Lymphocytic Leukemia (CLL)", "correct": false}, {"label": "B", "text": "Adult T-cell Leukemia-Lymphoma (ATLL)", "correct": true}, {"label": "C", "text": "Hodgkin's Lymphoma", "correct": false}, {"label": "D", "text": "Non-Hodgkin Lymphoma", "correct": false}], "correct_answer": "B. Adult T-cell Leukemia-Lymphoma (ATLL)", "question_images": ["https://image.prepladder.com/notes/4ccEYmWKAlmrVirsfqml1744418430.png"], "explanation_images": ["https://image.prepladder.com/notes/9816N5hLI80IQHlZ3RVn1744418545.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nuclear Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cleaved and <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> resembling a cloverleaf; seen in <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> lymphocytes (e.g., ATLL).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cytoplasm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Basophilic, larger than normal lymphocytes (twice the size of an erythrocyte).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral Blood Smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shows cloverleaf cells with <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> nuclear <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> and increased size in ATLL.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reveals <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> lymphocytes, useful for diagnosis and <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> of ATLL.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adult T-cell Leukemia-Lymphoma (ATLL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"0bf7f32c9d16927771894f74e84c94\">HTLV-1</span> infection; presents with leukocytosis,Tax gene +, thrombocytosis, and elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> levels. <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> may show <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> lymphadenopathy.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral Blood Smears</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identification of cloverleaf cells (CD3+ T- lymphocytes).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HTLV-1 Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirmation of <span class=\"customMeta\" data-dictid=\"0bf7f32c9d16927771894f74e84c94\">HTLV-1</span> presence via serological testing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flow Cytometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assists in characterizing the T-cell population involved in ATLL.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with fatigue, weakness, and pallor. A peripheral blood smear reveals red blood cells that are smaller than normal and exhibit a decreased color saturation, with a prominent central pallor noted in the histological examination as shown below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Thalassemia", "correct": false}, {"label": "B", "text": "Sideroblastic anemia", "correct": false}, {"label": "C", "text": "Iron deficiency", "correct": true}, {"label": "D", "text": "Chronic disease", "correct": false}], "correct_answer": "C. Iron deficiency", "question_images": ["https://image.prepladder.com/notes/c0zcBgCYuvrUAecnUCLB1746006551.png"], "explanation_images": ["https://image.prepladder.com/notes/MQdxNBVrAVuPcpujZQYx1744417601.png", "https://image.prepladder.com/notes/HDCsfYdModPPgA1jb1kW1745644793.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iron Deficiency</strong></p>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common cause</strong>; iron is essential for <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> synthesis, and its <strong>deficiency leads to decreased <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> production</strong>, resulting in microcytic, <span class=\"customMeta\" data-dictid=\"07ccd8f461169277718970a6f1a131\">hypochromic</span> red blood cells.</p>\n<figure class=\"caption_element\"><img alt=\"Iron &lt;span class=\" custommeta\"=\"\" data-dictid=\"209b85faf71692777185767d43e3bd\"/>deficiency anemia- peripheral smear\" data-author=\"Ed Uthman\" data-hash=\"9755\" data-license=\"CC BY 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Iron-deficiency_Anemia,_Peripheral_Blood_Smear_%284422704616%29.jpg#/media/File:Iron-deficiency_Anemia,_Peripheral_Blood_Smear_(4422704616).jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Q6oPG4JNzpNWeVui8F361744415830.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thalassemia</strong></p>\n<p> </p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genetic disorder affecting <span class=\"customMeta\" data-dictid=\"debd75cb191692777188288f956f22\">globin</span> chain synthesis, leading to <strong>imbalanced <span class=\"customMeta\" data-dictid=\"debd75cb191692777188288f956f22\">globin</span> production and impaired <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> synthesis</strong>, resulting in smaller, paler red blood cells. <strong>(Option A ruled out) </strong></p>\n<figure class=\"caption_element\"><img alt=\"Peripheral smear- Beta &lt;span class=\" custommeta\"=\"\" data-dictid=\"baed0c93841692777200be26c8b9d2\"/>thalassemia minor\" data-author=\"Khera, Rachna &amp; Singh, Tejinder. \" data-hash=\"9747\" data-license=\"ResearchGate GmbH. All rights reserved.\" data-source=\"https://www.researchgate.net/figure/b-Thalassemia-minor-Peripheral-smear-showing-mild-anisopoikilocytosis-and-microcytic_fig5_273835999\" data-tags=\"April2025\" height=\"263\" src=\"https://image.prepladder.com/notes/bTPc1oPiox3FCvcjZdV01744410489.png\" width=\"400\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sideroblastic Anemia</strong></p>\n<p></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Less common causes are characterized by <strong>defective iron utilization</strong>, leading to iron accumulation in <span class=\"customMeta\" data-dictid=\"18c9e7b9721692777192bd042528cc\">mitochondria</span> and ineffective <span class=\"customMeta\" data-dictid=\"7bc107ea09169277719095466ee864\">incorporation</span> into hemoglobin. <strong>(Option B ruled out) </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Sideroblastic anemia- peripheral smear\" data-author=\"Prof. Erhabor Osaro\" data-hash=\"9756\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Basophilic_stippling#/media/File:Basophilic_stippling_2.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/MQdxNBVrAVuPcpujZQYx1744417601.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ringed sideroblasts\" data-author=\"Camille Lours ,Laurane Cottin,Margaux Wiber,Valérie Andrieu ,Véronique Baccini ,Lucile Baseggio ,Chantal Brouzes 6,Bernard Chatelain 7,Sylvie Daliphard 8,Odile Fenneteau 9,Franck Geneviève 2,Sandrine Girard 1,Vincent Leymarie 10,Karim Maloum 11,Jean-Baptiste Rieu 12,Gérard Sebahoun 13,Isabelle Sudaka 14,Xavier Troussard 15,Orianne Wagner-Ballon 16,Soraya Wuilleme 17,Valérie Bardet Jean-François Lesesve \" data-hash=\"11327\" data-license=\"CC BY\" data-source=\"https://www.mdpi.com/2075-4418/12/7/1698\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/HDCsfYdModPPgA1jb1kW1745644793.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n<p style=\"text-align:center\"><strong>Ringed sideroblast</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient presents with bone pain, anemia, and increased susceptibility to infections. A bone marrow biopsy reveals hypercellularity with the infiltration of plasma cells exhibiting a distinctive fiery red cytoplasm and a prominent Golgi apparatus as shown below. Immunohistochemical staining shows positivity for CD38 and CD138. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Chronic lymphocytic leukemia", "correct": false}, {"label": "B", "text": "Multiple myeloma", "correct": true}, {"label": "C", "text": "Lymphoma", "correct": false}, {"label": "D", "text": "Acute myeloid leukemia", "correct": false}], "correct_answer": "B. Multiple myeloma", "question_images": ["https://image.prepladder.com/notes/clRHK2l5vPNKT20bwVPY1744413388.png"], "explanation_images": ["https://image.prepladder.com/notes/clRHK2l5vPNKT20bwVPY1744413388.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multiple Myeloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MM usually presents in the fifth to seventh decade of life with fatigue, bone pain, anemia, and hypercalcemia</p>\n<p>Associated with flame cells; indicates a more aggressive disease course.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eosinophilic Dermatosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of flame figures (eosinophilic major basic protein deposits in collagen) <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to hematologic malignancies; characterized by pruritic, erythematous papules and <span class=\"customMeta\" data-dictid=\"4b0fee14c816927772016e67cf3a13\">vesicular</span> lesions.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-month-old child presents with severe pallor, failure to thrive, and hepatosplenomegaly. Peripheral blood smear shows microcytic hypochromic anemia, erythroblasts in circulation, and target cells. Bone marrow biopsy reveals increased cellularity with dysplastic erythroid precursors and iron-laden macrophages. Hemoglobin electrophoresis reveals elevated HbF levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Beta-thalassemia major", "correct": true}, {"label": "B", "text": "Iron deficiency anemia", "correct": false}, {"label": "C", "text": "Hemoglobin H disease", "correct": false}, {"label": "D", "text": "Sideroblastic anemia", "correct": false}], "correct_answer": "A. Beta-thalassemia major", "question_images": ["https://image.prepladder.com/notes/6J2ynDHmo8FY9kvVSjex1746006729.png"], "explanation_images": ["https://image.prepladder.com/notes/F9b9SUfCxhzMP3xGJEw41744411247.png", "https://image.prepladder.com/notes/sbuz4lkeKoJxURL7Fiwc1744411679.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prevalence</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alpha-thalassemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutation in <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> gene <span class=\"customMeta\" data-dictid=\"464bf779d5169277719153249764b9\">loci</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 16 (1-4 deletions)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in Southeast Asia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-thalassemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Point mutations impairing <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> chain <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> (β0 or β–)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevalent in the Mediterranean</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-thalassemia major</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"07ccd8f461169277718970a6f1a131\">hypochromic</span> anemia, red cell dysplasia, erythroblastosis, high HbF</p>\n<p>Bone marrow: Increased <span class=\"customMeta\" data-dictid=\"aed7aaaa4516927771844cded86cdb\">cellularity</span> with <span class=\"customMeta\" data-dictid=\"fd29b16a0e1692777186324bd9a553\">dysplastic</span> <span class=\"customMeta\" data-dictid=\"892718f3e916927771871389d2e1a3\">erythroid</span> cells and <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> iron deposits (non-ring sideroblasts).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-thalassemia minor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild anemia, <span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\">microcytic</span> <span class=\"customMeta\" data-dictid=\"07ccd8f461169277718970a6f1a131\">hypochromic</span> RBCs (without iron deficiency), target cells and <span class=\"customMeta\" data-dictid=\"77074d46b51692777196747de93965\">punctate</span> <span class=\"customMeta\" data-dictid=\"e2d6b9c32d16927771827c402706c3\">basophilia</span> on blood smear, high HbA2</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:384px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deletions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Outcome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No clinical effect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymptomatic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypochromic RBCs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemoglobin H disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate anemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydrops fetalis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fatal in utero</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:511px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-thalassemia major</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular transfusions</p>\n<p>Folic acid</p>\n<p>Iron chelation</p>\n<p>Splenectomy (if needed)</p>\n<p>Hematopoietic <span class=\"customMeta\" data-dictid=\"467c0b4fc016927771997e1043aeda\">stem cell transplantation</span> (HSCT)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemoglobin H disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Folic acid</p>\n<p>Occasional transfusions</p>\n<p>Avoid iron supplements</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-thalassemia Major</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> from <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> (pallor, fatigue, failure to thrive).</li>\n<li>Growth <span class=\"customMeta\" data-dictid=\"680dfbc5a5169277719748281f877e\">retardation</span> and developmental delays.</li>\n<li>Skeletal deformities (facial bones and skull) due to <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> expansion.</li>\n<li>Splenomegaly and <span class=\"customMeta\" data-dictid=\"08b6b28bdd1692777188bad018e4e9\">hepatomegaly</span> from <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> destruction and <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> hematopoiesis.</li>\n<li>Iron <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> from frequent transfusions affects the heart, liver, and <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> glands.</li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Splenomegaly in &lt;span class=\" custommeta\"=\"\" data-dictid=\"baed0c93841692777200be26c8b9d2\"/>Thalassemia patient\" data-author=\"ShazidSharif\" data-hash=\"9748\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Thalassemia#/media/File:%E0%A6%8F%E0%A6%95%E0%A6%9C%E0%A6%A8_%E0%A6%A5%E0%A7%8D%E0%A6%AF%E0%A6%BE%E0%A6%B2%E0%A6%BE%E0%A6%B8%E0%A7%87%E0%A6%AE%E0%A6%BF%E0%A6%AF%E0%A6%BC%E0%A6%BE%E0%A6%B0_%E0%A6%B0%E0%A7%8B%E0%A6%97%E0%A7%80.jpg\" data-tags=\"April2025\" height=\"261\" src=\"https://image.prepladder.com/notes/cKs0CNfH2hRO29SnfFWg1744411066.png\" width=\"300\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Thalassemic facies\" data-author=\"Gibbons R.\" data-hash=\"9749\" data-license=\"CC BY 2.0\" data-source=\"https://commons.wikimedia.org/wiki/Category:Alpha-thalassemia_mental_retardation_syndrome#/media/File:Atr-x.jpg\" data-tags=\"April2025\" height=\"410\" src=\"https://image.prepladder.com/notes/F9b9SUfCxhzMP3xGJEw41744411247.png\" width=\"300\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hair on end Appearance\" data-author=\"Sunil, Aswathy &amp; Sivarajakumar, Baranitharan &amp; Kumari, Vijaya. \" data-hash=\"9750\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Lateral-skull-radiograph-a-showing-widened-diploic-space-with-hair-on-end-appearance_fig4_370439537\" data-tags=\"April2025\" height=\"314\" src=\"https://image.prepladder.com/notes/sbuz4lkeKoJxURL7Fiwc1744411679.png\" width=\"300\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-thalassemia Minor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymptomatic or mild anemia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old male presents with fatigue, melena, and frequent bruising. Physical examination reveals a systolic ejection murmur. Laboratory tests show reduced levels of high molecular weight von Willebrand factor (VWF). Which of the following interventions is most likely to reduce his gastrointestinal bleeding?", "options": [{"label": "A", "text": "Colonoscopic resection of angiodysplastic lesions", "correct": false}, {"label": "B", "text": "Initiation of von Willebrand factor replacement therapy", "correct": false}, {"label": "C", "text": "Aortic valve replacement", "correct": true}, {"label": "D", "text": "Long-term use of proton pump inhibitors", "correct": false}], "correct_answer": "C. Aortic valve replacement", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/e2iDaSA8GOqg7LlsLE8h1744409899.png", "https://image.prepladder.com/notes/cN3IxOzILh4CTD3q8kv91744409975.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms of Aortic Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms of GI Bleeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs of <span class=\"customMeta\" data-dictid=\"4cb859ed5d16927771884925c4eef7\">Hemostasis</span> Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chest pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hematochezia (blood in stool)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Easy bruising</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Syncope</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Melena (black stools)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemarthrosis (joint bleeding)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dyspnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hematemesis (vomiting blood)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Petechiae (small red spots)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fatigue due to low <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fatigue secondary to anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotension if severe bleeding</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Angiodysplasia Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VWF Abnormalities</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated, <span class=\"customMeta\" data-dictid=\"4632fe89141692777200f671693e55\">tortuous</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Structural vessel damage from ischemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of high-molecular-weight VWF</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fragile GI vessels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoxia-induced changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired hemostasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old girl comes to the clinic for evaluation of heavy menstrual bleeding and frequent nosebleeds. She reports having significant bruising after minor injuries and has had prolonged bleeding after dental extractions. Her family history is significant for similar bleeding tendencies among her relatives. Which of the following findings would most likely support a diagnosis of von Willebrand Disease?", "options": [{"label": "A", "text": "Normal platelet count with prolonged aPTT", "correct": true}, {"label": "B", "text": "Prolonged PT with elevated fibrinogen", "correct": false}, {"label": "C", "text": "Normal aPTT and PT with decreased vWF levels", "correct": false}, {"label": "D", "text": "Thrombocytopenia with decreased platelet aggregation", "correct": false}], "correct_answer": "A. Normal platelet count with prolonged aPTT", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>aPTT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>vWF antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>vWF activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FVIII activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multimer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal distribution, decreased in quantity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of high- and intermediate-MW multimers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of high-MW multimers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2M</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal distribution, decreased in quantity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2N</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal distribution</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-year-old boy is scheduled for a dental extraction. He has a history of recurrent epistaxis and prolonged bleeding when he is hurt. His parents are first cousins. Physical examination shows petechiae. The dentist was worried about the medical history and ordered blood investigations as follows: Tests Results aPTT, PT, and ristocetin cofactor activity Normal Bleeding time Increased Light transmission aggregometry (LTA) Altered platelet aggregation with ADP Normal aggregation with ristocetin. Flow cytometry Defective expression of alpha IIb beta 3 integrin Which of the following is the most appropriate treatment to prevent bleeding during the procedure?", "options": [{"label": "A", "text": "Desmopressin", "correct": false}, {"label": "B", "text": "Tranexamic acid", "correct": false}, {"label": "C", "text": "Recombinant activated clotting factor VII (rFVIIa)", "correct": true}, {"label": "D", "text": "Fresh frozen plasma", "correct": false}], "correct_answer": "C. Recombinant activated clotting factor VII (rFVIIa)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:468px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Results</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>aPTT, PT, and <span class=\"customMeta\" data-dictid=\"94ec122d611692777197d287df7f88\">ristocetin</span> <span class=\"customMeta\" data-dictid=\"a416d7580c1692777184952da793d1\">cofactor</span> activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Light transmission <span class=\"customMeta\" data-dictid=\"895694f7ec16927771804a7a8e1592\">aggregometry</span> (LTA) (gold standard test)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Altered <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"a00e90be0416927771803afbbf099b\">aggregation</span> with ADP, collagen, and epinephrine.</p>\n<p>Normal <span class=\"customMeta\" data-dictid=\"a00e90be0416927771803afbbf099b\">aggregation</span> with ristocetin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flow cytometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defective expression of <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> IIb <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> 3 integrin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular genetic tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gene mutations in <em>ITGA2B</em> or <em>ITGB3</em></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:465px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical setting</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Desmopressin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild bleeding<strong> (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Platelets and/or <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">recombinant</span> activated <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> <span class=\"customMeta\" data-dictid=\"53b8a0a39a1692777202e2b614eef6\">factor VII</span> (rFVIIa)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery prophylaxis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tranexamic acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucocutaneous <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> <strong> (Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recombinant FVIIa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Platelet <span class=\"customMeta\" data-dictid=\"761a0230a6169277719742118ccc9c\">refractoriness</span> cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Wiskott-Aldrich Syndrome is suspected in a 3-year-old boy who has eczema, gingival bleeding, and recurrent respiratory tract infections. His mother also noticed blood in his stools. What test would confirm the diagnosis of this syndrome?", "options": [{"label": "A", "text": "Serum immunoelectrophoresis", "correct": false}, {"label": "B", "text": "Platelet function assay", "correct": false}, {"label": "C", "text": "Intracellular immunofluorescence", "correct": true}, {"label": "D", "text": "Complete blood count (CBC) with differential", "correct": false}], "correct_answer": "C. Intracellular immunofluorescence", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old male child with a recent history of viral infection presents with bleeding in gums and petechiae. There is no significant past medical history. Laboratory investigations are as follows: Platelets: 15,000/µL Peripheral blood smear: Large platelets Bone marrow aspirate: Increased number of megakaryocytes Which of the following is the most appropriate initial treatment?", "options": [{"label": "A", "text": "Splenectomy", "correct": false}, {"label": "B", "text": "Anti-Rh0 (D) therapy", "correct": false}, {"label": "C", "text": "Eltrombopag", "correct": false}, {"label": "D", "text": "Intravenous immunoglobulin (IVIgG)", "correct": true}], "correct_answer": "D. Intravenous immunoglobulin (IVIgG)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/zq2oTSMSZamn9SyJ8JV61744408998.png", "https://image.prepladder.com/notes/HfyZ4F7UcAqJWM5dUC3d1744409104.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 33 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 50 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What is the mutation seen in Sickle cell anemia?", "options": [{"label": "A", "text": "Glu → Val (6)", "correct": true}, {"label": "B", "text": "Lys → Arg", "correct": false}, {"label": "C", "text": "Glu → Lysine", "correct": false}, {"label": "D", "text": "Ala → Gly (9)", "correct": false}], "correct_answer": "A. Glu → Val (6)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QIRhaNXdJAx8W4aL3V7h1741865719.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A girl experiences prolonged menstrual bleeding and has normal platelet count, PT, and aPTT, but an increased bleeding time, which was determined to be due to a deficiency of GpIIb-IIIa after further analysis. What is the diagnosis?", "options": [{"label": "A", "text": "Bernard Soulier syndrome", "correct": false}, {"label": "B", "text": "Glanzmann thrombasthenia", "correct": true}, {"label": "C", "text": "Haemophilia A", "correct": false}, {"label": "D", "text": "Von Willebrand disease", "correct": false}], "correct_answer": "B. Glanzmann thrombasthenia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:468px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Results</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>aPTT, PT, and <span class=\"customMeta\" data-dictid=\"94ec122d611692777197d287df7f88\">ristocetin</span> <span class=\"customMeta\" data-dictid=\"a416d7580c1692777184952da793d1\">cofactor</span> activity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding time</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Light transmission <span class=\"customMeta\" data-dictid=\"895694f7ec16927771804a7a8e1592\">aggregometry</span> (LTA) (gold standard test)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Altered <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"a00e90be0416927771803afbbf099b\">aggregation</span> with ADP, collagen, and epinephrine.</p>\n<p>Normal <span class=\"customMeta\" data-dictid=\"a00e90be0416927771803afbbf099b\">aggregation</span> with ristocetin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flow cytometry</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defective expression of <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> IIb <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> 3 integrin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molecular genetic tests</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gene mutations in ITGA2B or ITGB3</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:465px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical setting</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild bleeding<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Platelets and/or <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">recombinant</span> activated <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factor VII (rFVIIa)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery prophylaxis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tranexamic acid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mucocutaneous bleeding</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recombinant FVIIa</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Platelet <span class=\"customMeta\" data-dictid=\"761a0230a6169277719742118ccc9c\">refractoriness</span> cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female with a history of recurrent headaches presented for further evaluation. On further workup, haemoglobin and total WBC count were normal, while an elevated platelet count was seen. Bone marrow aspiration showed increased megakaryocytes and a JAK2 mutation. Which is the most likely diagnosis?", "options": [{"label": "A", "text": "Polycythemia vera", "correct": false}, {"label": "B", "text": "Essential thrombocytosis", "correct": true}, {"label": "C", "text": "Primary myelofibrosis", "correct": false}, {"label": "D", "text": "Chronic myelogenous leukaemia", "correct": false}], "correct_answer": "B. Essential thrombocytosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male came to the physician with complaints of chronic back pain, easy fatigability and a history of multiple urinary tract infections in the last 3 months. His ESR is elevated, and an x-ray of his skull is shown below. Which of the following investigations is useful for diagnosis?", "options": [{"label": "A", "text": "MRI brain", "correct": false}, {"label": "B", "text": "PET scan", "correct": false}, {"label": "C", "text": "Head CT scan with contrast", "correct": false}, {"label": "D", "text": "Serum electrophoresis", "correct": true}], "correct_answer": "D. Serum electrophoresis", "question_images": ["https://image.prepladder.com/content/hDEJLeEOPdkakQ7hMg1J1746786391.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A ten-year-old boy was brought to the OPD with fever and swelling of his hands after playing football. He gives a history of previous episodes of swelling of his hands. On imaging, his spleen was found to be shrunken. Which of the following is a likely diagnosis?", "options": [{"label": "A", "text": "Sickle cell anaemia", "correct": true}, {"label": "B", "text": "Malaria", "correct": false}, {"label": "C", "text": "Pancreatitis", "correct": false}, {"label": "D", "text": "Measles", "correct": false}], "correct_answer": "A. Sickle cell anaemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Thrombocytopenia, eczema and recurrent infections are seen in:", "options": [{"label": "A", "text": "Wiskott-Aldrich syndrome", "correct": true}, {"label": "B", "text": "Chediak-Higashi syndrome", "correct": false}, {"label": "C", "text": "Thrombocytopenia - absent radius syndrome", "correct": false}, {"label": "D", "text": "Hermansky-Pudlak syndrome", "correct": false}], "correct_answer": "A. Wiskott-Aldrich syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For hairy cell leukemia, which drug is considered the preferred choice?", "options": [{"label": "A", "text": "Rituximab", "correct": false}, {"label": "B", "text": "Vemurafenib", "correct": false}, {"label": "C", "text": "Cladribine", "correct": true}, {"label": "D", "text": "Interferon-alpha", "correct": false}], "correct_answer": "C. Cladribine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2BnGx6R2VK1lm3MKtPL51745478327.png", "https://image.prepladder.com/content/UcMdl7pRENkoYFTgU8x31745478327.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:1px solid #0d0d0d\">\n<p><strong>Hairy cell leukemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Mutations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>BRAF V600E</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Mutation of BRAF V600E gene → Activation of the BRAF protein → MAPK/ERK signalling <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> → Uncontrolled <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> and survival of <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> B-cells (Hairy cells).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Presents with fatigue, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections, easy bruising, and symptoms related to <span class=\"customMeta\" data-dictid=\"b3eb52fe3b1692777199de8465eea8\">splenomegaly</span> (e.g., early satiety, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort), pancytopenia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Peripheral Blood Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Hairy cells with round, oblong, or <span class=\"customMeta\" data-dictid=\"77adee7b1016927771972574741517\">reniform</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and pale blue cytoplasm.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Paulo Henrique Orlandi Mourao \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hairy_cell_leukemia#/media/File:Hairy_cell_leukemia_smear_2009-08-20.JPG\" data-tags=\"\" height=\"231\" src=\"https://image.prepladder.com/content/2BnGx6R2VK1lm3MKtPL51745478327.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> Biopsy Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Hypocellular or fibrotic <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> with \"hairy cells\".</li>\n<li>Fried egg appearance.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Oligodendroglioma1_high_mag.jpg\" data-tags=\"\" height=\"226\" src=\"https://image.prepladder.com/content/UcMdl7pRENkoYFTgU8x31745478327.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Flow cytometry</li>\n<li>Immunophenotyping</li>\n<li>Genetic testing for BRAF V600E mutation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li><strong>Splenectomy</strong>: Often leads to prolonged remission.</li>\n<li><strong>Nucleosides (Cladribine, Deoxycoformycin)</strong>: Highly effective but cause immunosuppression;</li>\n<li><strong>Interferon-α (Option D): </strong>Effective but less so than nucleosides.</li>\n<li><strong>Vemurafenib (Option B) (BRAF inhibitor)</strong>: Used in chemotherapy-refractory cases; not <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> but maintains response with chronic use.</li>\n<li><strong>Vemurafenib + <span class=\"customMeta\" data-dictid=\"e3802f488416927771979c6d76c756\">Rituximab</span> (Option A)</strong>: Leads to more durable remissions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Excellent</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman was brought to the emergency department with symptoms of breathlessness anemia and severe bone pain. On evaluation a hemoglobin level was found to be 5.4 g/dl, urea level of 86 mg/dl, creatinine level of 6 mg/dl, calcium level of 12, and potassium level of 4.4 and the bone marrow aspiration revealed over 60% of plasma cells. Which of the following could be the appropriate next course of action for the management of this patient?", "options": [{"label": "A", "text": "Urgent consultation for dialysis", "correct": false}, {"label": "B", "text": "Dexamethasone + lenalidomide", "correct": false}, {"label": "C", "text": "Dexamethasone + fluids", "correct": true}, {"label": "D", "text": "Bone marrow transplantation", "correct": false}], "correct_answer": "C. Dexamethasone + fluids", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/muoWDzxDXrLGLDKe6j1y1745841956.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male patient with heart failure is scheduled for a heart transplant. His renal function test is deranged, and haemoglobin is 6gm%. The physician ordered 2 units of whole blood. Four hours after transfusion, he developed severe respiratory distress. On examination, he is hypoxemic, has tachycardia and his mean arterial pressure is elevated. Which of the following are the best investigations for the above scenario? Chest X-ray Brain natriuretic peptide (BNP) level Absolute neutrophil count Leucocyte antibodies Platelets", "options": [{"label": "A", "text": "4 and 5", "correct": false}, {"label": "B", "text": "3 and 5", "correct": false}, {"label": "C", "text": "1 and 2", "correct": true}, {"label": "D", "text": "2 only", "correct": false}], "correct_answer": "C. 1 and 2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 1 and 2</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Occur after <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> of red blood cells or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> products in 1% to 8.9% of transfusions.</li>\n<li>Has become the leading cause of transfusion-related deaths</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes/Risk Factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Older age</strong></li>\n<li><strong>Renal failure</strong></li>\n<li>Preexisting fluid overload</li>\n<li><strong>Cardiac dysfunction</strong></li>\n<li><strong>Administration of a large volume of blood components</strong></li>\n<li>Excessive <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> rate beyond the patient's <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> tolerance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hypoxia, dyspnea</strong></li>\n<li><strong>Tachycardia</strong></li>\n<li>Systolic hypertension</li>\n<li>Left heart failure</li>\n<li>Pulmonary edema</li>\n<li>Increased central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure</li>\n<li><strong>Elevated <span class=\"customMeta\" data-dictid=\"76ae7252af169277718371dee6d3cf\">brain <span class=\"customMeta\" data-dictid=\"bd16654d3e169277719371077d7a8c\">natriuretic</span> peptide</span> (BNP)</strong></li>\n<li><strong>Chest X-ray: <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> alveolar infiltrates</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Identify at-risk patients.</li>\n<li>Close monitoring and slow <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> rates, 1 <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> concentrate over 3-4 hours.</li>\n<li>Diuretics for hemodynamically stable patients with a history of TACO.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stopping the transfusion</li>\n<li>Administering oxygen</li>\n<li>Diuretics</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman presented with symptoms of confusion, thirst, and abdominal pain. On examination, she had pallor and thoracic spine tenderness. X-ray spine showed osteolytic lesions. Her lab investigations showed the following findings. What is the most likely diagnosis? Hb - 6.9g/dl WBC 4000/cm3 with normal differential count Serum calcium 13mg/dl Creatinine 2.3mg/dl Total protein 9g/dl Albumin 2.4g/dl", "options": [{"label": "A", "text": "Metastatic breast cancer", "correct": false}, {"label": "B", "text": "Multiple myeloma", "correct": true}, {"label": "C", "text": "Primary hyperparathyroidism", "correct": false}, {"label": "D", "text": "Milk alkali syndrome", "correct": false}], "correct_answer": "B. Multiple myeloma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Mu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following interfere with iron absorption?", "options": [{"label": "A", "text": "Vitamin C", "correct": false}, {"label": "B", "text": "Phytates", "correct": true}, {"label": "C", "text": "Oxalate", "correct": false}, {"label": "D", "text": "Myoglobin", "correct": false}], "correct_answer": "B. Phytates", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factors Increasing Iron Absorption</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factors Decreasing Iron Absorption</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acidic stomach environment</li>\n<li>Vitamin C (ascorbic acid) <strong>(Option A Ruled Out)</strong></li>\n<li>Empty stomach</li>\n<li>Meat proteins</li>\n<li>Citric acid</li>\n<li>Haem iron sources (meat, fish)</li>\n<li>Fermented foods</li>\n<li>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> state</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reduced stomach acid</li>\n<li>Proton pump inhibitors</li>\n<li>Antacids</li>\n<li>Tetracycline (chelates iron)</li>\n<li><strong>Phytates (Option B) </strong>(in cereals, legumes)</li>\n<li>Tea and coffee (tannins)</li>\n<li>Calcium-rich foods</li>\n<li>High fiber meals</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the interpretation of elevated serum Calcium levels in a patient with normal serum alkaline phosphatase, PTH, and Vitamin D3 levels?", "options": [{"label": "A", "text": "Vitamin D intoxication", "correct": false}, {"label": "B", "text": "Hyperparathyroidism", "correct": false}, {"label": "C", "text": "Multiple myeloma", "correct": true}, {"label": "D", "text": "Nutritional rickets", "correct": false}], "correct_answer": "C. Multiple myeloma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following investigations should be conducted in a 7-month-old child who has a hemoglobin level of 6.3, a history of recurrent blood transfusions, an MCV of 70 fl, normal MCH, normal MCHC, and a peripheral smear indicating a hypochromic microcytic image?", "options": [{"label": "A", "text": "Serum iron", "correct": false}, {"label": "B", "text": "Direct coomb’s test", "correct": false}, {"label": "C", "text": "Osmotic fragility test", "correct": false}, {"label": "D", "text": "Hb electrophoresis", "correct": true}], "correct_answer": "D. Hb electrophoresis", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:449px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Hemoglobin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>At Birth (1st day)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>At Adult (6 months)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HbF (Fetal Hemoglobin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>95%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HbA (Adult Hemoglobin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>95% (α2β2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HbA2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a 50-year-old man who presents with symptoms of anemia, fever, and recurrent nosebleeds? The patient has hepatosplenomegaly and lab investigations indicate a hemoglobin level of 6g/dL, a total leukocyte count of 40,000/cu.mm with 10% blasts, and a platelet count of 12,000/cu.mm. Further investigation reveals the presence of t(8;21) in the blasts.", "options": [{"label": "A", "text": "Acute lymphoblastic leukemia", "correct": false}, {"label": "B", "text": "Acute myeloblastic leukemia", "correct": true}, {"label": "C", "text": "Preleukemia", "correct": false}, {"label": "D", "text": "Aleukemic leukemia", "correct": false}], "correct_answer": "B. Acute myeloblastic leukemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ol>\n<li>Idiopathic</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>25-50% cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> Failure</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fanconi Anemia</li>\n<li>Diamond-Blackfan Syndrome Diamond-Blackfan <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">Anemia</span> (DBA) is a rare inherited <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of macrocytic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> characterised by a failure of <span class=\"customMeta\" data-dictid=\"317dbdacdb16927771878c7860f69b\">erythropoiesis</span> in the bone marrow.</li>\n<li>Shwachman-Diamond Syndrome: An autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder involving <span class=\"customMeta\" data-dictid=\"938890efd616927771870f4a611546\">exocrine</span> pancreatic insufficiency.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Defective DNA Repair</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bloom Syndrome</li>\n<li>Ataxia Telangiectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Down Syndrome</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>AML is associated with Down syndrome, particularly the subtype known as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Megakaryoblastic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (AML M7), which involves the GATA1 gene.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Exposure to Anticancer Drugs</li>\n</ol>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alkylating agents -&gt; <span class=\"customMeta\" data-dictid=\"93e077ee021692777192666a61cfbc\">Monosomy</span> 5 &amp; 7 -&gt; <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> (After 4-6 years).</li>\n<li>Anticancer drugs (Topoisomerase 2 inhibitors) -&gt; <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">Chromosome</span> 11 involvement -&gt; <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> (After 1-3 years).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Radiation Exposure</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exposure to radiation, benzene, phenylbutazone, and <span class=\"customMeta\" data-dictid=\"a1b9b992ca1692777184a69772eb33\">chloramphenicol</span> may increase the risk of developing <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> and <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>t(15:17)</li>\n</ol>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chromosomal <span class=\"customMeta\" data-dictid=\"8ba7332e86169277720060bd4507c8\">translocation</span> results in the PML-RARA <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene, which is associated with <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> promyelocytic leukaemia (APL), a subtype of AML.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>t(8:21)</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chromosomal <span class=\"customMeta\" data-dictid=\"8ba7332e86169277720060bd4507c8\">translocation</span> (RUNX1- RUNX1T1) is associated with <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> sarcoma.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Inversion 16 or t(16;16).</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male came to the physician with complaints of chronic back pain, easy fatigability, and a past history of multiple urinary tract infections in the last 3 months. His ESR is elevated, x-ray of his skull is shown below. Which of the following investigations is useful for diagnosis?", "options": [{"label": "A", "text": "MRI brain", "correct": false}, {"label": "B", "text": "PET scan", "correct": false}, {"label": "C", "text": "Head CT scan with contrast", "correct": false}, {"label": "D", "text": "Serum electrophoresis", "correct": true}], "correct_answer": "D. Serum electrophoresis", "question_images": ["https://image.prepladder.com/content/jZfAkDzMwHtBevArfcnq1745843973.png"], "explanation_images": ["https://image.prepladder.com/notes/iuXjibfVjcy46yyQPqjO1747902027.png", "https://image.prepladder.com/content/dA5F4ByrJJZwhTi6HP5F1745844028.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young woman presents with recurrent headaches, easy bruising, and episodes of visual blurring. Her platelet count is elevated, while her red blood cell (RBC) and white blood cell (WBC) counts are normal. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Essential Thrombocytosis", "correct": true}, {"label": "B", "text": "Polycythemia Vera", "correct": false}, {"label": "C", "text": "Chronic Myeloid Leukemia (CML)", "correct": false}, {"label": "D", "text": "Acute Myeloid Leukemia (AML)", "correct": false}], "correct_answer": "A. Essential Thrombocytosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Essential Thrombocytosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clonal <span class=\"customMeta\" data-dictid=\"8dd789d7d1169277719303d4744837\">myeloproliferative</span> disorder</li>\n<li>Characterized by increased <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> production</li>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"a9e4aca9db16927771925f99eb40c9\">megakaryocyte</span> proliferation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>JAK2 V617F <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (50-60% of cases)</li>\n<li>CALR mutations (type 1 and 2)</li>\n<li>MPL mutations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Platelet count &gt;450,000/μL</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> megakaryocytes</li>\n<li>Normal RBC and WBC Count</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often asymptomatic</li>\n<li>Thrombotic events (arterial &gt; venous)</li>\n<li>Erythromelalgia</li>\n<li>Ocular migraines &amp; visual disturbances</li>\n<li>TIAs</li>\n<li>Spontaneous <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> &amp; easy bruising</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Platelet count &gt;450,000/μL</li>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> showing <span class=\"customMeta\" data-dictid=\"a9e4aca9db16927771925f99eb40c9\">megakaryocyte</span> proliferation</li>\n<li>Not meeting WHO criteria for other <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> neoplasms</li>\n<li>Presence of JAK2, CALR, or MPL mutation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thrombosis (major cause of morbidity)</li>\n<li>Hemorrhage (especially with counts &gt;1 million/μL)</li>\n<li>Progression to myelofibrosis</li>\n<li>Small risk of leukemic transformation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low-dose <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> for <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> prevention</li>\n<li>Hydroxyurea for high-risk patients</li>\n<li>Anagrelide for cytoreduction</li>\n<li>Plateletpheresis for severe cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents to the AIIMS emergency department with severe fatigue. She is a known case of chronic stable angina. While collecting a blood sample, you notice the blood has a brownish hue. What is the underlying diagnosis?", "options": [{"label": "A", "text": "Carboxy-hemoglobinemia", "correct": false}, {"label": "B", "text": "Sideroblastic anaemia", "correct": false}, {"label": "C", "text": "Methemoglobinemia", "correct": true}, {"label": "D", "text": "Sulfhemoglobinemia", "correct": false}], "correct_answer": "C. Methemoglobinemia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a feature of thrombotic thrombocytopenic purpura?", "options": [{"label": "A", "text": "Thrombocytopenia", "correct": false}, {"label": "B", "text": "Thrombosis", "correct": false}, {"label": "C", "text": "Microangiopathic hemolytic anemia", "correct": false}, {"label": "D", "text": "Renal failure", "correct": true}], "correct_answer": "D. Renal failure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Thrombotic Thrombocytopenic <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">Purpura</span> (TTP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hemolytic-Uremic Syndrome (HUS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deficiency or antibodies to <strong>ADAMTS13</strong> leading to <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> aggregation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhea associated with</p>\n<p><strong>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> O157:H7 or shigella</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pentad</strong></p>\n<p>1. Microangiopathic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (MAHA)</p>\n<p>2. <span class=\"customMeta\" data-dictid=\"fc28c74bb716927772003aee4aa43c\">Thrombocytopenia</span> <strong>(severe)</strong></p>\n<p>3. <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> failure,</p>\n<p>4. Neurologic findings</p>\n<p>5. Fever</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triad</strong></p>\n<p>1. Microangiopathic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (MAHA)</p>\n<p>2. Thrombocytopenia</p>\n<p>3. <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in <strong>adults</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in <strong>children</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often <strong>women</strong>, especially those with <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> or during pregnancy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Preceded by <strong>diarrhea</strong>, especially hemorrhagic diarrhea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Not a predominant feature</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Renal failure is a hallmark, especially in children</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ADAMTS13 Activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&lt;10% ADAMTS13 activity is diagnostic</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ADAMTS13 activity is normal, except in rare cases (Atypical HUS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Precipitating Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic</li>\n<li>Infections (HIV)</li>\n<li>Medications (Ticlopidine, Cyclosporine)</li>\n<li>Pregnancy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often follows GI infections</li>\n<li>Atypical HUS has genetic/ <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> involvement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Plasma exchange (mainstay)</li>\n<li>Glucocorticoids</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supportive care</li>\n<li>Dialysis (in severe cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relapse Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>25-45% relapse</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Relapses can occur, but less frequent than TTP</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In hemolytic anemia, which of the following statements are true? Indirect Van den Bergh test is positive. Serum conjugated bilirubin is raised. Serum transaminases are raised. Urobilinogen is high. GGT is elevated.", "options": [{"label": "A", "text": "1, 3, 5", "correct": false}, {"label": "B", "text": "1, 4", "correct": true}, {"label": "C", "text": "2, 5", "correct": false}, {"label": "D", "text": "1, 4, 5", "correct": false}], "correct_answer": "B. 1, 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:737px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prehepatic Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hepatic Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Posthepatic (Obstructive) Jaundice</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemolysis (e.g., <strong>hemolytic anemia</strong>, malaria)</li>\n<li>Sickle cell disease</li>\n<li>G6PD deficiency</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver diseases (e.g., <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> hepatitis, cirrhosis, <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> liver disease)</li>\n<li>Liver tumors</li>\n<li>Drug-induced liver injury</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (e.g., gallstones, pancreatic cancer, cholangiocarcinoma, strictures, tumors)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of red blood cells</li>\n<li>Excessive <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> production</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <span class=\"customMeta\" data-dictid=\"5bf9387ee91692777185685e187e76\">conjugation</span> and <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> due to liver dysfunction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blocked <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow</li>\n<li>Accumulation of conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> in bloodstream</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Yellowing of skin and sclera</li>\n<li>Anemia</li>\n<li>Fatigue</li>\n<li>Splenomegaly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Yellowing of skin and sclera</li>\n<li>Fatigue</li>\n<li>Nausea</li>\n<li>Hepatomegaly</li>\n<li>Pruritus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Yellowing of skin and sclera</li>\n<li>Pale stools</li>\n<li>Dark urine</li>\n<li>Pruritus</li>\n<li>Hepatomegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilirubin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated unconjugated (indirect) bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated unconjugated and conjugated (direct) bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated conjugated (direct) bilirubin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">Enzyme</span> Values</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>AST, ALT: Normal or slightly elevated</li>\n<li>ALP: Normal</li>\n<li>GGT: Normal</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>AST, ALT: Markedly elevated</li>\n<li>ALP: Elevated</li>\n<li>GGT: Elevated</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>AST, ALT: Mildly elevated</li>\n<li>ALP: Markedly elevated</li>\n<li>GGT: Elevated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prothrombin time (PT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal Prolonged PT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolonged PT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolonged PT</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or slightly dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> due to <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> urobilinogen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (due to increased conjugated bilirubin)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (due to conjugated bilirubin)</li>\n<li>Pale stools (due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> excretion)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reaction Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bilirubin Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Direct (Positive within seconds)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate pink-red color in <span class=\"customMeta\" data-dictid=\"0f0067663b16927771818fe253b3b9\">aqueous</span> solution</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjugated (Water-soluble)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in obstructive jaundice, <span class=\"customMeta\" data-dictid=\"6165f47a8c1692777188c0dfc0d75d\">hepatocellular</span> jaundice</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indirect</strong><strong> (Delayed or requires methanol)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pink-red color appears only after adding methanol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unconjugated (Water-insoluble)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> jaundice, Gilbert syndrome, Crigler-Najjar syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biphasic (Both direct and <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> reaction present)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Color change seen both in <span class=\"customMeta\" data-dictid=\"0f0067663b16927771818fe253b3b9\">aqueous</span> and after <span class=\"customMeta\" data-dictid=\"c578fa95fe16927771927ea57020f0\">methanol</span> addition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed (Conjugated + Unconjugated)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> (e.g., <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> hepatitis, cirrhosis)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding von Willebrand disease is incorrect?", "options": [{"label": "A", "text": "Type 2 von Willebrand disease is associated with a moderate bleeding tendency", "correct": false}, {"label": "B", "text": "Type 3 von Willebrand disease is associated with a complete absence of factor VIII", "correct": false}, {"label": "C", "text": "Type 1 von Willebrand disease presents with severe bleeding since childhood", "correct": true}, {"label": "D", "text": "Type 2 von Willebrand disease includes subtypes with varying defects in von Willebrand factor.", "correct": false}], "correct_answer": "C. Type 1 von Willebrand disease presents with severe bleeding since childhood", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\"&gt;Type 1&lt;/span&gt; von Willebrand disease presents with severe &lt;span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\"&gt;bleeding&lt;/span&gt; since childh\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type 1 von Willebrand Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Mild <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> tendency; partial <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of von Willebrand factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2 von Willebrand Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> tendency; includes subtypes with varying defects in von Willebrand factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3 von Willebrand Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> tendency; severe <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> or absence of von Willebrand factor, leading to very low <span class=\"customMeta\" data-dictid=\"65dc2273b5169277720208ba704b7f\">factor VIII</span> levels</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is incorrect regarding myelodysplastic syndrome?", "options": [{"label": "A", "text": "More commonly seen in females", "correct": true}, {"label": "B", "text": "Treatment-induced MDS is not dependent on age", "correct": false}, {"label": "C", "text": "Median age of onset 70 years", "correct": false}, {"label": "D", "text": "It can be radiation-induced", "correct": false}], "correct_answer": "A. More commonly seen in females", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 46-year-old male presents to the outpatient department with a history of lower back pain and painful urination. Upon investigation, he is found to have normocytic normochromic anemia and hypercalcemia. Serum protein electrophoresis reveals an M-spike in the gamma region. Which of the following tests is most appropriate to confirm the diagnosis of multiple myeloma?", "options": [{"label": "A", "text": "Liver function test", "correct": false}, {"label": "B", "text": "Bence Jones protein in urine", "correct": true}, {"label": "C", "text": "Urine albumin-to-creatinine ratio (UACR) test", "correct": false}, {"label": "D", "text": "Heat and acetic acid test", "correct": false}], "correct_answer": "B. Bence Jones protein in urine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with symptoms of fatigue, pallor, and weakness. Laboratory tests reveal a low hemoglobin (Hb) level, but the reticulocyte count is normal. Based on these findings, which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Aplastic Anemia", "correct": false}, {"label": "B", "text": "Pure Red Cell Aplasia", "correct": true}, {"label": "C", "text": "Iron Deficiency Anemia", "correct": false}, {"label": "D", "text": "Hemolytic Anemia", "correct": false}], "correct_answer": "B. Pure Red Cell Aplasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pure Red Cell Aplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A condition characterized by anemia, reticulocytopenia, and absent or rare <span class=\"customMeta\" data-dictid=\"892718f3e916927771871389d2e1a3\">erythroid</span> <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> cells in <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> with normal white cell and <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital:</p>\n<ul>\n<li>Diamond-Blackfan anemia</li>\n<li>Diagnosed at birth or early childhood</li>\n</ul>\n<p>Acquired:</p>\n<ul>\n<li>Thymoma</li>\n<li>MDS (5s- syndrome)</li>\n<li>Cancer</li>\n<li>Autoimmune conditions</li>\n<li>Viral infections (especially B19 parvovirus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Associations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thymoma (most frequent)</li>\n<li>Lymphoid malignancies</li>\n<li>Autoimmune disorders</li>\n<li>Chronic lymphocytic leukemia</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</li>\n<li>Pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>T-cell mediated immune response</li>\n<li>Antibodies to erythropoietin</li>\n<li>Neutralizing antibodies to B19 parvovirus</li>\n<li>Direct chemical <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> or immune destruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>General Approach:</p>\n<ul>\n<li>Identify and treat underlying cause</li>\n<li>Regular monitoring of <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> levels</li>\n<li>Supportive care with transfusions</li>\n</ul>\n<p>Specific Treatments:</p>\n<ul>\n<li>Immunosuppression (corticosteroids, cyclosporine, ATG, azathioprine)</li>\n<li>Intravenous <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> for B19 <span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\">parvovirus</span> infection</li>\n<li>Thymectomy if <span class=\"customMeta\" data-dictid=\"76ecb330ba169277720078d984ef2a\">thymoma</span> present</li>\n<li>Iron <span class=\"customMeta\" data-dictid=\"11199cbd1816927771841f1eb35b86\">chelation</span> as needed</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old female presents with menorrhagia and excessive bleeding after a minor surgery. She gave the history of her father and sister having the same bleeding issues and the pattern of inheritance was determined to be autosomal dominant. What is the most likely disorder?", "options": [{"label": "A", "text": "Von Willebrand disease", "correct": true}, {"label": "B", "text": "Hemophilia A", "correct": false}, {"label": "C", "text": "Christmas disease", "correct": false}, {"label": "D", "text": "Factor 10 deficiency", "correct": false}], "correct_answer": "A. Von Willebrand disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Von Willebrand disease</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>aPTT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>vWF antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>vWF activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>FVIII activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Multimer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Inheritance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal distribution, decreased in quantity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Loss of high- and intermediate-MW multimers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Loss of high-MW multimers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2M</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal distribution, decreased in quantity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Autosomal dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal distribution</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Autosomal recessive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Autosomal recessive</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT a complication of blood transfusion in a 25-year-old mother who developed acute postpartum haemorrhage (PPH), hypovolemic shock, and underwent major blood transfusion after delivering a baby boy?", "options": [{"label": "A", "text": "Hypocalcemia", "correct": false}, {"label": "B", "text": "Hypokalemia", "correct": true}, {"label": "C", "text": "Hypothermia", "correct": false}, {"label": "D", "text": "Hyperkalemia", "correct": false}], "correct_answer": "B. Hypokalemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Hypokalemia</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention/ Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transfusion of cold blood (stored at 4°C).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Body temperature drops, leading to impaired <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> mechanisms (coagulopathy), and worsening bleeding.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Warm blood products before transfusion</li>\n<li>Use external warming methods (e.g., warming blankets).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coagulopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilution of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors and platelets due to transfusion; consumption of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors by ongoing haemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired blood clotting, prolonged <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> time, increased risk of continued bleeding.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administer <span class=\"customMeta\" data-dictid=\"0339123c621692777203964a9056bb\">fresh frozen plasma</span> (FFP), platelets, and cryoprecipitate.</li>\n<li>For massive BT, blood products should be administered in a 1:1:1 ratio.</li>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors (e.g., PT, aPTT).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Citrate Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large volumes of transfused blood contain citrate, which binds to calcium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypocalcemia (Option A)</strong>, leads to muscle cramps, seizures, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Administer <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"ff3235f97616927771884121a800e7\">gluconate</span> or <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> prophylactically.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium leaks from stored red blood cells into <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels (hyperkalemia) can cause <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, potentially leading to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels.</li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> to stabilize the myocardium.</li>\n<li>Insulin with <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> to shift <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> intracellularly if needed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> into bicarbonate.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased pH (alkalosis) can lead to muscle twitching, irritability, and impaired oxygen release from haemoglobin.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gases (ABG)</li>\n<li>Adjust <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> speed and, if necessary, reduce <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> levels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inadequate tissue <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> leads to <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid accumulation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lowered blood pH (acidosis) leads to confusion, fatigue, rapid breathing, and worsened <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Correct underlying cause (e.g., improve perfusion).</li>\n<li>Administer sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> in severe cases of acidosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury (TRALI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibodies in transfused blood <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> the recipient's immune response, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fluid buildup in the lungs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema, presenting as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> with <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> within 6 hours of transfusion.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate cessation of transfusion.</li>\n<li>Oxygen therapy and <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">mechanical ventilation</span> if necessary.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Associated <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">Circulatory</span> <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (TACO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The volume of transfused blood exceeds the patient’s capacity to manage, leading to fluid overload.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary oedema, shortness of breath, hypertension, and signs of heart failure.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administer diuretics (e.g., furosemide).</li>\n<li>Slow the rate of transfusion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeated transfusions lead to excessive accumulation of iron.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iron deposits in organs (e.g., liver, heart, pancreas), lead to organ damage and failure over time.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Administer iron chelators (e.g., deferoxamine, deferasirox).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolytic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ABO or Rh incompatibility.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid destruction of red blood cells (hemolysis), causes fever, chills, hemoglobinuria, and potentially <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure or shock.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate cessation of transfusion.</li>\n<li>Supportive care with IV fluids.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Allergic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reaction to proteins in transfused blood products.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms range from mild itching, rash, or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> to severe <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">anaphylaxis</span> (airway constriction, low blood pressure, shock).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administer antihistamines for mild reactions.</li>\n<li>Corticosteroids and <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> for severe reactions like anaphylaxis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial Contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood products are contaminated during collection or storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sepsis is characterized by fever, chills, low blood pressure, and possibly <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate cessation of transfusion.</li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Elective splenectomy is preferred in which of the following conditions?", "options": [{"label": "A", "text": "G6PD deficiency-Glucose-6-phosphate dehydrogenase deficiency", "correct": false}, {"label": "B", "text": "Paroxysmal nocturnal hemoglobinuria", "correct": false}, {"label": "C", "text": "Hereditary spherocytosis", "correct": true}, {"label": "D", "text": "Hairy cell leukemia", "correct": false}], "correct_answer": "C. Hereditary spherocytosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hgyeqn63oryxF4XjdFAL1746190022.png"], "explanation": "<p>Correct Answer C- Hereditary spherocytosis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management of Hereditary <span class=\"customMeta\" data-dictid=\"d30f4533661692777199385959bd9f\">Spherocytosis</span> (HS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Splenectomy as Primary Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Splenectomy significantly improves <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> by prolonging red cell survival, reducing the need for transfusions, and preventing <span class=\"customMeta\" data-dictid=\"64bbd63a0c1692777190f0c8e06e91\">iron overload</span> and related organ damage.</li>\n<li>Post splenectomy: <span class=\"customMeta\" data-dictid=\"d30f4533661692777199385959bd9f\">Spherocytosis</span> and altered osmotic <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> persist, but <span class=\"customMeta\" data-dictid=\"249592767b16927771976df58de24d\">reticulocyte</span> counts and <span class=\"customMeta\" data-dictid=\"64e0895e441692777187dad4949f29\">erythrocyte</span> lifespan normalize.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood Film Changes Post-Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Features like <strong>Howell-Jolly bodies</strong>, acanthocytes, target cells, <strong>cabot ring</strong> and<strong> Pappenheimer bodies</strong> appear after splenectomy.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\". Paulo Henrique Orlandi Mourao 2.Paulo Henrique Orlandi Mourao 3. Prof. Osaro Erhabor 4. Jarkeld Medical Centre Alkmaar, hematology department of Laboratory for Clinical Chemistry, Hematology and Immunology\" data-hash=\"\" data-license=\"1. CC BY-SA 4.0 2. CC BY SA 3.0 3. CC0 1.0 4. CC BY SA 3.0\" data-source=\"1. https://en.wikipedia.org/wiki/Pappenheimer_bodies 2. https://commons.wikimedia.org/wiki/File:Howell-Jolly_body.png 3. https://commons.wikimedia.org/wiki/File:Target_cells.jpg 4. https://en.wikipedia.org/wiki/Cabot_rings\" data-tags=\"\" height=\"539\" src=\"https://image.prepladder.com/content/hgyeqn63oryxF4XjdFAL1746190022.png\" width=\"824\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications for Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recommended for patients with severe, transfusion-dependent anemia, growth failure, skeletal changes, leg ulcers, or <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> tumors.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timing of Splenectomy</strong>:</p>\n<ul>\n<li>Should be <strong>delayed until age 5–9</strong> if possible or at least age 3, to reduce the risk of post-splenectomy <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> while balancing the increased risk of gallstones in older children.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laparoscopic Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Preferred method, with benefits like less discomfort, quicker recovery, and shorter hospital stays. Combined <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> and <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> is an option for patients with <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> gallstones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used in infants or young children to alleviate <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> while preserving some splenic immune function. It reduces <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> needs but may eventually require total <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> in about half of patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pre- and Post-Splenectomy Care</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li><strong>Vaccination</strong>: Patients should receive vaccines against pneumococcus, <em>Haemophilus influenzae</em> type B, and <span class=\"customMeta\" data-dictid=\"dba7aeeec71692777192ce43dc13f5\">meningococcus</span> before surgery.</li>\n<li><strong>Antibiotic Prophylaxis</strong>: Use of <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> antibiotics post-splenectomy is controversial but recommended by some for at least 5 years or even lifelong.</li>\n<li><strong>Folic Acid</strong>: Continued supplementation (1 mg/day) is recommended to prevent <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a feature of Gaisböck syndrome?", "options": [{"label": "A", "text": "Hypotension", "correct": true}, {"label": "B", "text": "Erythrocytosis", "correct": false}, {"label": "C", "text": "Normal leukocyte counts", "correct": false}, {"label": "D", "text": "Obesity", "correct": false}], "correct_answer": "A. Hypotension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Hypotension</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gaisböck syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"2e114d4cdc169277718882a0a01076\">hematocrit</span> levels</li>\n<li><strong>Erythrocytosis (Option B Ruled Out)</strong></li>\n<li><strong>Normal <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> counts</strong> <strong>(Option C Ruled Out)</strong></li>\n<li>No splenomegaly</li>\n<li>Hypertension</li>\n<li>Facial rubor</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Patient Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Predominantly affects males</li>\n<li><strong>Obese and anxious personality (Option D Ruled Out)</strong></li>\n<li>Often cigarette smokers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcoholism</li>\n<li>Diuretic therapy</li>\n<li>Physical &amp; Emotional stress</li>\n<li>Obesity</li>\n<li>Smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiological Mechanisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Psychiatric disorders causing chronic stress</li>\n<li>Volume <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> (diuresis)</li>\n<li>Hypertension</li>\n<li>Nocturnal hypoxemia</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> production</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Formation of microthrombi</li>\n<li>Cerebral infarction</li>\n<li>Vascular disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Management of hypertension</li>\n<li>Weight reduction</li>\n<li>Smoking cessation</li>\n<li>Alcohol reduction/cessation</li>\n<li>Stress management</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment for neutropenia following chemotherapy?", "options": [{"label": "A", "text": "Leucovorin", "correct": false}, {"label": "B", "text": "Filgastrim", "correct": true}, {"label": "C", "text": "Ondansetron", "correct": false}, {"label": "D", "text": "Darbepoetin", "correct": false}], "correct_answer": "B. Filgastrim", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Filg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Adhesion of platelets is the main function of von-willebrand factor. Which of the following is true for von-willebrand disease?", "options": [{"label": "A", "text": "Normal partial thromboplastin time", "correct": false}, {"label": "B", "text": "Decreased platelets", "correct": false}, {"label": "C", "text": "Normal prothrombin time", "correct": true}, {"label": "D", "text": "Normal bleeding time", "correct": false}], "correct_answer": "C. Normal prothrombin time", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Normal &lt;span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\"&gt;prothrombin&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which test is utilized for the diagnosis of DIC among the following options?", "options": [{"label": "A", "text": "Fibrin degradation products", "correct": false}, {"label": "B", "text": "Activation partial thromboplastin time", "correct": false}, {"label": "C", "text": "Prothrombin time", "correct": false}, {"label": "D", "text": "Dimer assay", "correct": true}], "correct_answer": "D. Dimer assay", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"15131f1b0a1692777186cd434919ce\"&gt;Dimer&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is correct regarding polycythemia vera?", "options": [{"label": "A", "text": "Risk of thrombosis strongly correlates with the degree of thrombocytosis", "correct": false}, {"label": "B", "text": "Generalized pruritus is a consequence of mast cell activation by JAK 2 mutation", "correct": true}, {"label": "C", "text": "It is protective against H. Pylori infection", "correct": false}, {"label": "D", "text": "Acute myeloid leukaemia is the most common cause of mortality", "correct": false}], "correct_answer": "B. Generalized pruritus is a consequence of mast cell activation by JAK 2 mutation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Generalized &lt;span class=\"customMeta\" data-dictid=\"c238cff71916927771965fb88e6cc4\"&gt;pruritus&lt;/span&gt; is a consequence of &lt;span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\"&gt;mast&lt;/span&gt; cell &lt;span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\"&gt;activation&lt;/span&gt; by JAK2 mu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient of haemophilia received multiple blood transfusions. Which of the following metabolic abnormalities can be seen in a patient?", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": true}, {"label": "B", "text": "Respiratory alkalosis", "correct": false}, {"label": "C", "text": "Metabolic acidosis", "correct": false}, {"label": "D", "text": "Respiratory acidosis", "correct": false}], "correct_answer": "A. Metabolic alkalosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/95ucHqD9UBpmPF4aN2pP1714026889.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\"&gt;Metabolic&lt;/span&gt; alk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of inheritance seen in sickle cell anemia?", "options": [{"label": "A", "text": "AD", "correct": false}, {"label": "B", "text": "AR", "correct": true}, {"label": "C", "text": "X-linked dominant", "correct": false}, {"label": "D", "text": "X-linked recessive", "correct": false}], "correct_answer": "B. AR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Translocation of lymphoma asked in match the following Column A Column B 1. Burkitt lymphoma 2. Mantle cell lymphoma 3. Marginal cell lymphoma 4. Follicular lymphoma 5. Ewing’s sarcoma A. t(11,18) B. t(14,18) C. t(8,14) D. t(11,22) E. t(11,14)", "options": [{"label": "A", "text": "1-A, 2-E, 3-C, 4-B, 5-D", "correct": false}, {"label": "B", "text": "1-C, 2-D, 3-A, 4-B, 5-E", "correct": false}, {"label": "C", "text": "1-C, 2-E, 3-A, 4-D, 5-B", "correct": false}, {"label": "D", "text": "1-C, 2-E, 3-A, 4-B, 5-D", "correct": true}], "correct_answer": "D. 1-C, 2-E, 3-A, 4-B, 5-D", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: 1-C, 2-E, 3-A, 4-B, 5-D:</p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Burkitt lymphoma</strong></td>\n<td>t(8,14)</td>\n</tr>\n<tr>\n<td><strong>Mantle cell lymphoma</strong></td>\n<td>t(11,14)</td>\n</tr>\n<tr>\n<td><strong>Marginal cell lymphoma</strong></td>\n<td>t(11,18)</td>\n</tr>\n<tr>\n<td><strong>Follicular lymphoma</strong></td>\n<td>t(14,18)</td>\n</tr>\n<tr>\n<td><strong>Ewing's sarcoma</strong></td>\n<td>t(11,22)</td>\n</tr>\n</tbody>\n\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Disease</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Associated Translocation</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Burkitt lymphoma</p>\n</td>\n<td>\n<p>t(8,14)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mantle cell lymphoma</p>\n</td>\n<td>\n<p>t(11,14)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Marginal zone lymphoma</p>\n</td>\n<td>\n<p>t(11,18)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Follicular lymphoma</p>\n</td>\n<td>\n<p>t(14,18)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ewing's sarcoma</p>\n</td>\n<td>\n<p>t(11,22)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chronic <span class=\"customMeta\" data-dictid=\"258737f45016927771931e053a03d1\">myelogenous</span> <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> (CML)</p>\n</td>\n<td>\n<p>t(9,22) (Philadelphia chromosome)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acute promyelocytic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> (APL)</p>\n</td>\n<td>\n<p>t(15,17)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acute lymphoblastic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> (ALL)</p>\n</td>\n<td>\n<p>t(9,22) (Philadelphia chromosome)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Desmoplastic small round cell tumor</p>\n</td>\n<td>\n<p>t(11,22)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alveolar rhabdomyosarcoma</p>\n</td>\n<td>\n<p>t(2,13) or t(1,13)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of cancer is not linked to viral infection among the options provided?", "options": [{"label": "A", "text": "Kaposi sarcoma", "correct": false}, {"label": "B", "text": "Primary effusion lymphoma", "correct": false}, {"label": "C", "text": "Merkel cell carcinoma", "correct": false}, {"label": "D", "text": "Superficial spreading melanoma", "correct": true}], "correct_answer": "D. Superficial spreading melanoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Superficial &lt;span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\"&gt;spreading&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18-year-old girl with the diagnosis of acute promyelocytic leukemia was treated medically. She developed fever and tachypnea and a chest X-ray showed pulmonary infiltrates. What drug should she be given next?", "options": [{"label": "A", "text": "Cytarabine", "correct": false}, {"label": "B", "text": "Dexamethasone", "correct": true}, {"label": "C", "text": "Doxorubicin", "correct": false}, {"label": "D", "text": "Methotrexate", "correct": false}], "correct_answer": "B. Dexamethasone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Dexameth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is incorrect regarding Disseminated Intravascular Coagulation (DIC)?", "options": [{"label": "A", "text": "Increased schistocytes", "correct": false}, {"label": "B", "text": "Increased PT", "correct": false}, {"label": "C", "text": "Increased fibrinogen", "correct": true}, {"label": "D", "text": "Increased FDPs", "correct": false}], "correct_answer": "C. Increased fibrinogen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Increased fibrinog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed bleeding manifestation in individuals with severe hemophilia?", "options": [{"label": "A", "text": "Recurrent hematomas", "correct": false}, {"label": "B", "text": "Recurrent hemarthrosis", "correct": true}, {"label": "C", "text": "Hematuria", "correct": false}, {"label": "D", "text": "Intracranial hemorrhage", "correct": false}], "correct_answer": "B. Recurrent hemarthrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\"&gt;Recurrent&lt;/span&gt; hemarth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with thalassemia has a history of multiple blood transfusions, iron overload, and cardiac arrhythmia. She has now come for blood transfusion and during the process, complains of backache and looks very anxious. What would you do next?", "options": [{"label": "A", "text": "Stop the blood transfusion", "correct": true}, {"label": "B", "text": "Continue the transfusion but do an ECG", "correct": false}, {"label": "C", "text": "Stop the transfusion. Wait for patient to become normal and then start it again", "correct": false}, {"label": "D", "text": "Do clerical check and get ECG", "correct": false}], "correct_answer": "A. Stop the blood transfusion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Stop the blood transfu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In fever of unknown origin, blood sample should be drawn how many times?", "options": [{"label": "A", "text": "2", "correct": false}, {"label": "B", "text": "3", "correct": true}, {"label": "C", "text": "4", "correct": false}, {"label": "D", "text": "5", "correct": false}], "correct_answer": "B. 3", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable condition of a 10-year-old boy complaining of recurrent episodes of intense pain in his fingers and toes that spontaneously resolve over the course of the last year?", "options": [{"label": "A", "text": "Alpha-thalassemia", "correct": false}, {"label": "B", "text": "Beta-thalassemia", "correct": false}, {"label": "C", "text": "Sickle cell anemia", "correct": true}, {"label": "D", "text": "Von Willebrand disease type 1", "correct": false}], "correct_answer": "C. Sickle cell anemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sick\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement is accurate regarding paroxysmal nocturnal hemoglobinuria (PNH)?", "options": [{"label": "A", "text": "Inherited defect in PIG-A", "correct": false}, {"label": "B", "text": "Extravascular haemolysis", "correct": false}, {"label": "C", "text": "Deficiency of CD 55 and CD 59", "correct": true}, {"label": "D", "text": "Microcytic anaemia", "correct": false}], "correct_answer": "C. Deficiency of CD 55 and CD 59", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\"&gt;Deficiency&lt;/span&gt; of CD55 and CD59\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old man with a diagnosis of acute myeloid leukemia with a blood type O negative presents to the transplant clinic to discuss proceeding with an allogeneic stem cell transplant. Which of the following would be an optimal donor?", "options": [{"label": "A", "text": "His brother", "correct": false}, {"label": "B", "text": "Umbilical cord transplant", "correct": false}, {"label": "C", "text": "His HLA twin identical brother who is otherwise healthy and is blood type O+", "correct": true}, {"label": "D", "text": "An HLA identical matched unrelated donor", "correct": false}], "correct_answer": "C. His HLA twin identical brother who is otherwise healthy and is blood type O+", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - His &lt;span class=\"customMeta\" data-dictid=\"b1debe2a7c16927771890479332d98\"&gt;HLA&lt;/span&gt; twin identical brother who is otherwise healthy and is &lt;span class=\"customMeta\" data-dictid=\"8cb71c753c16927771831c74cb7271\"&gt;blood type&lt;/span&gt; O+\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following factors hinder the absorption of iron?", "options": [{"label": "A", "text": "Vitamin C", "correct": false}, {"label": "B", "text": "Phytates", "correct": true}, {"label": "C", "text": "Oxalate", "correct": false}, {"label": "D", "text": "Myoglobin", "correct": false}], "correct_answer": "B. Phytates", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1yOd0uSDvGj3CJuYgpua1714024927.png"], "explanation": "<p>Correct Option B - Phytates: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mark the true statements 1. Pernicious anemia is an example of Type II Hypersensitivity 2. Serum Sickness is a example of Type III Hypersensitivity 3. Pathergy test is an example of Type IV Hypersensitivity 4. Pathergy test is done for Reiter's disease", "options": [{"label": "A", "text": "1, 2 and 3 are true", "correct": true}, {"label": "B", "text": "2, 3 and 4 are true", "correct": false}, {"label": "C", "text": "1, 2, 3 and 4 are true", "correct": false}, {"label": "D", "text": "3 and 4 are true", "correct": false}], "correct_answer": "A. 1, 2 and 3 are true", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - 1, 2 and 3 are tru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following conditions will the pneumococcal vaccine PPV-23 provide the greatest advantage?", "options": [{"label": "A", "text": "Recurrent rhinitis and sinusitis", "correct": false}, {"label": "B", "text": "Cystic fibrosis", "correct": false}, {"label": "C", "text": "Sickle cell anemia", "correct": true}, {"label": "D", "text": "Child &amp;lt;2 years", "correct": false}], "correct_answer": "C. Sickle cell anemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sick\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding the diagnosis of accelerated phase of chronic myeloid leukemia (CML)?", "options": [{"label": "A", "text": "Leukocytosis more than 1000 ×10 6 not responding to treatment", "correct": true}, {"label": "B", "text": "Blast concentration in PBS should be greater than 15%", "correct": false}, {"label": "C", "text": "Increased spleen size not responsive to therapy", "correct": false}, {"label": "D", "text": "No response to tyrosine kinase inhibitor", "correct": false}], "correct_answer": "A. Leukocytosis more than 1000 ×10 6 not responding to treatment", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\"&gt;Leukocytosis&lt;/span&gt; more than 1000 × 10^\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the most appropriate course of action for managing a patient presenting with fatigue, a haemoglobin level below 9 g/dl, and sickle-shaped red blood cells on peripheral smear examination?", "options": [{"label": "A", "text": "Administer IV antibiotics", "correct": false}, {"label": "B", "text": "Blood transfusion", "correct": true}, {"label": "C", "text": "Administer desferoxamine", "correct": false}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "B. Blood transfusion", "question_images": ["https://image.prepladder.com/content/t41gZVrZN8lS7uf0Hnou1747953636.png"], "explanation_images": ["https://image.prepladder.com/content/wIK1QtQYhO9bt0VA9EiH1747953932.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man presents with fatigue, pallor, weight loss, and heaviness in the left hypochondrium, for the past 2 months. Abdominal palpation reveals splenomegaly. His hemogram and peripheral smear results are given below. What is the most likely diagnosis? Hemogram: Hb-10 gm/dl WBC count – 1,65,000/cu.mm (leukocytosis) Platelet count – 3 lakhs/mm 3 Peripheral smear: Metamyelocytes – 15% Promyeloblasts – 30% Myeloblasts – 45%", "options": [{"label": "A", "text": "Chronic lymphocytic leukemia", "correct": false}, {"label": "B", "text": "Chronic myeloid leukemia", "correct": true}, {"label": "C", "text": "Acute lymphoblastic leukemia", "correct": false}, {"label": "D", "text": "Acute myeloid leukemia", "correct": false}], "correct_answer": "B. Chronic myeloid leukemia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman presented with symptoms of confusion, thirst, and abdominal pain. On examination, she had pallor and thoracic spine tenderness. Her lab investigations showed the following findings. An x-ray of her skull is shown below. What is the most likely diagnosis? Hb-6.9g/dl WBC 4000/cm3 with normal differential count Serum calcium 13mg/dl Creatinine 2.3mg/dl Albumin 2.4g/dl Urinalysis: positive for Bence-Jones proteins", "options": [{"label": "A", "text": "Metastatic breast cancer", "correct": false}, {"label": "B", "text": "Multiple myeloma", "correct": true}, {"label": "C", "text": "Primary hyperparathyroidism", "correct": false}, {"label": "D", "text": "Milk alkali syndrome", "correct": false}], "correct_answer": "B. Multiple myeloma", "question_images": ["https://image.prepladder.com/content/dFjwadUHFCV7ZEsQGSNy1711975150.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 60 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 21 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old woman presents with a sudden onset of fatigue, jaundice, and dark urine. On examination, she has splenomegaly. Laboratory tests reveal an elevated reticulocyte count, elevated lactate dehydrogenase (LDH), and positive direct Coombs test for IgG antibodies. Which of the following is the most appropriate first-line treatment for this patient?", "options": [{"label": "A", "text": "Splenectomy", "correct": false}, {"label": "B", "text": "Prednisone + Azathioprine", "correct": false}, {"label": "C", "text": "Prednisone + Rituximab", "correct": true}, {"label": "D", "text": "Intravenous Immunoglobulin (IVIG)", "correct": false}], "correct_answer": "C. Prednisone + Rituximab", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of Warm <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">Autoimmune</span> <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> Anemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-Line Treatment</strong>:</p>\n<ul>\n<li>Initiate treatment with<strong> prednisone</strong> at <strong>1 mg/kg/day</strong>, which induces <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> in approximately <strong>50%</strong> of cases.</li>\n<li>Combine with anti-CD20 <strong>Rituximab</strong> (100 mg/week for 4 weeks) to potentially reduce <span class=\"customMeta\" data-dictid=\"b4b361c37616927771979541177070\">relapse</span> rates. <strong>(Option C)</strong></li>\n</ul>\n<p><strong>Alternative Therapies for Relapse/Refractoriness</strong>:</p>\n<ul>\n<li><strong>Splenectomy</strong> can improve <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> and decrease reliance on other therapies by eliminating a primary site of hemolysis, but it also poses risks of <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> and thrombosis. <strong>(Option A ruled out)</strong></li>\n<li><strong>Second- and Third-Line Treatments</strong>: <span class=\"customMeta\" data-dictid=\"80fd8ffd0816927771826bfe7129d6\">Azathioprine</span> <strong>(Option B ruled out)</strong>, Cyclophosphamide, Cyclosporine, Mycophenolate, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">Intravenous</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> <strong>(Option D ruled out)</strong></li>\n</ul>\n<p><strong>Additional Support</strong>:</p>\n<ul>\n<li><strong>Erythropoietin</strong> may be used to help reduce or avoid the need for <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">red blood cell</span> transfusions in cases of severe <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> associated with reticulocytopenia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of Cold <span class=\"customMeta\" data-dictid=\"793dda05ac1692777180345347d49c\">Agglutinin</span> Disease (CAD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-Line Treatment</strong>:</p>\n<ul>\n<li><strong>Rituximab</strong> is the primary treatment for CAD, as <span class=\"customMeta\" data-dictid=\"5dff8e3fac1692777196f8c0c960f3\">prednisone</span> and <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> are ineffective in managing this condition.</li>\n</ul>\n<p><strong>Emerging Therapies</strong>:</p>\n<ul>\n<li>For relapses, consider B-cell <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> inhibitors such as <strong>venetoclax</strong> &amp; <strong>ibrutinib</strong>, as well as the <span class=\"customMeta\" data-dictid=\"f8f858a92616927771968a69ba60d6\">proteasome</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> <strong>bortezomib</strong>.</li>\n</ul>\n<p><strong>Supportive Care</strong>:</p>\n<ul>\n<li>Blood transfusions may be beneficial, though donor red cells (I-positive) will have a similar survival rate to the patient’s own cells.</li>\n<li>It is essential to keep both the blood bag and the patient's extremities warm during transfusions.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old female patient is admitted to the emergency department with a sudden onset of fever, chills, and dark urine. She recently received a blood transfusion for severe anemia due to menorrhagia. Laboratory tests reveal elevated free hemoglobin, increased lactate dehydrogenase (LDH), and decreased haptoglobin. Urinalysis shows hemoglobinuria. What is the most likely mechanism responsible for the hemolysis observed in this patient?", "options": [{"label": "A", "text": "Mechanical shear-force associated lysis", "correct": false}, {"label": "B", "text": "Complement fixation and direct lysis", "correct": true}, {"label": "C", "text": "Membrane or hemoglobin disorder-associated lysis", "correct": false}, {"label": "D", "text": "Exogenous toxic factors", "correct": false}], "correct_answer": "B. Complement fixation and direct lysis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conditions </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complement <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> and direct <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> (Immune-Mediated)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cold <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia</li>\n<li>ABO antibody-mediated <span class=\"customMeta\" data-dictid=\"5b854dc031169277718181b6e0b418\">alloimmune</span> <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (e.g., following a <strong>mismatched transfusion</strong>)</li>\n<li><strong>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> <span class=\"customMeta\" data-dictid=\"ddeb334a351692777188795bb090ef\">hemoglobinuria</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanical shear-force associated <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> (Non-Immune-Mediated) <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Microangiopathic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemias (e.g., thrombotic thrombocytopenic purpura)</li>\n<li>Cardiac valvular disorders (e.g., <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> heart valves)</li>\n<li>March hemoglobinuria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Membrane or <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> disorder-associated <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> (Non-Immune-Mediated) <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sickle cell anemia</li>\n<li>Thalassemia</li>\n<li>Severe burns</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exogenous toxic factors or infections <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Falciparum malaria</li>\n<li>Clostridial sepsis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Destruction of older fraction of G6PD-deficient red cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Favism</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravascular <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extravascular <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemoglobinemia</li>\n<li>Hemoglobinuria</li>\n<li>Very low/ absent <span class=\"customMeta\" data-dictid=\"8d8151fa671692777188a59bbec61f\">haptoglobin</span> values</li>\n<li>No hepatosplenomegaly</li>\n<li>Raised <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> due to <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> breakage in the vessels</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"91d8b928d516927771883c7ad32630\">hemoglobinemia</span> or hemoglobinuria</li>\n<li>Low/ normal <span class=\"customMeta\" data-dictid=\"8d8151fa671692777188a59bbec61f\">haptoglobin</span> (not as low as intravascular)</li>\n<li>Hepatosplenomegaly is seen</li>\n<li>Elevated unconjugated bilirubin</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman presents with a 3-day history of confusion, fatigue, and diffuse petechial rash. Physical examination reveals mild jaundice and scattered petechiae over her arms and legs. Laboratory studies show the following results: Hemoglobin: 7.8 g/dL Platelet count: 22,000/µL Lactate dehydrogenase (LDH): Elevated Peripheral blood smear: Schistocytes present What is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Platelet transfusion", "correct": false}, {"label": "B", "text": "Plasmapheresis", "correct": true}, {"label": "C", "text": "High-dose intravenous immunoglobulin (IVIG)", "correct": false}, {"label": "D", "text": "Intravenous heparin", "correct": false}], "correct_answer": "B. Plasmapheresis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy presents with symptoms of fatigue, pallor, dysentery, abdominal pain, and reduced urine output. He has a recent history of consuming undercooked ground beef. Laboratory findings reveal elevated serum creatinine, elevated lactate dehydrogenase (LDH), low haptoglobin, and a peripheral blood smear shows characteristic findings. Considering the patient's clinical presentation and laboratory results, what is the definitive diagnostic method to identify the pathogen causing his condition?", "options": [{"label": "A", "text": "Blood culture", "correct": false}, {"label": "B", "text": "Urinalysis", "correct": false}, {"label": "C", "text": "Stool culture", "correct": true}, {"label": "D", "text": "Serologic testing", "correct": false}], "correct_answer": "C. Stool culture", "question_images": ["https://image.prepladder.com/notes/M1p9EQe3eQrfBnv3nYVG1744392238.png"], "explanation_images": ["https://image.prepladder.com/notes/rwIbuUGO8IK56EprNJEQ1744392587.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man with hypertension is prescribed α-methyldopa. After a few months of therapy, he develops mild anemia. His DAT is positive for IgG, and the eluate shows panagglutination. There is no evidence of renal dysfunction or hemoglobinuria. What is the most likely cause of his anemia?", "options": [{"label": "A", "text": "Drug Adsorption", "correct": false}, {"label": "B", "text": "Immune Complex Mechanism", "correct": false}, {"label": "C", "text": "Autoimmune Mechanism", "correct": true}, {"label": "D", "text": "Non-Immunologic Protein Adsorption", "correct": false}], "correct_answer": "C. Autoimmune Mechanism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:771px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug-immune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Example Drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Adsorption</strong> (Penicillin Type) <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IgG antibodies bind to drug-coated RBCs leading to <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> by splenic macrophages</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> over 7-10 days; splenic sequestration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Penicillin</strong></li>\n<li>Cephalosporin</li>\n<li>Tetracycline</li>\n<li>Tolbutamide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neoantigen/Immune Complex</strong> (Quinidine Type) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibodies bind to newly formed <span class=\"customMeta\" data-dictid=\"331db7d96b16927771813cfafb0985\">antigenic</span> sites on RBCs, <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> leads to <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> hemolysis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute, severe hemolysis; hemoglobinuria; <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Quinidine</strong></li>\n<li>Stibophen</li>\n<li>Sulfonamides</li>\n<li>Rifampicin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoimmune Mechanism </strong>(α-Methyldopa Type) <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polyclonal <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> autoantibodies attack <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> components.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic, mild hemolysis; similar to <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> warm AIHA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>α-methyldopa</strong></li>\n<li>Cladribine</li>\n<li>Fludarabine</li>\n<li>Mefenamic acid</li>\n<li><strong>Procainamide</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Immunologic Protein <span class=\"customMeta\" data-dictid=\"5888a38d3616927771807ef93913a2\">Adsorption</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proteins like fibrinogen, complement, or <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> <span class=\"customMeta\" data-dictid=\"1228502b9d1692777180d52d2ce776\">adsorb</span> to <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> membranes, not associated with <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> destruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive DAT; no hemolysis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cephalosporin</li>\n<li>Cisplatin</li>\n<li>Oxaliplatin</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old woman with a history of rheumatoid arthritis presents with fatigue, pallor, and splenomegaly. Laboratory evaluation reveals anemia and a positive direct Coombs test. The DAT shows agglutination with both anti-IgG and anti-C3 reagents. Which of the following conditions is most likely associated with her presentation?", "options": [{"label": "A", "text": "Cold-agglutinin disease", "correct": false}, {"label": "B", "text": "Warm-antibody autoimmune hemolytic anemia", "correct": true}, {"label": "C", "text": "Hapten type drug-induced immune hemolytic anemia", "correct": false}, {"label": "D", "text": "Paroxysmal cold hemoglobinuria", "correct": false}], "correct_answer": "B. Warm-antibody autoimmune hemolytic anemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:585px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major Patterns of Direct <span class=\"customMeta\" data-dictid=\"18665cc70b1692777181f6f3baa32c\">Antiglobulin</span> Reaction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reaction Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Immune Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgG Alone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Warm-antibody <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia.</li>\n<li>Drug-immune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia: <span class=\"customMeta\" data-dictid=\"2bee100aec1692777188d7a8a52f34\">hapten</span> drug <span class=\"customMeta\" data-dictid=\"5888a38d3616927771807ef93913a2\">adsorption</span> type or <span class=\"customMeta\" data-dictid=\"06e07ce7821692777182e8ffd9676f\">autoantibody</span> type. <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complement Alone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cold-agglutinin disease. <strong>(Option A)</strong></li>\n<li>Paroxysmal cold hemoglobinuria. <strong>(Option D)</strong></li>\n<li>Drug-immune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia: <span class=\"customMeta\" data-dictid=\"6e71126f6416927772001715e3e3a0\">ternary</span> complex type.</li>\n<li>Warm-antibody <span class=\"customMeta\" data-dictid=\"f86191337d16927771806ed6645fc9\">AHA</span> with subthreshold <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> deposition.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgG Plus Complement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Warm-antibody AHA. <strong>(Option B)</strong></li>\n<li>Drug-immune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia: <span class=\"customMeta\" data-dictid=\"06e07ce7821692777182e8ffd9676f\">autoantibody</span> type (rare)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Features of Immune-Mediated <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">Anemia</span> (AIHA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemoglobin &amp; Hematocrit</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ranges from normal (compensated hemolysis) to extremely low (severe <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> destruction)</p>\n<p>Elevated MCV.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reticulocyte Counts</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically elevated.</p>\n<p>May be low early due to <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> shutdown, infection, or <span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\">parvovirus</span> B19; hyperplastic marrow.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral Blood Smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Immune-Mediated &lt;span class=\" custommeta\"=\"\" data-dictid=\"d30ae941d516927771889351160b00\"/>Hemolytic Anemia\" data-author=\"Barbaryan, Aram &amp; Iyinagoro, Chioma &amp; Nwankwo, Nwabundo &amp; Ali, Alaa &amp; Saba, Raya &amp; Kwatra, Shawn &amp; Hussain, Nasir &amp; Uzoka, Cameron &amp; Prueksaritanond, Suartcha &amp; Mirrakhimov, Aibek.\" data-hash=\"9581\" data-license=\"CC BY \" data-source=\"https://www.researchgate.net/figure/Peripheral-blood-smear-shows-microspherocytes-black-arrows-polychromasia-white_fig1_236941134\" data-tags=\"April2025\" height=\"231\" src=\"https://image.prepladder.com/notes/oNxXsSGnl6haqTyeMkJx1744391850.png\" width=\"300\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shows:</p>\n<ul>\n<li>Reticulocytosis</li>\n<li><strong>Polychromatophilia </strong>(white arrow)</li>\n<li>Macrocytosis (red arrow)</li>\n<li>Nucleated RBCs</li>\n<li><strong>Spherocytes</strong> (black arrow)</li>\n<li>Agglutination</li>\n<li>Erythrophagocytosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WBC &amp; <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">Platelet</span> Counts</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>WBCs may be elevated or low.</li>\n<li>Thrombocytopenia suggests Evans syndrome; possible immune-mediated cytopenias.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Tests</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated unconjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> (&lt;5 mg/dL)</li>\n<li>Hemoglobinemia, hemoglobinuria.</li>\n<li>Low haptoglobin, increased urobilinogen, increased LDH.</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"b0151941a0169277720265b58da84e\">false-positive</span> <span class=\"customMeta\" data-dictid=\"23f8d40f6a1692777199029dbec026\">syphilis</span> tests.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presents with complaints of acrocyanosis and fatigue. She has a history of multiple myeloma and has been on lenalidomide therapy for the past 3 months. Laboratory tests reveal a hemoglobin level of 10.5 g/dL, a reticulocyte count of 5%, and a positive direct Coombs test. What is the most likely antibody type involved in this patient’s condition?", "options": [{"label": "A", "text": "IgG", "correct": false}, {"label": "B", "text": "IgM", "correct": true}, {"label": "C", "text": "IgA", "correct": false}, {"label": "D", "text": "IgE", "correct": false}], "correct_answer": "B. IgM", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:729px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Warm <span class=\"customMeta\" data-dictid=\"3b4c3c13fb169277718004f65ca0b1\">AIHA</span> (WAIHA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cold <span class=\"customMeta\" data-dictid=\"3b4c3c13fb169277718004f65ca0b1\">AIHA</span> (CAD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optimal Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>37°C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4°C–30°C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrupt and dramatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual and chronic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Idiopathic</p>\n<p>Secondary causes:</p>\n<ul>\n<li>Autoimmune diseases (e.g., <strong>SLE</strong>, <strong>scleroderma</strong>,<strong> RA</strong>)</li>\n<li>Infections:</li>\n</ul>\n<ul>\n<li>Parvovirus B19, HIV, HCV, <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> vaccines)</li>\n<li>Babesia</li>\n</ul>\n<ul>\n<li>Lymphoproliferative disorders (e.g., CLL, multiple myeloma)</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disorders (e.g., IBD, <span class=\"customMeta\" data-dictid=\"df0e1364a11692777200ed67550c12\">thyroiditis</span> including Hashimoto)</li>\n<li>Drug-induced cases (e.g., cefotetan, <strong>ceftriaxone</strong>, piperacillin, <strong>methyldopa</strong>, fludarabine)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Idiopathic</p>\n<p>Secondary causes:</p>\n<ul>\n<li>Infections:</li>\n</ul>\n<ul>\n<li>(e.g., <strong>EBV</strong>, CMV)</li>\n<li><strong>Mycoplasma</strong></li>\n</ul>\n<ul>\n<li>Waldenströms disease</li>\n<li>lymphoma</li>\n<li>Drug-induced cases (e.g., <strong>lenalidomide</strong>)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abrupt symptoms, potentially severe anemia.</li>\n<li>Jaundice, splenomegaly.</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"249592767b16927771976df58de24d\">reticulocyte</span> count, LDH</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gradual onset</li>\n<li>Symptoms worsen with cold exposure.</li>\n<li>Hemoglobinuria.</li>\n<li>Acrocyanosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Hemolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The Fc portion of the<strong> IgG</strong> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> <span class=\"customMeta\" data-dictid=\"d82fcb9d1f16927771836a9f6ccf14\">bound</span> to red cells is recognized by <span class=\"customMeta\" data-dictid=\"2748357f451692777191377abbe2a6\">macrophage</span> Fc receptors.</li>\n<li>Leading to <span class=\"customMeta\" data-dictid=\"35670eb0a016927771872de8dc0b96\">erythrophagocytosis</span> primarily in the <strong>spleen</strong>, liver, and <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> in an <strong>extravascular manner.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IgM </strong>bound to red blood cells activates the <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> cascade, leading to <strong>intravascular hemolysis</strong>, which can result in hemoglobinuria.</li>\n<li>Activated <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> components, such as C3b, <span class=\"customMeta\" data-dictid=\"7335d3393d1692777194cc915c08fe\">opsonize</span> red blood cells, which are then destroyed by macrophages in an <strong>extravascular manner</strong>.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy presents with hemoglobinuria and abdominal pain after playing outside in cold weather. He had a recent upper respiratory tract infection. Lab findings reveal hemoglobin of 4.2 g/dL, elevated LDH, and positive Donath-Landsteiner test. What is the pathophysiological mechanism of his condition?", "options": [{"label": "A", "text": "IgG autoantibodies causing RBC lysis at warm temperatures", "correct": false}, {"label": "B", "text": "IgM autoantibodies causing RBC agglutination at cold temperatures", "correct": false}, {"label": "C", "text": "IgG auto-antibodies binding to RBCs at cold temperatures and causing lysis upon warming", "correct": true}, {"label": "D", "text": "Complement-mediated destruction of RBCs without any antibody involvement", "correct": false}], "correct_answer": "C. IgG auto-antibodies binding to RBCs at cold temperatures and causing lysis upon warming", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paroxysmal Cold <span class=\"customMeta\" data-dictid=\"ddeb334a351692777188795bb090ef\">Hemoglobinuria</span> (PCH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D-L <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">Antibody</span> Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"9fea3db5bb16927771885315f60b70\">hemolysin</span> that binds to red blood cells (RBCs) at cold temperatures, fixing complement, and causes <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> when warmed.</li>\n<li>Typically<strong> IgG</strong>, directed against the <strong>P <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> on RBCs </strong>(a glycosphingolipid).</li>\n<li><strong>\"Biphasic\"</strong> hemolysin:<strong> binds</strong> at <strong>0°C–4°C</strong> and causes <strong>lysis</strong> when warmed to <strong>37°C</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden onset of fever, back/leg pain, and dark red-to-black <span class=\"customMeta\" data-dictid=\"ddeb334a351692777188795bb090ef\">hemoglobinuria</span> after cold exposure.</li>\n<li>Symptoms may include cold-induced urticaria, Raynaud phenomenon, cyanosis, and, rarely, gangrene.</li>\n<li>Affects <strong>mostly children</strong> following<strong> <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections </strong>(e.g., <strong>Mycoplasma</strong>, measles, mumps, influenza, EBV, varicella, parvo B19 etc.).</li>\n<li><strong>Chronic PCH</strong> is common in <strong>late-stage</strong> or<strong> <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> syphilis</strong>, now rare due to <span class=\"customMeta\" data-dictid=\"23f8d40f6a1692777199029dbec026\">syphilis</span> treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Severe <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> hemolysis:</strong> <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> &lt;5 g/dL, hemoglobinuria, elevated <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> and bilirubin.</li>\n<li><strong>Diagnostic hallmark</strong><strong>:</strong> positive Donath-Landsteiner test\n\t\t\t\t<ul>\n<li>It is an in-vitro test that detects <strong>anti-P antibodies</strong> in a patient's <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> by incubating it with red blood cells at low temperatures, causing <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> upon warming if the antibodies are present.</li>\n</ul>\n</li>\n<li><strong>Direct <span class=\"customMeta\" data-dictid=\"18665cc70b1692777181f6f3baa32c\">Antiglobulin</span> Test (</strong>DAT) is usually positive for <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> (C3) but not IgG.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Supportive care</strong>: <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">Transfusion</span> of warmed blood if necessary.</li>\n<li><strong>Steroids</strong>: Sometimes used in severe cases (though benefits are unproven).</li>\n<li><strong>Avoidance of cold exposure</strong>: Crucial for chronic cases.</li>\n<li><strong>Transfusion considerations</strong>: No need to search for rare P-negative blood units; standard P-positive blood is generally safe.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male who works in a battery manufacturing company presents with fatigue, weakness, pallor, confusion, and a single seizure episode. He also reports numbness and tingling in his hands. A peripheral blood smear is ordered, which reveals characteristic findings. Based on the results of the blood smear, which of the following inclusions can be identified in the red blood cells?", "options": [{"label": "A", "text": "Cabot rings", "correct": false}, {"label": "B", "text": "Howell-Jolly bodies", "correct": false}, {"label": "C", "text": "Pappenheimer bodies", "correct": true}, {"label": "D", "text": "Heinz bodies", "correct": false}], "correct_answer": "C. Pappenheimer bodies", "question_images": ["https://image.prepladder.com/notes/od6JVSjFdAkNh5XEQtcu1744391040.png"], "explanation_images": ["https://image.prepladder.com/notes/qStFWGDA7yjAublPfCUi1744391182.png", "https://image.prepladder.com/notes/hfX8lmQHrk6x0KsKqxIl1744391319.png", "https://image.prepladder.com/notes/Hc6ecpOF2fhHhXU0YoOS1744391427.png", "https://image.prepladder.com/notes/VL9L9ZyRLqwNr44RSghm1744391521.png", "https://image.prepladder.com/notes/dXxVaaLTr8lIfGqgkqGA1744391619.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:609px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inclusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cabot Rings</strong><strong> (Option A ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Cabot Ring \" data-author=\"J3D3\" data-hash=\"9567\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Cabot_rings\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/qStFWGDA7yjAublPfCUi1744391182.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Megaloblastic anemia, sometimes seen in lead poisoning</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Howell-Jolly Bodies </strong><strong>(Option B ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Howell-Jolly Bodies\" data-author=\"Paulo Henrique Orlandi Mourao and Mikael Häggström\" data-hash=\"9568\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Howell-Jolly_body.png\" data-tags=\"April2025\" height=\"344\" src=\"https://image.prepladder.com/notes/hfX8lmQHrk6x0KsKqxIl1744391319.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asplenia, post-splenectomy, certain hematologic disorders</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pappenheimer Bodies</strong></p>\n<figure class=\"caption_element\"><img alt=\"Pappenheimer Bodies \" data-author=\"Paulo Henrique Orlandi Mourao\" data-hash=\"9569\" data-license=\"BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Pappenheimer_bodies\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Hc6ecpOF2fhHhXU0YoOS1744391427.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sideroblastic anemia, thalassemia, <span class=\"customMeta\" data-dictid=\"64bbd63a0c1692777190f0c8e06e91\">iron overload</span> states, lead poisoning.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heinz Bodies</strong><strong> (Option D ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Heinz Bodies \" data-author=\"Elord \" data-hash=\"9572\" data-license=\"CC BY SA\" data-source=\"https://www.wikidoc.org/index.php/Heinz_body\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/VL9L9ZyRLqwNr44RSghm1744391521.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>G6PD deficiency, <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress, certain <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basophilic Stippling</strong></p>\n<figure class=\"caption_element\"><img alt=\"Basophilic Stippling\" data-author=\"Prof. Erhabor Osaro \" data-hash=\"9575\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Basophilic_stippling\" data-tags=\"April2025\" height=\"302\" src=\"https://image.prepladder.com/notes/dXxVaaLTr8lIfGqgkqGA1744391619.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lead poisoning, thalassemia, <span class=\"customMeta\" data-dictid=\"6e8ada09fa1692777189bfbace851a\">heavy metal</span> poisoning</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents with jaundice, dark urine, fatigue, and pallor following recent travel to the Middle East, returning just two days ago. Routine blood tests indicate anemia with elevated bilirubin levels and decreased haptoglobin. A peripheral blood smear reveals specific findings. What is the most appropriate management for this condition?", "options": [{"label": "A", "text": "Administer intravenous antibiotics.", "correct": false}, {"label": "B", "text": "Provide a blood transfusion", "correct": false}, {"label": "C", "text": "Avoid trigger factors and monitor", "correct": true}, {"label": "D", "text": "Initiate corticosteroid therapy", "correct": false}], "correct_answer": "C. Avoid trigger factors and monitor", "question_images": ["https://image.prepladder.com/notes/Pesvs7LOAIV8X1p9IZrd1744390497.png"], "explanation_images": ["https://image.prepladder.com/notes/BijCLvg33ZY9lX3pPuqi1744390768.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child suffering from malaria was treated with chloroquine and primaquine for several days but did not improve. The child has now developed new symptoms, including high-colored urine, severe abdominal pain, and shortness of breath. Which of the following conditions is most likely responsible for these symptoms?", "options": [{"label": "A", "text": "Hypersensitivity reaction", "correct": false}, {"label": "B", "text": "Cinchonism", "correct": false}, {"label": "C", "text": "G6PD deficiency", "correct": true}, {"label": "D", "text": "Stevens-Johnson Syndrome", "correct": false}], "correct_answer": "C. G6PD deficiency", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/rh7QvHAKJDKwPMuLMhbN1744378743.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old boy from southern India presents with recurrent severe joint pain, fatigue, and jaundice. Lab tests show hemoglobin of 7 g/dL, high reticulocyte count, and sickle-shaped erythrocytes on a blood smear. Which of the following is not a pathophysiology consistent with this disorder?", "options": [{"label": "A", "text": "HbS polymerization causes sickling and hemolysis, releasing cell-free hemoglobin.", "correct": false}, {"label": "B", "text": "Vaso-occlusion from sickle cell and inflammatory cell aggregation, leads to ischemia.", "correct": false}, {"label": "C", "text": "Endothelial dysfunction due to depletion of nitric oxide and the generation of free radicals.", "correct": false}, {"label": "D", "text": "Impaired erythropoietin production leading to inadequate bone marrow response", "correct": true}], "correct_answer": "D. Impaired erythropoietin production leading to inadequate bone marrow response", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/M6JL67JfJB2ww7A1c3s21744375955.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old woman presents to the hospital with yellowish discoloration of the skin for a few days. She has no severe symptoms and the discoloration was gradual in onset. On blood analysis, he is found to have raised unconjugated bilirubin levels. Which of the following is not a cause of this condition?", "options": [{"label": "A", "text": "Direct damage to erythrocytes", "correct": false}, {"label": "B", "text": "Shear stress from microangiopathy", "correct": false}, {"label": "C", "text": "Immune-mediated hemolysis", "correct": false}, {"label": "D", "text": "Destruction of older fraction of G6PD-deficient red cells", "correct": true}], "correct_answer": "D. Destruction of older fraction of G6PD-deficient red cells", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extravascular Hemolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravascular Hemolysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site of Hemolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs in the spleen, liver, and <span class=\"customMeta\" data-dictid=\"77c058b3b21692777197f5fd539d12\">reticuloendothelial</span> system.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs within the blood vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Destruction of RBCs by macrophages (phagocytosis).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RBCs <span class=\"customMeta\" data-dictid=\"9d2e2f9bd016927771914cc90f468c\">lyse</span> due to mechanical injury, <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> activation, or toxins.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Haptoglobin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased or slightly reduced.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significantly decreased or absent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemoglobinemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present due to free <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> in plasma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemoglobinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (causes dark-colored urine).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Hemosiderin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (due to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> of hemoglobin).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LDH Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mildly increased.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Markedly increased.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unconjugated Bilirubin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (due to <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> in macrophages).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (from released heme).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral Blood Smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spherocytes or target cells may be seen.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Schistocytes (fragmented RBCs) are typical.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reticulocyte Count</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased (if <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> compensates).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hereditary spherocytosis, <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (warm type).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> hemoglobinuria, mechanical <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> (e.g., <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valves), cold AIHA, <span class=\"customMeta\" data-dictid=\"96985248371692777188cfb38ca861\">G6PD</span> deficiency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Splenomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common (due to increased <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> destruction).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"39be9b36e21692777185ebcac8d57f\">Coombs test</span> is positive in <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> hemolysis.</p>\n<p>- <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">Splenectomy</span> may be beneficial in some cases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"d255f5eb7916927771885bd197ec11\">Hemosiderinuria</span> indicates chronic <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> hemolysis.</p>\n<p>- Schistocytes are a hallmark of microangiopathic hemolysis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents with fatigue, jaundice, and dark urine. Laboratory tests reveal elevated indirect bilirubin levels and a hemoglobin level of 8 g/dL. A peripheral blood smear shows spherocytes. Which of the following classifications best describes this patient's condition?", "options": [{"label": "A", "text": "Acquired hemolytic anemia due to autoimmune hemolysis", "correct": false}, {"label": "B", "text": "Inherited hemolytic anemia due to enzyme abnormalities", "correct": false}, {"label": "C", "text": "Acquired hemolytic anemia due to mechanical destruction", "correct": false}, {"label": "D", "text": "Inherited hemolytic anemia due to membrane-cytoskeletal defects", "correct": true}], "correct_answer": "D. Inherited hemolytic anemia due to membrane-cytoskeletal defects", "question_images": [], "explanation_images": [], "explanation": "<p><strong>Educational Objective:</strong></p>\n<ul><li>➤ Learning Objective:</li><li>➤ General features of hemolytic anemias:</li><li>➤ Clinical features Jaundice Pallor Splenomegaly Bossing of the skull in severe congenital cases Laboratory findings Normal to severely low hemoglobin Increased MCV, and MCH Increased reticulocytes Increased bilirubin (unconjugated) Increased LDH (up to 10x normal with intravascular hemolysis) Reduced to absent haptoglobin (if intravascular hemolysis is also present)</li><li>➤ Clinical features Jaundice Pallor Splenomegaly Bossing of the skull in severe congenital cases</li><li>➤ Clinical features</li><li>➤ Clinical features</li><li>➤ Clinical features</li><li>➤ Jaundice Pallor Splenomegaly Bossing of the skull in severe congenital cases</li><li>➤ Jaundice Pallor Splenomegaly Bossing of the skull in severe congenital cases</li><li>➤ Bossing of the skull in severe congenital cases</li><li>➤ Laboratory findings Normal to severely low hemoglobin Increased MCV, and MCH Increased reticulocytes Increased bilirubin (unconjugated) Increased LDH (up to 10x normal with intravascular hemolysis) Reduced to absent haptoglobin (if intravascular hemolysis is also present)</li><li>➤ Laboratory findings</li><li>➤ Laboratory findings</li><li>➤ Laboratory findings</li><li>➤ Normal to severely low hemoglobin Increased MCV, and MCH Increased reticulocytes Increased bilirubin (unconjugated) Increased LDH (up to 10x normal with intravascular hemolysis) Reduced to absent haptoglobin (if intravascular hemolysis is also present)</li><li>➤ Normal to severely low hemoglobin Increased MCV, and MCH Increased reticulocytes Increased bilirubin (unconjugated) Increased LDH (up to 10x normal with intravascular hemolysis) Reduced to absent haptoglobin (if intravascular hemolysis is also present)</li><li>➤ Normal to severely low hemoglobin</li><li>➤ Increased MCV, and MCH</li><li>➤ Increased reticulocytes</li><li>➤ Increased bilirubin (unconjugated)</li><li>➤ Increased LDH (up to 10x normal with intravascular hemolysis)</li><li>➤ Reduced to absent haptoglobin (if intravascular hemolysis is also present)</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intracorpuscular defects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extracorpuscular defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Inherited </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemoglobinopathies\n\t\t\t\t<ul>\n<li>Eg: Sickle cell disease</li>\n</ul>\n</li>\n<li>Enzymopathies\n\t\t\t\t<ul>\n<li>Eg: <span class=\"customMeta\" data-dictid=\"96985248371692777188cfb38ca861\">G6PD</span> Deficiency</li>\n</ul>\n</li>\n<li>Membrane-cytoskeletal defects\n\t\t\t\t<ul>\n<li>Eg: <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">Hereditary</span> spherocytosis</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Familial (atypical) <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> <span class=\"customMeta\" data-dictid=\"7b92610b86169277720111ae27d1d8\">uremic</span> syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Acquired </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> hemoglobinuria</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mechanical destruction (microangiopathies)</li>\n<li>Toxic agents</li>\n<li>Drugs</li>\n<li>Infectious</li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Jaundice</li>\n<li>Pallor</li>\n<li>Splenomegaly</li>\n<li>Bossing of the skull in severe <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Laboratory findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normal to severely low hemoglobin</li>\n<li>Increased MCV, and MCH</li>\n<li>Increased reticulocytes</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> (unconjugated)</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> (up to 10x normal with <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> hemolysis)</li>\n<li>Reduced to absent <span class=\"customMeta\" data-dictid=\"8d8151fa671692777188a59bbec61f\">haptoglobin</span> (if <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> is also present)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old girl with a confirmed diagnosis of sickle cell anemia presents to the emergency department with severe fatigue, pallor, and a recent history of frequent painful episodes. Her mother reports that she has experienced a headache and dizziness over the past two days. The physician suspects severe anemia and potential complications. What is the most appropriate initial management, considering her clinical presentation?", "options": [{"label": "A", "text": "Initiate gene therapy immediately", "correct": false}, {"label": "B", "text": "Administer hydroxyurea", "correct": false}, {"label": "C", "text": "Start transfusion therapy", "correct": true}, {"label": "D", "text": "Schedule a stem cell transplant consultation", "correct": false}], "correct_answer": "C. Start transfusion therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 19-year-old male with a known history of sickle cell anemia presents to the clinic with recurrent painful crises over the past month. He has been on hydroxyurea for the last year, which has provided some relief, but his symptoms remain frequent and debilitating. Which of the following treatments should the physician consider adding to help reduce the frequency of his painful crises?", "options": [{"label": "A", "text": "Voxelotor", "correct": true}, {"label": "B", "text": "Crizanlizumab", "correct": false}, {"label": "C", "text": "Increase the dose of hydroxyurea", "correct": false}, {"label": "D", "text": "L-Glutamine", "correct": false}], "correct_answer": "A. Voxelotor", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy is brought to the emergency department with severe pain in his hands and feet, with several episodes of pain over the past year and occasional experiences of fatigue. His hand appears as follows: A blood film shows the presence of sickle cells and target cells. Which of the following is the investigation of choice for the diagnosis of this child’s condition?", "options": [{"label": "A", "text": "X-ray spine", "correct": false}, {"label": "B", "text": "High-performance liquid chromatography", "correct": true}, {"label": "C", "text": "HbS detection using a reducing agent", "correct": false}, {"label": "D", "text": "Parental genetic testing", "correct": false}], "correct_answer": "B. High-performance liquid chromatography", "question_images": ["https://image.prepladder.com/notes/VaI9nEmKoDnoz4DVCJax1744377409.png"], "explanation_images": ["https://image.prepladder.com/notes/x9nbrF5D7y8tD4M4x20d1744378059.png", "https://image.prepladder.com/notes/KQ3x6A8ZbW6BjjeeEyX31744378267.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents for evaluation after experiencing fatigue and occasional pain during a recent hiking trip. He reports that his family has a history of sickle cell disease. A laboratory evaluation reveals that he carries sickle cell trait. Which of the following statements best describes this patient's condition?", "options": [{"label": "A", "text": "He has two copies of the hemoglobin S gene.", "correct": false}, {"label": "B", "text": "He is likely to experience frequent vaso-occlusive crisis.", "correct": false}, {"label": "C", "text": "He has HbS, HbF, and HbA2 present, while HbA is absent.", "correct": false}, {"label": "D", "text": "His symptoms may arise from hypoxia, dehydration, or extreme temperatures", "correct": true}], "correct_answer": "D. His symptoms may arise from hypoxia, dehydration, or extreme temperatures", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:706px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sickle Cell Trait</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sickle Cell Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Profile </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One copy of the <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> S gene</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two copies of the <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> S gene<strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemoglobin electrophoresis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HbA, <span class=\"customMeta\" data-dictid=\"81bb02697216927771887f2fffc386\">HbS</span> present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HbS, HbF, HbA2 present.</p>\n<p>HbA absent. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually asymptomatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Broad clinical manifestations (eg, generalized pain and fatigue) due to vaso-occlusive crisis, hemolysis, and <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> exacerbations. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset of symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exposure to conditions that favor sickling, including:</p>\n<ul>\n<li>Severe hypoxia</li>\n<li>Dehydration</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> outflow</li>\n<li>Hypothermia</li>\n<li>Hyperthermia</li>\n<li>High 2,3-DPG levels</li>\n<li>Release of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a characteristic special finding of sickle cell anemia?", "options": [{"label": "A", "text": "Presence of Heinz bodies.", "correct": true}, {"label": "B", "text": "Elongated, crescent-shaped red blood cells on peripheral smear.", "correct": false}, {"label": "C", "text": "Presence of target cells due to splenic sequestration.", "correct": false}, {"label": "D", "text": "Crew-cut appearance on skull X-ray due to extramedullary hematopoiesis.", "correct": false}], "correct_answer": "A. Presence of Heinz bodies.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/MWjqeasICJmL3xYCat9F1744376255.png", "https://image.prepladder.com/notes/HeCty4NFQ5RTXgahgnjX1744376480.png", "https://image.prepladder.com/notes/MHVqdd1MHv3cDb4M7UyF1744376749.png", "https://image.prepladder.com/notes/2rtviycvn4DAgUu8Rina1744377003.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old male is diagnosed with sickle cell anemia. His parents are concerned and want to know the potential complications associated with the disease. Which of the following complications is most commonly associated with sickle cell anemia?", "options": [{"label": "A", "text": "Osteonecrosis, typically affecting the hips bilaterally.", "correct": false}, {"label": "B", "text": "Acute Chest Syndrome, marked by cough and chest pain.", "correct": false}, {"label": "C", "text": "Vaso-occlusive crises, leading to severe unprovoked pain", "correct": true}, {"label": "D", "text": "Leg ulcers, which can become deep and difficult to manage.", "correct": false}], "correct_answer": "C. Vaso-occlusive crises, leading to severe unprovoked pain", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old African American boy has recurrent leg pain, fatigue, and occasional yellowing of eyes. Examination shows scleral icterus and splenomegaly. Labs reveal anemia with elevated reticulocytes, and the blood smear shows sickle-shaped red cells. Which of the following features is not consistent with his condition?", "options": [{"label": "A", "text": "Increased susceptibility to infections due to splenic dysfunction.", "correct": false}, {"label": "B", "text": "Severe abdominal pain due to splenic dysfunction, resembling pancreatitis.", "correct": true}, {"label": "C", "text": "Recurrent bone pain leads to avascular necrosis (AVN), which is best assessed by MRI.", "correct": false}, {"label": "D", "text": "Painful swelling of hands and feet (dactylitis) from blood vessel blockage.", "correct": false}], "correct_answer": "B. Severe abdominal pain due to splenic dysfunction, resembling pancreatitis.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 12 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 6-year-old child presents with pallor, jaundice, and characteristic facial deformities such as frontal bossing and maxillary prominence. Blood tests reveal microcytic anaemia, and Hb electrophoresis shows a significant increase in fetal hemoglobin levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Thalassemia", "correct": true}, {"label": "B", "text": "Autoimmune hemolytic anemia", "correct": false}, {"label": "C", "text": "Hereditary spherocytosis", "correct": false}, {"label": "D", "text": "Iron deficiency anemia", "correct": false}], "correct_answer": "A. Thalassemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/igFfJdceTogZ3xpy1RNW1744716680.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-month-old baby presents with severe anemia, pallor, and jaundice. The clinical history indicates a similar episode two months prior. An electrophoresis was conducted to differentiate among various forms of thalassemia, and the results are shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Alpha thalassemia trait", "correct": false}, {"label": "B", "text": "Beta thalassemia major", "correct": true}, {"label": "C", "text": "Beta thalassemia minor", "correct": false}, {"label": "D", "text": "Alpha thalassemia major", "correct": false}], "correct_answer": "B. Beta thalassemia major", "question_images": ["https://image.prepladder.com/notes/sElebOA52p87w9Z1qMjx1744716781.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta Thalassemias</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major (Transfusion-dependent)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intermedia (Non-transfusion-dependent)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor (Trait or Carrier)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genotype</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homozygous:</p>\n<p><strong>β⁰/β⁰</strong></p>\n<p><strong>β⁰/β⁺</strong></p>\n<p><strong>β⁺/β⁺</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable:</p>\n<p><strong>β⁰/β⁺ or β⁺/β⁺ or β⁰/β or β⁺/β</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heterozygous:</p>\n<p><strong>β⁰/β or β⁺/β</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n<br/>\n\t\t\t </td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe</strong> <span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\">microcytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> with target cells (Hb 3–4 g/dL)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate</strong> <span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\">microcytic</span> anemia</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild</strong> <span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\">microcytic</span> anemia</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemoglobin Electrophoresis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HbA₂ (5% or more);</p>\n<p>HbF (up to 95%); No HbA</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HbA₂ (4% or more);</p>\n<p>HbF (up to 50%)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HbA₂ (4% or more);</p>\n<p>HbF (up to 5%)</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">Thalassemia</span> Minor (Trait)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">Thalassemia</span> Intermedia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">Thalassemia</span> Major (Cooley's Anemia)</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>One beta-globin gene mutated</strong>, and the other is functional</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Both beta-globin genes mutated</strong> but allowed some beta-chain production</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Both beta-globin genes are severely mutated or absent</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically asymptomatic, with mild fatigue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pallor, jaundice, delayed growth, bone deformities</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Profound fatigue, failure to thrive, bone deformities, hepatosplenomegaly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually diagnosed incidentally through routine blood tests</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable; symptoms often arise in childhood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms present within the first year of life</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Transfusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rarely needed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occasional transfusions, particularly during stress/illness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular, lifelong transfusions required</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iron Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May occur if frequent transfusions are given</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant risk due to frequent transfusions; iron <span class=\"customMeta\" data-dictid=\"11199cbd1816927771841f1eb35b86\">chelation</span> therapy needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None significant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Splenomegaly, growth delay, bone changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iron <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> complications (heart, liver damage), severe growth issues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hb Electrophoresis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or slight increase in HbA2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased HbA2 and possibly HbF</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated HbF with very low or absent HbA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HPLC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> profile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal profile with increased HbA2 and/or HbF</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal profile with high levels of HbF and very low HbA</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A community survey revealed a high incidence of thalassemia, leading to the initiation of a screening program using the NESTROFT test. What would be the expected appearance of the NESTROFT test for a negative result?", "options": [{"label": "A", "text": "Clear fluid with no visible lines in either tube.", "correct": false}, {"label": "B", "text": "Black lines visible in both the test and control tubes.", "correct": true}, {"label": "C", "text": "Black line visible in the control tube only.", "correct": false}, {"label": "D", "text": "Black line visible in the test tube only.", "correct": false}], "correct_answer": "B. Black lines visible in both the test and control tubes.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BS60rxCpUDl1amVHMrDV1744716863.png", "https://image.prepladder.com/content/9wIGBeJt8bI58rgJwNMZ1740492437.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test Result</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Observation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Negative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distinct black lines visible in both the test and control tubes.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"NESTROF Test\" data-author=\"Piplani S, Manan R, Lalit M, Manjari M, Bhasin T, Bawa\" data-hash=\"10391\" data-license=\"\" data-source=\"https://www.jcdr.net/article_fulltext.asp?id=3759\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/BS60rxCpUDl1amVHMrDV1744716863.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates no unlysed RBCs present. <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">Thalassemia</span> is not detected; osmotic stability is normal.</p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black lines not visible in the test tube, but visible in the control tube.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Piplani S, Manan R, Lalit M, Manjari M, Bhasin T, Bawa\" data-hash=\"\" data-license=\"\" data-source=\"https://www.jcdr.net/article_fulltext.asp?id=3759\" data-tags=\"\" height=\"183\" src=\"https://image.prepladder.com/content/9wIGBeJt8bI58rgJwNMZ1740492437.png\" width=\"316\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suggests the presence of unlysed RBCs, indicating osmotic fragility. May imply <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">thalassemia</span> or other conditions affecting <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> stability.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An X-ray of the skull shows the characteristic findings described below. Which of the following diseases is most likely indicated by these findings?", "options": [{"label": "A", "text": "Thalassemia", "correct": true}, {"label": "B", "text": "Multiple Myeloma", "correct": false}, {"label": "C", "text": "Paget's Disease", "correct": false}, {"label": "D", "text": "Histiocytosis X", "correct": false}], "correct_answer": "A. Thalassemia", "question_images": ["https://image.prepladder.com/notes/R4ubum5fhkaGCGqsvopb1744717005.png"], "explanation_images": ["https://image.prepladder.com/notes/R4ubum5fhkaGCGqsvopb1744717005.png", "https://image.prepladder.com/notes/vcxBh6RKFFEjVsEKlqqw1744717458.png", "https://image.prepladder.com/notes/aW1G7k6llN8SKYM7PlDI1744717528.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:587px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Skull Finding</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thalassemia</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Hair-on-end\" appearance due to increased <span class=\"customMeta\" data-dictid=\"317dbdacdb16927771878c7860f69b\">erythropoiesis</span> and skull remodelling.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hair on end appearance\" data-author=\"Weerakkody Y, Niknejad M, Skalski M, et al\" data-hash=\"10392\" data-license=\"\" data-source=\"https://radiopaedia.org/articles/hair-on-end-sign-mnemonic\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/R4ubum5fhkaGCGqsvopb1744717005.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multiple Myeloma</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Punched-out\" <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> lesions in the skull, indicative of bone <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> caused by <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> cells.</p>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Multiple &lt;span class=\" custommeta\"=\"\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\"/>Myeloma Xray Skull\" data-author=\"Ranchod A\" data-hash=\"10393\" data-license=\"\" data-source=\"https://radiopaedia.org/cases/multiple-myeloma-67?lang=gb\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/wfDG2cj1rHioR99TJz3E1744717155.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paget's Disease</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thickened skull bones with a \"cotton wool\" appearance due to disorganized bone remodelling.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Paget Disease\" data-author=\"Gaillard F\" data-hash=\"10394\" data-license=\"\" data-source=\"https://radiopaedia.org/cases/paget-disease-skull-1\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/vcxBh6RKFFEjVsEKlqqw1744717458.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histiocytosis X</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lytic bone lesions with a \"punched-out\" appearance, especially in the skull, due to aggressive bone involvement.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Histiocytosis X\" data-author=\"Khatami, Alireza &amp; Alavi, Samin &amp; Kord Valeshabad, Ali &amp; Arzanian, Mohammad &amp; Mozaffarinejadm, Negar &amp; Sharif rohani, Amirhossein\" data-hash=\"10395\" data-license=\"\" data-source=\"https://www.researchgate.net/figure/A-4-year-old-boy-with-histiocytosis-Lateral-skull-X-ray-reveals-multiple-lytic-lesions_fig2_264348370\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/aW1G7k6llN8SKYM7PlDI1744717528.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old man with transfusion-dependent beta-thalassemia is receiving regular packed red blood cell transfusions and oral iron chelation therapy. He seeks additional treatment options to improve his quality of life. Which of the following treatment options is available for this patient?", "options": [{"label": "A", "text": "Hematopoietic stem cell transplantation (HSCT) with a matched sibling donor.", "correct": false}, {"label": "B", "text": "Lentiviral gene therapy with autologous CD34+ hematopoietic stem cells.", "correct": false}, {"label": "C", "text": "Luspatercept to enhance erythropoiesis and reduce transfusion needs.", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old girl presents with fatigue, pallor, and recurrent infections. Laboratory tests reveal microcytic hypochromic anaemia (Hb 8 g/dL) and elevated serum ferritin. Haemoglobin electrophoresis shows increased fetal haemoglobin (HbF) and decreased adult haemoglobin (HbA). She is started on blood transfusions every 2-4 weeks. Which of the following is not a complication associated with this condition?", "options": [{"label": "A", "text": "Cardiac failure due to iron overload", "correct": false}, {"label": "B", "text": "Yersinia infection from transfusions", "correct": false}, {"label": "C", "text": "Increased risk of hyperthyroidism", "correct": true}, {"label": "D", "text": "Osteoporosis due to chronic anemia", "correct": false}], "correct_answer": "C. Increased risk of hyperthyroidism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications of ß <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">Thalassemia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth retardation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually results from delayed or inadequate transfusions, but can also occur in well-transfused children.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed puberty; secondary amenorrhea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50% and 25%, respectively.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Splenomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can trap 1-40% of <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">red blood cell</span> volume, increasing <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume and worsening heart failure.</li>\n<li>Splenectomy is recommended when <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> needs rise.</li>\n<li>Prophylactic <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> required post-splenectomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to chronic anaemia, iron toxicity, and thromboembolic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension, heart issues progress to congestive failure and arrhythmias. <strong>(Option A)</strong></li>\n<li>Assessed by T2 weighted <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> MRI.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leg ulcers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">thalassemia</span> intermedia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrosis progressing to <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> is <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> iron concentration.</li>\n<li>Hepatitis contributes to the progression.</li>\n<li>Monitored by MRI.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lung disease/</strong></p>\n<p><strong>pulmonary</strong></p>\n<p><strong>hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lung fibrosis</li>\n<li>Chronic thromboembolic disease</li>\n<li>Restrictive pathophysiology</li>\n<li>Intravascular hemolysis</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> bioavailability</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thromboembolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> activation, red cell-endothelial interactions, thrombocytosis, endothelial <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> and splenectomy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrinopathies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bronze diabetes</li>\n<li><strong>Hypothyroidism (vs Option C)</strong></li>\n<li>Hypoparathyroidism</li>\n<li>Adrenal insufficiency</li>\n<li>Hypogonadism</li>\n<li>Excess iron damages the <span class=\"customMeta\" data-dictid=\"234a90c85516927771894197380566\">HPA</span> axis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by:\n\t\t\t\t<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> expansion</li>\n<li>Severe iron loading</li>\n<li>Hypogonadism</li>\n<li>Osteoporosis <strong>(Option D)</strong></li>\n</ul>\n</li>\n<li>Extramedullary <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> masses are common in <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">thalassemia</span> intermedia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transfusion-associated, often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to iron overload, increases the risk of:</p>\n<ul>\n<li>Yersinia infection <strong>(Option B)</strong></li>\n<li>Malaria</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-month-old infant of Southeast Asian descent is brought in for evaluation due to jaundice and failure to thrive. A physical exam reveals hepatosplenomegaly. Laboratory tests show moderate anaemia, with a haemoglobin level of 80 g/L. A peripheral smear is shown below. What is the underlying pathophysiology of this condition?", "options": [{"label": "A", "text": "Excess α-globin chain precipitation causing ineffective erythropoiesis", "correct": false}, {"label": "B", "text": "Formation of β4 tetramers, leading to unstable hemoglobin", "correct": true}, {"label": "C", "text": "Increased synthesis of γ-globin chains leading to Hb Bart's formation", "correct": false}, {"label": "D", "text": "Reduced β-globin chain synthesis, leading to increased fetal hemoglobin", "correct": false}], "correct_answer": "B. Formation of β4 tetramers, leading to unstable hemoglobin", "question_images": ["https://image.prepladder.com/notes/3l3JRntee2sx4QmceICy1744717623.png"], "explanation_images": ["https://image.prepladder.com/notes/3l3JRntee2sx4QmceICy1744717623.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>α-globin gene arrangement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>α-Thalassemia Trait</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>−α/αα, −α/−α, −−/αα, αTα/αα</p>\n<p>(<strong>1-2 α-globin</strong> genes missing)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild hematologic abnormalities, often asymptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemoglobin H (HbH) Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>−−/−α, αTα/−−, αTα/−α</p>\n<p>(<strong>3 α-globin</strong> genes missing)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate anaemia, variable severity depending on genotype.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hb Bart’s <span class=\"customMeta\" data-dictid=\"7b09c2b34916927771896ff30fcaa0\">Hydrops</span> Fetalis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>−−/−−</p>\n<p>(<strong>0 functioning</strong> α-globin genes)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fatal <span class=\"customMeta\" data-dictid=\"f5942e813b16927771906ad4b3d288\">in utero</span> or shortly after birth.</li>\n<li>Hydrops fetalis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>α-Thalassemia with <span class=\"customMeta\" data-dictid=\"6b9286cde51692777190fded98b3e5\">Intellectual Disability</span> </strong></p>\n<ol>\n<li>(ATR-16)</li>\n<li>(ATR-X)</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>−−/αα or −−/−α</li>\n<li>αα/αα</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Associated with large deletions and rearrangements on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 16 (ATR-16).</li>\n<li>No α-globin gene deletion, mutations in the ATRX gene, or <span class=\"customMeta\" data-dictid=\"dd35346fc716927772029e2f0bb10f\">X-linked</span> inheritance.</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>α-Thalassemia with <span class=\"customMeta\" data-dictid=\"f83010a1b916927771938e24573a72\">Myelodysplasia</span> (ATMDS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>αα/αα</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mutations in ATRX</li>\n<li>HbH disease-like hematologic findings.</li>\n<li>predominantly in males.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman is a silent carrier for α-thalassemia (α-/αα). Her partner has the α-thalassemia trait (αα/--). They are concerned about the risk of their child inheriting α-thalassemia. What is the probability that their child will have Hemoglobin H (HbH) disease?", "options": [{"label": "A", "text": "0%", "correct": false}, {"label": "B", "text": "25%", "correct": true}, {"label": "C", "text": "50%", "correct": false}, {"label": "D", "text": "75%", "correct": false}], "correct_answer": "B. 25%", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/IOEr4Lk26d8fzjbgx6JL1744717827.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:316px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\"> </td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>α- (Mother)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>αα (Mother)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>αα (Father)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>α-/αα</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>αα/αα</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>-- (Father)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>α-/--</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>αα/--</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:737px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Affected Genes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Genotype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Hemoglobin Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Silent Carrier </strong>(Typically asymptomatic)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>1 out of 4 genes</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>-α/αα or αα/-α</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Normal or slightly <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"62849f5c661692777192fc6b3aeade\">MCV</span> and MCH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Alpha <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">Thalassemia</span> Trait (Minor)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>2 out of 4 genes</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>-α/-α (trans) or --/αα (cis)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Reduced MCV, MCH, normal Hb electrophoresis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Hemoglobin H Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>3 out of 4 genes</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>--/-α</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Presence of Hb H (β4), <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"62849f5c661692777192fc6b3aeade\">MCV</span> and MCH, Hb <span class=\"customMeta\" data-dictid=\"0284ae84d21692777187eb03c87a57\">electrophoresis</span> shows Hb H</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Hydrops Fetalis (Hb Bart's)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>4 out of 4 genes</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>--/--</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Presence of Hb Bart's (γ4)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn is admitted to the neonatal intensive care unit due to respiratory distress and severe jaundice. The infant is lethargic and has poor feeding. Physical examination reveals pallor, marked hepatosplenomegaly, and generalized oedema. Laboratory tests indicate a haemoglobin level of 6 g/dL, elevated indirect bilirubin, and a reticulocyte count of 12%. What is the most likely underlying genetic cause of this condition?", "options": [{"label": "A", "text": "Deletion of three α-globin genes", "correct": false}, {"label": "B", "text": "Deletion of all four α-globin genes", "correct": true}, {"label": "C", "text": "Increased β-globin chain synthesis", "correct": false}, {"label": "D", "text": "Mutation in the G6PD gene", "correct": false}], "correct_answer": "B. Deletion of all four α-globin genes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hb Bart <span class=\"customMeta\" data-dictid=\"7b09c2b34916927771896ff30fcaa0\">Hydrops</span> Fetalis Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The most severe <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of α-thalassemia, caused by the <strong>absence of all four α-globin genes</strong> (homozygous α0-thalassemia).</p>\n<p><strong>Common in Southeast Asia</strong>: <span class=\"customMeta\" data-dictid=\"a386d4402b169277718999a5a8e452\">High frequency</span> due to the <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of α0-thalassemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fetuses with α0-thalassemia mainly produce <strong>Hb Bart (γ4)</strong>, which is ineffective for oxygen transport.</li>\n<li>Small amounts of embryonic haemoglobins (Hbs Portland 1 and 2) allow survival until late pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Course</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by <strong>severe anaemia</strong> (Hb 3-8 g/dL), hepatosplenomegaly, <strong>generalized oedema</strong>, heart failure, and <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> erythropoiesis.</li>\n<li>Associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> abnormalities include skeletal, cardiovascular, and <span class=\"customMeta\" data-dictid=\"2942e9d19616927772014161ee8f70\">urogenital</span> defects.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Maternal</strong>: Preeclampsia, <span class=\"customMeta\" data-dictid=\"4dfcb33af61692777196cc08481fa0\">polyhydramnios</span> or oligohydramnios, <span class=\"customMeta\" data-dictid=\"c185c3ca4916927771819d8aa68cb9\">antepartum</span> haemorrhage.</li>\n<li><strong>Postpartum</strong>: Retained placenta, eclampsia, haemorrhage, anaemia, sepsis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Management</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intrauterine <span class=\"customMeta\" data-dictid=\"64e0895e441692777187dad4949f29\">erythrocyte</span> transfusions and <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> <span class=\"customMeta\" data-dictid=\"467c0b4fc016927771997e1043aeda\">stem cell transplantation</span> have uncertain benefits due to developmental risks.</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of at-risk pregnancies is advised due to severe complications.</li>\n<li>Universal <span class=\"customMeta\" data-dictid=\"d554413593169277719693b8e38638\">prenatal</span> screening programs have been implemented to detect homozygous α-thalassemia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old boy presents with fatigue and intermittent jaundice. His blood film shows spherocytes, and his parents report a family history of similar symptoms. Laboratory tests reveal elevated indirect bilirubin and reticulocytosis. What is the most common underlying defect in this patient’s condition?", "options": [{"label": "A", "text": "Deficiency of beta-spectrin", "correct": false}, {"label": "B", "text": "Deficiency of Ankyrin", "correct": true}, {"label": "C", "text": "Deficiency of Protein 4.2", "correct": false}, {"label": "D", "text": "Deficiency of AE1 (Band 3)", "correct": false}], "correct_answer": "B. Deficiency of Ankyrin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hereditary <span class=\"customMeta\" data-dictid=\"d30f4533661692777199385959bd9f\">Spherocytosis</span> (HS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>An inherited disorder caused by <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> defects in the <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">red blood cell</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> skeleton, leading to spheroid, less deformable red cells vulnerable to splenic <span class=\"customMeta\" data-dictid=\"dd02fbdad81692777198e605d5fbd2\">sequestration</span> and destruction.</li>\n<li>75% of cases are <strong>autosomal dominant</strong>.</li>\n<li>Remaining cases often involve severe forms due to <strong>compound heterozygosity</strong> (inheritance of two different defects).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n<p style=\"text-align:center\"><img alt=\"Hereditary &lt;span class=\" custommeta\"=\"\" data-dictid=\"d30f4533661692777199385959bd9f\"/>Spherocytosis Etiopathogenesis\" data-author=\"\" data-hash=\"10398\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/mEFsMIbiKrxPlmLOsDtR1744717931.png\" /&gt;</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>HS is marked by a loss of <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> surface area relative to the <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> volume, leading to <strong>spherical red blood cells</strong> with <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> or<strong> absent central pallor</strong>.</li>\n<li>Spherocytes have <strong>decreased deformability</strong>, resulting in their <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> and<strong> destruction </strong>in the<strong> spleen</strong>, causing hemolysis.</li>\n<li><strong>spectrin</strong>, ankyrin,<strong> AE1(band 3)</strong>, <strong>protein 4.2</strong> that weakens the vertical connections between the cytoskeletal framework and <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> bilayer.</li>\n<li>The<strong> ANK1 gene</strong> on <strong>chromosome 8p</strong> produces <strong>Ankyrin</strong>.</li>\n<li>Two proposed mechanisms for <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> loss:\n\t\t\t\t<ul>\n<li>In cells with<strong> spectrin/ankyrin deficiency</strong>.</li>\n<li>Reduced<strong> AE1/protein</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>60-70% of patients present with moderate disease, typically in <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> or childhood.</li>\n<li>Common findings in children include:\n\t\t\t\t<ul>\n<li><strong>Anaemia</strong> may be asymptomatic,</li>\n<li><strong>Jaundice</strong> is usually <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> and <span class=\"customMeta\" data-dictid=\"37f907d1001692777180f07b4bf251\">acholuric</span> (unconjugated hyperbilirubinemia).</li>\n<li>&gt;75% show <strong>palpable splenomegaly</strong>.</li>\n<li>Family history.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gallbladder Disease</strong>: Chronic <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> can lead to <strong>bilirubinate gallstones</strong>.</li>\n<li><strong>Crisis Events</strong>:\n\t\t\t\t<ul>\n<li><strong>Hemolytic Crisis</strong>: Commonly associated with <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> illnesses in childhood; typically mild and self-resolving.</li>\n<li><strong>Aplastic Crisis</strong>: Rare but may cause severe anaemia and require hospitalization, often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to<strong> parvovirus</strong> infection. Typically lasts 10–14 days and may reveal undiagnosed HS in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> patients.</li>\n<li><strong>Megaloblastic Crisis</strong>: Occurs in patients with increased <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> needs, preventable by supplementation.</li>\n</ul>\n</li>\n<li>Other rare complications may include<strong> leg ulcers</strong>, chronic dermatitis, and skeletal abnormalities.</li>\n<li>HS has been associated with increased risks of hematologic malignancies and thrombotic events post-splenectomy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presents to the emergency department with fatigue and pallor. A complete blood count reveals a haemoglobin level of 100 g/L. A blood film shows erythrocytes with a lack of central pallor, and the mean corpuscular haemoglobin concentration (MCHC) is reported as 38 g/dL. Which of the following laboratory findings would you expect to find in this patient?", "options": [{"label": "A", "text": "Positive Direct Coombs Test", "correct": false}, {"label": "B", "text": "Decreased lactate dehydrogenase (LDH) levels", "correct": false}, {"label": "C", "text": "Decreased serum haptoglobin", "correct": true}, {"label": "D", "text": "Decreased reticulocyte count", "correct": false}], "correct_answer": "C. Decreased serum haptoglobin", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/UkRtAKLlpIUZb0mopXHE1744718037.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory features of <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">Hereditary</span> Spherocytosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Film</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"spherocytes\" data-author=\"\" data-hash=\"10399\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/UkRtAKLlpIUZb0mopXHE1744718037.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Erythrocyte <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> in HS is inconsistent, often showing <strong>spherocytes</strong> lacking central pallor.</li>\n<li>Patients with <strong>AE1/ BAND3</strong> defects may exhibit \"pincered\" or mushroom-shaped red cells.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Erythrocyte Indices</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild to moderate <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (Hb - 90–120 g/L).</li>\n<li><strong>Mean corpuscular <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> concentration</strong> (MCHC) is <strong>elevated</strong> (&gt;36 g/dL) due to <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">dehydration</span> in about half of the patients.</li>\n<li>Increased red cell distribution width.</li>\n<li><strong>Mean corpuscular volume </strong>(MCV) is<strong> decreased</strong> in severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Markers of Hemolysis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laboratory features include <span class=\"customMeta\" data-dictid=\"9a38cb61041692777197136024394f\">reticulocytosis</span> <strong>(Option D)</strong>, <strong>elevated <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> </strong><strong>(Option B)</strong>, increased <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> and fecal urobilinogen, unconjugated hyperbilirubinemia, and <strong>decreased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> haptoglobin</strong>.</li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"39be9b36e21692777185ebcac8d57f\">Coombs Test</span> - Negative <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:260px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Erythrocyte <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">Fragility</span> Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spherocytes are <strong>osmotically fragile </strong>due to decreased surface area relative to volume.</li>\n<li>The osmotic <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> test measures red cell <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> in <span class=\"customMeta\" data-dictid=\"6c1412e72916927771893d06180642\">hypotonic</span> sodium <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> solutions; spherocytes burst at higher concentrations than normal cells.</li>\n<li>Other tests, such as <strong>glycerol <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> tests</strong>, have poor sensitivity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eosin 5′-Maleimide (EMA) Flow <span class=\"customMeta\" data-dictid=\"551a62b1ec169277718587f847e627\">Cytometry</span> Test</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>EMA is a <span class=\"customMeta\" data-dictid=\"df068e6efc16927772029693b5023e\">fluorescent</span> <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> that binds to <strong>specific <span class=\"customMeta\" data-dictid=\"f0c8d0b3871692777200426e503319\">transmembrane</span> proteins</strong> (AE1, Rh protein, Rh glycoprotein, CD47).</li>\n<li>HS patients exhibit<strong> decreased <span class=\"customMeta\" data-dictid=\"da0e2a00fa1692777202d6e2054b26\">fluorescence</span> </strong>compared to controls.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advanced <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Methods</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sodium Dodecyl <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">Sulfate</span> <span class=\"customMeta\" data-dictid=\"b64568eb0e169277719670f0af9e20\">Polyacrylamide</span> <span class=\"customMeta\" data-dictid=\"b0bdc3a1d416927771884d50c944ec\">Gel</span> <span class=\"customMeta\" data-dictid=\"0284ae84d21692777187eb03c87a57\">Electrophoresis</span> (SDS-PAGE)</strong>:</p>\n<ul>\n<li>SDS-PAGE identifies <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> proteins by separating and analyzing their quantities.</li>\n</ul>\n<p><strong>Molecular Diagnostics</strong>:</p>\n<ul>\n<li>Identify genetic mutations associated with HS, including SPTA1, SPTB, ANK1, SLC4A1, and EPB42.</li>\n<li>These methods are advanced and often used when other <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tests do not provide a clear result.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy presents with pallor, jaundice, and a history of recurrent episodes of hemolytic anemia requiring blood transfusions. He is diagnosed with hereditary spherocytosis (HS). His parents are concerned about the repeated need for transfusions and ask about definitive treatment options. What would be the most appropriate next step in managing this patient?", "options": [{"label": "A", "text": "Bone marrow transplant", "correct": false}, {"label": "B", "text": "Delaying splenectomy until age 10", "correct": false}, {"label": "C", "text": "Laparoscopic splenectomy", "correct": true}, {"label": "D", "text": "Erythropoietin therapy", "correct": false}], "correct_answer": "C. Laparoscopic splenectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/VPZvAAVD7efKkq6NR7h11744718280.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management of <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">Hereditary</span> <span class=\"customMeta\" data-dictid=\"d30f4533661692777199385959bd9f\">Spherocytosis</span> (HS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Splenectomy as Primary Treatment</strong> <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Splenectomy significantly improves <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> by prolonging red cell survival, reducing the need for transfusions, and preventing <span class=\"customMeta\" data-dictid=\"64bbd63a0c1692777190f0c8e06e91\">iron overload</span> and related organ damage.</li>\n<li>Post splenectomy: <span class=\"customMeta\" data-dictid=\"d30f4533661692777199385959bd9f\">Spherocytosis</span> and altered osmotic <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> persist, but <span class=\"customMeta\" data-dictid=\"249592767b16927771976df58de24d\">reticulocyte</span> counts and <span class=\"customMeta\" data-dictid=\"64e0895e441692777187dad4949f29\">erythrocyte</span> lifespan normalize.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Film Changes Post-Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Features like <strong>Howell-Jolly bodies</strong>, acanthocytes, target cells, <strong>cabot ring</strong> and<strong> Pappenheimer bodies</strong> appear after splenectomy.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Blood Film Changes Post Splenectomy\" data-author='\"1. Paulo Henrique Orlandi Mourao 2.Paulo Henrique Orlandi Mourao 3. Prof. Osaro Erhabor 4. Jarkeld Medical Centre Alkmaar, hematology department of Laboratory for Clinical Chemistry, Hematology and Immunology\"' data-hash=\"10401\" data-license='\"1. CC BY-SA 4.0 2. CC BY SA 3.0 3. CC0 1.0 4. CC BY SA 3.0\"' data-source='\"1. https://en.wikipedia.org/wiki/Pappenheimer_bodies 2. https://commons.wikimedia.org/wiki/File:Howell-Jolly_body.png 3. https://commons.wikimedia.org/wiki/File:Target_cells.jpg 4. https://en.wikipedia.org/wiki/Cabot_rings\"' data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/VPZvAAVD7efKkq6NR7h11744718280.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications for Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recommended for patients with severe, transfusion-dependent anemia, growth failure, skeletal changes, leg ulcers, or <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> tumours.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing of Splenectomy</strong>:</p>\n<ul>\n<li>Should be <strong>delayed until age 5–9</strong> if possible <strong>(Option B)</strong>, or at least age 3, to reduce the risk of post-splenectomy <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> while balancing the increased risk of gallstones in older children.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Preferred method, with benefits like less discomfort, quicker recovery, and shorter hospital stays. Combined <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> and <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> is an option for patients with <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> gallstones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used in infants or young children to alleviate <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> while preserving some splenic immune function. It reduces <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> needs but may eventually require total <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> in about half of patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pre- and Post-Splenectomy Care</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Vaccination</strong>: Patients should receive vaccines against pneumococcus, <em>Haemophilus influenzae</em> type B, and <span class=\"customMeta\" data-dictid=\"dba7aeeec71692777192ce43dc13f5\">meningococcus</span> before surgery.</li>\n<li><strong>Antibiotic Prophylaxis</strong>: Use of <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> antibiotics post-splenectomy is controversial but recommended by some for at least 5 years or even lifelong.</li>\n<li><strong>Folic Acid</strong>: Continued supplementation (1 mg/day) is recommended to prevent <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 22 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 11 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 30-year-old woman presents to the clinic with fatigue, jaundice, and abdominal discomfort. Lab tests show elevated liver enzymes (AST and ALT). Further testing reveals positive antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA). A liver biopsy demonstrates interface hepatitis with plasma cell infiltration . Given the specific autoantibody profile and the histological findings, which of the following options is associated with the condition and is most relevant to consider in this patient?", "options": [{"label": "A", "text": "Type 1 Autoimmune Hepatitis", "correct": true}, {"label": "B", "text": "Type 2 Autoimmune Hepatitis", "correct": false}, {"label": "C", "text": "Primary Biliary Cholangitis", "correct": false}, {"label": "D", "text": "Drug-Induced Liver Injury", "correct": false}], "correct_answer": "A. Type 1 Autoimmune Hepatitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 1 <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">Autoimmune</span> <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">Hepatitis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 2 <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">Autoimmune</span> Hepatitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in females (2nd-3rd decade)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in children</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with:</p>\n<ul>\n<li>ANA (also seen in SLE) - hence, <span class=\"customMeta\" data-dictid=\"a8c10a0344169277719165bdcc4700\">lupoid</span> hepatitis</li>\n<li><strong>Anti SMA (Anti smooth muscle antibody) - against <span class=\"customMeta\" data-dictid=\"8e023fb81e16927771802d21820404\">actin</span> </strong></li>\n<li>Anti-soluble liver antigen</li>\n<li>Atypical p-ANCA (x-ANCA)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with:</p>\n<ul>\n<li>ANA absent</li>\n<li><strong>Anti LKM1 (Liver <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> <span class=\"customMeta\" data-dictid=\"e073bd96e1169277719284ef3452ee\">microsome</span> type 1)</strong></li>\n<li>Anti-liver <span class=\"customMeta\" data-dictid=\"436b14255b16927771852beb42f2e1\">cytosol</span> - 1 antibody</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with fatigue, jaundice, abdominal discomfort, and significant weight loss for three months. She reports itchy skin. Laboratory tests show elevated liver enzymes and positive antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA). She has a family history of autoimmune diseases. Which of the following clinical features is most commonly associated with the above scenario?", "options": [{"label": "A", "text": "Splenomegaly", "correct": true}, {"label": "B", "text": "Weight gain", "correct": false}, {"label": "C", "text": "Presence of anti-mitochondrial antibodies (AMA)", "correct": false}, {"label": "D", "text": "Elevated alkaline phosphatase levels", "correct": false}], "correct_answer": "A. Splenomegaly", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding Autoimmune Hepatitis is False?", "options": [{"label": "A", "text": "SGPT is significantly raised", "correct": false}, {"label": "B", "text": "Albumin ↓ and γ-globulin ↑↑", "correct": false}, {"label": "C", "text": "It is a diagnosis of exclusion", "correct": false}, {"label": "D", "text": "RA factor is negative", "correct": true}], "correct_answer": "D. RA factor is negative", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Factors supporting diagnosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Factors against diagnosis:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Female gender.</li>\n<li>Predominant <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of aminotransferases.</li>\n<li>Level of <span class=\"customMeta\" data-dictid=\"1a8bcc07ca16927771882f63452d6e\">globulin</span> elevation.</li>\n<li>Presence of other <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases.</li>\n<li>HLA-DR3 or DR4 markers.</li>\n<li>Positive response to treatment.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Predominant <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase.</li>\n<li>Presence of mitochondrial antibodies.</li>\n<li>Positive markers for <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> hepatitis.</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"aad52f4a541692777188bfd2c5830b\">hepatotoxic</span> drug use or excessive alcohol consumption.</li>\n<li>Histological evidence of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> injury or <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> features (e.g., <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> infiltration, iron overload).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes the primary underlying mechanism of injury in Primary Biliary Cholangitis (PBC)?", "options": [{"label": "A", "text": "Autoimmune-mediated destruction of bile ducts", "correct": true}, {"label": "B", "text": "Genetic mutation affecting bile acid metabolism", "correct": false}, {"label": "C", "text": "Viral infection leading to bile duct inflammation", "correct": false}, {"label": "D", "text": "Cholestasis due to gallstone obstruction", "correct": false}], "correct_answer": "A. Autoimmune-mediated destruction of bile ducts", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presents with fatigue and pruritus. Laboratory tests show elevated alkaline phosphatase and positive antimitochondrial antibodies (AMAs). Which of the following is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Initiate ursodeoxycholic acid therapy", "correct": true}, {"label": "B", "text": "Schedule for liver transplantation evaluation", "correct": false}, {"label": "C", "text": "Start antiviral therapy for hepatitis", "correct": false}, {"label": "D", "text": "Refer for endoscopic retrograde cholangiopancreatography (ERCP)", "correct": false}], "correct_answer": "A. Initiate ursodeoxycholic acid therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with a 6-month history of progressive fatigue and pruritus. He reports a recent onset of jaundice. His past medical history is significant for ulcerative colitis. Laboratory tests reveal elevated serum alkaline phosphatase and bilirubin, and atypical pANCA are positive. An MRCP is given below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary Biliary Cholangitis", "correct": false}, {"label": "B", "text": "Primary Sclerosing Cholangitis", "correct": true}, {"label": "C", "text": "Choledocholithiasis", "correct": false}, {"label": "D", "text": "Chronic Pancreatitis", "correct": false}], "correct_answer": "B. Primary Sclerosing Cholangitis", "question_images": ["https://image.prepladder.com/notes/gLfrkRiXTULcEjkVn4Es1744716097.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> <span class=\"customMeta\" data-dictid=\"dd9fbecbed1692777184ab44e1624c\">Cholangitis</span> (PSC)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PSC is characterized by <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and obliterative <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> and large <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts, with <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of preserved segments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly occurs in individuals aged 30-50 years.</li>\n<li>Has a male predominance of 2:1.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Suggests an <strong>immunologically mediated process</strong> supported by circulating autoantibodies, <span class=\"customMeta\" data-dictid=\"9f1d97eb2b1692777200b3926afd54\">T lymphocytes</span> in the <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> stroma, and associations with<strong> HLA-B8</strong> and <strong>ulcerative colitis</strong>.</li>\n<li>A mix of <strong>environmental </strong>&amp; genetic factors may trigger <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> injury.</li>\n<li>Increased risk of PSC in first-degree relatives indicates a genetic component.</li>\n<li>Activated T cells from <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> may migrate to the liver, <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> antigens.</li>\n<li>Changes in the intestinal microbiome or infections may alter cholangiocytes, causing inflammation.</li>\n<li>Atypical <span class=\"customMeta\" data-dictid=\"2da8fc47cf169277719576cea1851f\">perinuclear</span> antineutrophil cytoplasmic antibodies (pANCA) are</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common symptoms include fatigue, pruritus, and jaundice.</li>\n<li>Nearly 50% of patients are <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> at diagnosis, often identified through elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase.</li>\n<li>Ascending cholangitis, chronic pancreatitis, and chronic <span class=\"customMeta\" data-dictid=\"180ce1a7c416927771844825c616f4\">cholecystitis</span> may also occur.</li>\n<li>Fibrosis can progress to <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> over 10-15 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lifetime risk of developing <strong>cholangiocarcinoma</strong> is about 20%.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">Biliary</span> Cholangitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> Cholangitis</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Site involved</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intrahepatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intrahepatic &amp; Extrahepatic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gender predominance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Female &gt; male</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Male &gt; female</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cause</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multifactorial (can be <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> also)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fatigue, pruritus, jaundice, hepatomegaly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can be asymptomatic; pruritus, fatigue, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, jaundice.</li>\n<li>Can also develop <span class=\"customMeta\" data-dictid=\"dd9fbecbed1692777184ab44e1624c\">cholangitis</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> and cholecystitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characteristic findings</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AMA antibodies are commonly found</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ERCP/MRCP shows <span class=\"customMeta\" data-dictid=\"db8c3d4b9e1692777182a03a530a28\">beaded</span> appearance of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts</li>\n<li>Biopsy shows onion skin fibrosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated conditions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sjögren's syndrome, <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcerative colitis, risk of developing cholangiocarcinoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with progressive jaundice and pruritus. She has a past medical history of ulcerative colitis. Her LFT revealed an elevated alkaline phosphatase &amp;amp; gamma-glutamyl transferase (GGT) and a prolonged prothrombin time. The liver biopsy is shown below. Which of the following serologic findings is most likely to be present in this patient?", "options": [{"label": "A", "text": "Anti-liver kidney microsomal-1 antibodies (Anti-LKM-1)", "correct": false}, {"label": "B", "text": "Anti-mitochondrial antibody (AMA)", "correct": false}, {"label": "C", "text": "Perinuclear anti-neutrophil cytoplasmic antibody (pANCA)", "correct": true}, {"label": "D", "text": "Anti-centromere antibody", "correct": false}], "correct_answer": "C. Perinuclear anti-neutrophil cytoplasmic antibody (pANCA)", "question_images": ["https://image.prepladder.com/notes/U4n0sZ5CRPd53mA8QbQf1744716191.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Workup of Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> Cholangitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Function Tests </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serum <span class=\"customMeta\" data-dictid=\"4228218c971692777181ed18105c0d\">ALP</span> is elevated up to 3-4 times.</li>\n<li>ALT &amp; <span class=\"customMeta\" data-dictid=\"b53d9f77801692777182738019ba62\">AST</span> increased.</li>\n<li>Gamma-glutamyl <span class=\"customMeta\" data-dictid=\"2288cbf3741692777200318d2f5b39\">transferase</span> elevated.</li>\n<li>Hypergammaglobulinemia (IgM) is elevated.</li>\n<li>Prothrombin Time is increased.</li>\n<li>Albumin is reduced.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P-ANCA +ve </strong>in about 65% of patients.</p>\n<p>ANA +ve</p>\n<p><strong>AMA -ve </strong>(Anti mitochondrial antibody)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Imaging</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Primary &lt;span class=\" custommeta\"=\"\" data-dictid=\"0aa16e71201692777198c4c07e2392\"/>Sclerosing <span class=\"customMeta\" data-dictid=\"dd9fbecbed1692777184ab44e1624c\">Cholangitis</span> <span class=\"customMeta\" data-dictid=\"e70450a3981692777193c65a0c79f1\">MRCP</span> 2\" data-author=\"Pegah Khoshpouri, Roya Rezvani Habibabadi, Bita Hazhirkarzar, Sanaz Ameli, Maryam Ghadimi, Mounes Aliyari Ghasabeh, Christine O. Menias, Amy Kim, Zhiping Li, Ihab R. Kamel\" data-hash=\"10386\" data-license=\"\" data-source=\"https://pubs.rsna.org/doi/10.1148/rg.2019180213\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/7520MoFLAaPhGooAOpbV1744716327.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>MRCP:</strong></li>\n</ul>\n<p>Key <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> investigation</p>\n<p>Reveals <strong>(beading)</strong> multiple <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> stricturing and dilatations.</p>\n<ul>\n<li><strong>ERCP:</strong></li>\n</ul>\n<p>Reserved for <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> intervention</p>\n<p>Conducted after MRCP</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Liver biopsy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Primary &lt;span class=\" custommeta\"=\"\" data-dictid=\"0aa16e71201692777198c4c07e2392\"/>Sclerosing <span class=\"customMeta\" data-dictid=\"dd9fbecbed1692777184ab44e1624c\">Cholangitis</span> Onion skin\" data-author=\"Oliveira, Elze &amp; Oliveira, Patricia &amp; Becker, Vitoria &amp; Dellavance, Alessandra &amp; Andrade, Luís &amp; Lanzoni, Valeria &amp; Silva, Antonio &amp; Ferraz, Maria Lucia.\" data-hash=\"10387\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Small-bile-duct-showing-an-onion-skin-type-of-periductal-fibrosis-H-and-E-40-x_fig3_233888792\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/IApTa5XStC1SQjZ2783U1744716356.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early features:</p>\n<ul>\n<li>Periductal<strong> \"onion skin\" fibrosis</strong> &amp; inflammation</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> &amp; <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ductular proliferation</li>\n</ul>\n<p>Later stages show progressive <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> leading to <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> and obliterative cholangitis, resulting in <strong>\"vanishing <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> syndrome\"</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old patient is treated with a combination of oxycodone and acetaminophen (325 mg per tablet). The patient has a history of opioid tolerance. What is a potential risk associated with this combination?", "options": [{"label": "A", "text": "Increased risk of renal toxicity.", "correct": false}, {"label": "B", "text": "Decreased effectiveness of acetaminophen.", "correct": false}, {"label": "C", "text": "Greater likelihood of unintentional acetaminophen overdose.", "correct": true}, {"label": "D", "text": "Development of opioid dependency.", "correct": false}], "correct_answer": "C. Greater likelihood of unintentional acetaminophen overdose.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YYDT8Bpa5s1XeYWPwTCZ1744716493.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Paracetamol poisoning\" data-author=\"\" data-hash=\"10388\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/YYDT8Bpa5s1XeYWPwTCZ1744716493.png\"/></p>\n<p>The <strong>Rumack-Matthew nomogram</strong> is used to assess the risk of <span class=\"customMeta\" data-dictid=\"cbc7c810ce1692777188e6eaf3eba2\">hepatotoxicity</span> by interpreting <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> levels in relation to the time since ingestion.</p>\n<p><strong>Purpose of the Nomogram</strong>:</p>\n<ul>\n<li>Predicts the risk of <span class=\"customMeta\" data-dictid=\"cbc7c810ce1692777188e6eaf3eba2\">hepatotoxicity</span> based on a single <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> concentration at a specific time.</li>\n<li>Not a <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> tool; it does not predict <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> liver failure or death.</li>\n<li>Best used for <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> concentrations measured<strong> 4–24 hours </strong>after ingestion.</li>\n</ul>\n<p><strong>Lines on the Nomogram</strong>:</p>\n<ul>\n<li><strong>Probable (Rumack-Matthew) Line</strong>:\n\n\t\t\t\t<ul>\n<li>Represents the threshold above which 60% of patients are likely to develop hepatotoxicity.</li>\n</ul>\n</li>\n<li><strong>Possible (Treatment) Line</strong>:\n\t\t\t\t<ul>\n<li>Added later by the FDA, incorporating a 25% margin of error for measurement variations or uncertainty about the <span class=\"customMeta\" data-dictid=\"eba893313f16927771906290ce7e79\">ingestion</span> time.</li>\n</ul>\n</li>\n</ul>\n<p><strong>Limitations of the Nomogram</strong>:</p>\n<ul>\n<li>Cannot be used for patients presenting more than 24 hours after <span class=\"customMeta\" data-dictid=\"eba893313f16927771906290ce7e79\">ingestion</span> or those with multiple ingestions.</li>\n<li>Less reliable for <span class=\"customMeta\" data-dictid=\"bc4d5a606b1692777187ebf7376d9b\">extended-release</span> <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> or co-ingestion with agents that delay <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> (e.g., anticholinergics, opioids).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Safe dose of paracetamol: <strong>3 grams</strong> per day</li>\n<li>Safe dose in the <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> patient: <strong>2 grams </strong>per day</li>\n<li>Opioid-PCM combinations are dangerous, as <span class=\"customMeta\" data-dictid=\"e22dbf6c52169277719441ac94a69e\">opioid</span> tolerance can lead to increased <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> intake. <strong>(Option C)</strong></li>\n<li>Acetaminophen in <span class=\"customMeta\" data-dictid=\"e22dbf6c52169277719441ac94a69e\">opioid</span> combination products is limited to 325 mg per tablet.</li>\n<li><strong>Toxic Doses</strong>:\n\t\t\t\t<ul>\n<li>8 g/day over several days can lead to liver failure.</li>\n<li>A single dose of 10–15 g may cause liver injury.</li>\n<li>≥25 g often results in fatal <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> liver failure.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents with a 2-day history of fatigue, jaundice, and dark urine after taking high doses of acetaminophen for headaches over the past week. Laboratory tests reveal elevated aminotransferases (&amp;gt;10,000 IU/L) and an INR of 2.5. What is the most likely underlying cause of her clinical presentation?", "options": [{"label": "A", "text": "Glutathione depletion with NAPQI buildup", "correct": true}, {"label": "B", "text": "Enhanced glucuronidation of acetaminophen", "correct": false}, {"label": "C", "text": "Increased glutathione levels leading to liver injury", "correct": false}, {"label": "D", "text": "Inhibition of CYP2E1 by acetaminophen", "correct": false}], "correct_answer": "A. Glutathione depletion with NAPQI buildup", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Metabolism of Acetaminophen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acetaminophen is mainly metabolized via <strong>phase II</strong> reactions into harmless<strong> sulfate</strong> and <strong>glucuronide</strong> metabolites.<strong>(Option B)</strong></li>\n<li>A small portion undergoes<strong> phase I </strong>metabolism by<strong> CYP2E1 </strong><strong>(Option D)</strong>, forming the <span class=\"customMeta\" data-dictid=\"aad52f4a541692777188bfd2c5830b\">hepatotoxic</span> <span class=\"customMeta\" data-dictid=\"fceb6bf8d01692777192b8b179f554\">metabolite</span> <strong>N-acetyl-p-benzoquinone-imine (NAPQI)</strong>.</li>\n</ul>\n<p><strong>Detoxification of NAPQI</strong></p>\n<ul>\n<li>NAPQI is neutralized by binding to glutathione, forming water-soluble mercapturic acid, which is excreted via the kidneys.</li>\n</ul>\n<p><strong>Glutathione <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">Depletion</span> </strong><strong>(Option C)</strong></p>\n<ul>\n<li>When excessive NAPQI is produced, or <span class=\"customMeta\" data-dictid=\"f945849e691692777188ad7ce5b5e2\">glutathione</span> is depleted <strong>(Option A)</strong>, NAPQI binds to <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> macromolecules, forming acetaminophen-protein adducts, causing <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> necrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic alcohol use (induces CYP2E1, depletes glutathione).</li>\n<li>Starvation.</li>\n<li>Prior use of mixed-function oxidase-inducing drugs (e.g.,<strong> phenobarbital</strong>, <strong>INH</strong>).</li>\n<li><strong>Hepatitis C</strong> infection increases the risk of liver injury in overdose.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Symptoms (4-12 hrs)</strong>:</p>\n<ul>\n<li>Nausea, vomiting, diarrhea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, shock.</li>\n</ul>\n<p><strong>Delayed Symptoms (24-48 hrs)</strong>:</p>\n<ul>\n<li>Hepatic injury becomes apparent.</li>\n<li>Coagulopathy and encephalopathy.</li>\n<li>Maximal damage seen 3–5 days post-ingestion with <span class=\"customMeta\" data-dictid=\"c011dc417616927771816fef085ce1\">aminotransferase</span> levels &gt;10,000 IU/L.</li>\n<li>Renal failure and myocardial injury may occur.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stages of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Time Post-Ingestion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0–24 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nausea, vomiting, and anorexia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24–72 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain; elevated liver enzymes (AST, ALT), and sometimes increased <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> and INR if <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> is severe.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>72–96 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vomiting, signs of liver failure; peak levels of AST, ALT, bilirubin, and INR. Possible <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure and pancreatitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 5 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recovery of liver function or <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to multiple organ failure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presents with complaints of nausea and abdominal pain after ingesting 20 paracetamol tablets approximately 8 hours ago. His vital signs are stable, but he has mild jaundice. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Administer activated charcoal orally.", "correct": false}, {"label": "B", "text": "Start intravenous N-acetylcysteine therapy.", "correct": true}, {"label": "C", "text": "Perform a liver biopsy to assess damage.", "correct": false}, {"label": "D", "text": "Refer for liver transplantation.", "correct": false}], "correct_answer": "B. Start intravenous N-acetylcysteine therapy.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management of <span class=\"customMeta\" data-dictid=\"fcdd3383341692777194cf2cd4e400\">Paracetamol</span> poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gastric Lavage</strong></li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"5dd23480451692777180e299cc38bc\">activated charcoal</span> or <span class=\"customMeta\" data-dictid=\"8cbc9195731692777184663e492746\">cholestyramine</span> (effective within 30 minutes of ingestion) <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N-acetylcysteine (NAC) Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initiate within <strong>8 hours</strong> of ingestion; may be partially effective up to <strong>24–36 hours</strong> post-overdose. <strong>(Option B)</strong></li>\n<li><strong>Administration</strong>:\n\t\t\t\t<ul>\n<li>IV: 140 mg/kg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose over 1 hour, followed by 70 mg/kg every 4 hours for 15–20 doses.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NAC acts as a <span class=\"customMeta\" data-dictid=\"1a1b98a5d7169277719914104ae697\">sulfhydryl</span> donor, replenishing glutathione.</li>\n<li>Neutralizes toxic metabolites and prevents binding to cell proteins, reducing the severity of <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> necrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">Transplantation</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Considered in cases of <strong>hepatic failure</strong> (jaundice, coagulopathy, confusion).</li>\n<li><strong>King's College Criteria</strong> is used to predict the need for a liver transplant in patients with paracetamol-induced <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure :</li>\n<li>Arterial blood pH &lt; 7.30</li>\n</ul>\n<p>Or all of the following:</p>\n<ul>\n<li>Prothrombin time (PT) &gt; 100 seconds (INR &gt; 6.5)</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> &gt; 300 μmol/L</li>\n<li>Grade III or IV <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> encephalopathy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old girl presents 20 hours after accidentally ingesting a large amount of iron supplements. Initially, she had abdominal pain, vomiting, and diarrhea, but these symptoms have resolved. Her vital signs are stable. What stage of iron toxicity is she experiencing?", "options": [{"label": "A", "text": "Stage I", "correct": false}, {"label": "B", "text": "Stage II", "correct": true}, {"label": "C", "text": "Stage III", "correct": false}, {"label": "D", "text": "Stage IV", "correct": false}], "correct_answer": "B. Stage II", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:723px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Time Frame</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage I </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrointestinal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30 mins to 6 hrs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> (GI) symptoms such as <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, vomiting, diarrhea, hematemesis, and hematochezia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage II </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Latent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 to 24 hrs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apparent recovery phase where GI symptoms</strong> may resolve despite significant iron absorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage III </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> &amp; Shock</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 to 72 hrs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrence of GI symptoms, shock, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis, and complications like cardiomyopathy, and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatotoxicity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 to 96 hrs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Development of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure.</p>\n<p>Coma &amp; coagulopathy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bowel Obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 to 8 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Consequences of healing, including <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> and <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of the <span class=\"customMeta\" data-dictid=\"8e56d9271316927771965c8ad6e48d\">pylorus</span> or <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> bowel.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of Iron Toxicity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment Aspect</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Activated Charcoal</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ineffective for iron toxicity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnesium Hydroxide</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>1% oral solution may reduce iron <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> by forming <span class=\"customMeta\" data-dictid=\"ffb2e30f4b1692777202053635c365\">ferrous</span> hydroxide.</li>\n<li>Therapeutic doses of <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> <span class=\"customMeta\" data-dictid=\"0a57b1bc5916927771895a4f4e60b4\">hydroxide</span> and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"fdae4d6e3a1692777183b5745d0c02\">carbonate</span> antacids are safe for use.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obtain <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> iron, creatinine, electrolytes, hemoglobin, <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> time, liver function tests, and <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gas in severely poisoned patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corrective Measures</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Correct <span class=\"customMeta\" data-dictid=\"b93b1c964f16927771894edc409f80\">hypovolemia</span> and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chelation Therapy</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Agents: <span class=\"customMeta\" data-dictid=\"e02014314f1692777186904f0f9565\">Desferrioxamine</span> (IV)</strong> or <span class=\"customMeta\" data-dictid=\"82daa1d68b1692777185d611dc0e63\">deferiprone</span> (oral).</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> episodes, significant <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, hypovolemia, acidosis.</li>\n<li>Multiple radiopacities on X-ray.</li>\n<li>Serum iron &gt; 350 mcg/100 ml.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dosage (Desferrioxamine):</strong></p>\n<ul>\n<li>IV: Continuous <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> up to <strong>15 mg/kg/hr</strong> (up to 35 mg/kg/hr for severe cases in children)</li>\n<li>Total Daily Dose: Do not exceed <strong>6 grams.</strong></li>\n<li>Infusion Duration: 8-12 hours for moderate toxicity; &gt; 24 hours for severe toxicity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Therapy Endpoint</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> for \"vin rose\" color indicating chelated iron excretion.</li>\n<li>Therapy can stop when <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> color normalizes and the patient is asymptomatic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse Effects of Desferrioxamine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> (Yersinia enterocolitica, mucormycosis)</li>\n<li>visual <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> (low iron stores)</li>\n<li>ototoxicity (abnormal audiograms),</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> (high doses)</li>\n<li>Hypotension (rate-related)</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> (elevated creatinine).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Treatments</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Continuous <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> <span class=\"customMeta\" data-dictid=\"b1ee0dbe9016927771880b6c428ffc\">hemofiltration</span> (CAVH) for severe poisoning.</li>\n<li>Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> for <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Renal vasoconstriction Systemic vasodilation Vasopressin release Cytokine release", "options": [{"label": "A", "text": "1,2,3,4", "correct": false}, {"label": "B", "text": "4,3,2,1", "correct": false}, {"label": "C", "text": "4,2,3,1", "correct": true}, {"label": "D", "text": "3,4,2,1", "correct": false}], "correct_answer": "C. 4,2,3,1", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/hwMu1dtdW4s5eqmyRc7i1744762692.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hepatorenal syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury in advanced liver disease</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Hepatorenal syndrome\" data-author=\"\" data-hash=\"10402\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/hwMu1dtdW4s5eqmyRc7i1744762692.png\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a feature of hepatorenal syndrome?", "options": [{"label": "A", "text": "Stepwise decrease in serum creatinine", "correct": true}, {"label": "B", "text": "Jaundice which begins in the sclera", "correct": false}, {"label": "C", "text": "Altered mental status", "correct": false}, {"label": "D", "text": "Increased risk of bleeding", "correct": false}], "correct_answer": "A. Stepwise decrease in serum creatinine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fatigue and lethargy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Loss of appetite</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to increasing nausea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Begins in the <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> and progresses from head-to-toe. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coagulopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired liver <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">synthetic</span> function, increasing the risk of bleeding. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slow, gradual buildup of fluid in the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> due to <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> loss of albumin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic encephalopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confusion and altered mental status <strong>(Option C ruled out)</strong> as the liver fails to metabolize toxins.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oliguria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progressive decrease in <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> frequency and volume as <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function deteriorates.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Creatinine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stepwise progressive <strong>increase</strong> in <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old man with a history of cirrhosis due to chronic hepatitis C presents with worsening ascites, oliguria, and fatigue. Physical examination reveals tense ascites, mild jaundice, and peripheral edema. Laboratory investigations show: Serum creatinine: 2.3 mg/dL (baseline: 0.9 mg/dL) Serum sodium: 126 mEq/L Urine sodium: &amp;lt;10 mEq/L Albumin infusion is planned as part of his management. What is the recommended dosage of albumin infusion for this patient?", "options": [{"label": "A", "text": "1g/kg per day", "correct": true}, {"label": "B", "text": "5g/kg per day", "correct": false}, {"label": "C", "text": "2g/kg per day", "correct": false}, {"label": "D", "text": "3g/kg per day", "correct": false}], "correct_answer": "A. 1g/kg per day", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:538px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Discontinue diuretics</li>\n<li>Albumin infusion- <strong>1 g/kg per day</strong></li>\n<li>Vasoconstrictors-Terlipressin, Low-dose norepinephrine</li>\n<li>Midodrine (an α-agonist), along with <span class=\"customMeta\" data-dictid=\"e705e1d6aa1692777194f6571628c6\">octreotide</span> and <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> albumin</li>\n<li>The best therapy for <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">HRS</span> is liver transplantation; recovery of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function is typical in this setting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a characteristic feature of Type 1 hepatorenal syndrome?", "options": [{"label": "A", "text": "Doubling of serum creatinine over 2 weeks", "correct": false}, {"label": "B", "text": "Urine output less than 500mL/day", "correct": false}, {"label": "C", "text": "Normal urine sediment", "correct": false}, {"label": "D", "text": "High urinary sodium", "correct": true}], "correct_answer": "D. High urinary sodium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type 1 HRS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type 2 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">HRS</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<ul>\n<li>Doubling of the <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> to at least greater than 2.5 or a decrease in the <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> by half or more over a two-week period. <strong>(Option A ruled out)</strong></li>\n<li>Urine output of less than 500mL/day <strong>(Option B ruled out)</strong></li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"9b0000368f1692777198c43627cbce\">sediment</span> <strong>(Option C ruled out)</strong></li>\n<li>Low <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> sodium <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<ul>\n<li>Stable</li>\n<li>Better prognosis</li>\n<li>Less severe <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury</li>\n<li>Diuretic-resistant ascites</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old male with a long history of cirrhosis presents to the clinic with worsening shortness of breath over the past few months. He reports that his breathlessness worsens when standing and improves when lying down. Physical examination reveals spider angiomas. Pulse oximetry shows an oxygen saturation of 85% on room air. A contrast-enhanced echocardiogram (bubble study) is performed, and delayed bubbles are seen in the left atrium. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hepatopulmonary syndrome", "correct": true}, {"label": "B", "text": "Atelectasis", "correct": false}, {"label": "C", "text": "Chronic obstructive pulmonary disease (COPD)", "correct": false}, {"label": "D", "text": "Recurrent pulmonary emboli", "correct": false}], "correct_answer": "A. Hepatopulmonary syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Characterised by the <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> of:</strong>\n<ul>\n<li>Liver disease</li>\n<li>Intrapulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> dilatation</li>\n<li>Arterial hypoxemia</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>PaO2 <strong>less than 80 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> while breathing in room air.</strong></li>\n<li><strong>Platypnoea</strong>: Worsening of <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> when moving from a <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> to an upright position.</li>\n<li><strong>Orthodeoxia</strong>: Decrease in PaO2 of more than 5% or more than 4 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> when moving from <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> to upright.</li>\n<li><strong>Portal hypertension</strong></li>\n<li><strong>Diffuse telangiectasia/Spider naevi </strong></li>\n<li><strong>Cyanosis</strong></li>\n<li><strong>Fatigue and clubbing</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Refractory <span class=\"customMeta\" data-dictid=\"bc817d72fd1692777188eee18d7f64\">hepatopulmonary</span> syndrome.</li>\n<li>Severe post-transplant hypoxemia.</li>\n<li>Post-transplant portopulmonary hypertension.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions causes intrapulmonary shunting?", "options": [{"label": "A", "text": "Hepatopulmonary syndrome (HPS)", "correct": true}, {"label": "B", "text": "Portopulmonary hypertension", "correct": false}, {"label": "C", "text": "Recurrent pulmonary emboli", "correct": false}, {"label": "D", "text": "Pneumonia", "correct": false}], "correct_answer": "A. Hepatopulmonary syndrome (HPS)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HPS is most commonly associated with <strong>chronic liver disease or cirrhosis.</strong></p>\n<ul>\n<li><strong>Liver disease:</strong> Chronic liver conditions like <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> trigger <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> inflammation, releasing vasodilatory substances.</li>\n<li><strong>Nitric <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> (NO) and other vasodilators: </strong>increased NO causes <span class=\"customMeta\" data-dictid=\"65d8dfe7c616927771902cc9249bd7\">intrapulmonary</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> dilatation. These dilated vessels result in <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> as blood bypasses the <span class=\"customMeta\" data-dictid=\"0dd428c12116927771819285c8849c\">alveoli</span> without adequate gas exchange, leading to <strong>shunt-like physiology.</strong></li>\n<li><strong>Imbalance in <span class=\"customMeta\" data-dictid=\"6b0ed9e19a1692777181bee4557523\">angiogenic</span> factors: </strong>Dysregulation of <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> growth factors such as endothelin-1 and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> endothelial growth factor (VEGF) promotes <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"c182a5c58f1692777197ad47b9c2ef\">remodeling</span> in the lungs.</li>\n<li><strong>Ventilation-perfusion mismatch: </strong>The dilated <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vessels result in a mismatch between areas of <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> and blood flow, reducing the lung’s ability to <span class=\"customMeta\" data-dictid=\"478676c9e61692777194a6002a02c1\">oxygenate</span> blood efficiently.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Characterised by a <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> of:</strong>\n<ul>\n<li>Liver disease</li>\n<li>Intrapulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> dilatation</li>\n<li>Arterial hypoxemia</li>\n</ul>\n</li>\n<li>PaO2 <strong>less than 80 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> while breathing in room air.</strong></li>\n<li><strong>Platypnoea</strong>: Worsening of <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> when moving from a <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> to an upright position.</li>\n<li><strong>Orthodeoxia</strong>: Decrease in PaO2 of more than 5% or more than 4 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> when moving from <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> to upright.</li>\n<li><strong>Portal hypertension</strong></li>\n<li><strong>Diffuse telangiectasia/Spider naevi </strong></li>\n<li><strong>Cyanosis</strong></li>\n<li><strong>Fatigue and clubbing</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with a history of cirrhosis presents with worsening dyspnea.Physical examination reveals clubbing and cyanosis, which worsen when the patient sits upright and decrease in oxygen saturation when the patient changes position from supine to upright.Which of the following is considered the gold standard diagnostic method for confirming this condition?", "options": [{"label": "A", "text": "Pulmonary angiography", "correct": false}, {"label": "B", "text": "Transesophageal echocardiogram (TEE)", "correct": false}, {"label": "C", "text": "Radioactive lung perfusion scan", "correct": false}, {"label": "D", "text": "Bubble contrast echocardiography", "correct": true}], "correct_answer": "D. Bubble contrast echocardiography", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Arterial blood gas (ABG):</strong> Demonstrates <strong>hypoxemia</strong> with a low <span class=\"customMeta\" data-dictid=\"a66961ad3a16927771941f00c5ed57\">partial pressure</span> of oxygen (PaO₂).</li>\n<li><strong>Contrast-enhanced <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> (bubble study): Gold standard for diagnosing <span class=\"customMeta\" data-dictid=\"65d8dfe7c616927771902cc9249bd7\">intrapulmonary</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> dilatations</strong>. Bubbles from <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> will <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> the lung's capillaries and appear in the left <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> after a delay <strong>(delayed bubbles).</strong></li>\n<li><strong>Pulmonary angiography</strong>: Diagnose and distinguish <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> and <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">type II</span> HPS.</li>\n<li><strong>99mTc-labeled macroaggregated <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> scan:</strong> Can show <strong>intrapulmonary shunting </strong>where labeled particles <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> the lungs and accumulate in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> organs such as the brain or kidneys.</li>\n<li>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> or CT scan</li>\n<li>Transesophageal Echocardiogram</li>\n<li>Pulmonary function tests</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential diagnoses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Portopulmonary hypertension</li>\n<li>Atelectasis</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> emboli</li>\n<li>Atrial septal defect</li>\n<li>Chronic obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease</li>\n<li>Pneumonia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Liver transplantation</strong>: The <strong>definitive treatment</strong>, as it addresses the underlying liver disease. It has been shown to reverse <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> abnormalities and improve <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> over time.</li>\n<li><strong>Oxygen therapy:</strong> Supplemental oxygen can help manage <span class=\"customMeta\" data-dictid=\"9f81027f0116927771892823259e5d\">hypoxemia</span> but is only <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief.</li>\n<li><strong>Transjugular <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"e2218202be1692777196fa2a021f5e\">portosystemic</span> <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">shunt</span> (TIPS):</strong> This procedure is used to reduce <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension.</li>\n<li><strong>Pulmonary arterial <span class=\"customMeta\" data-dictid=\"d01779560916927771845f3a964516\">coil</span> embolization</strong></li>\n<li><strong>No medical therapy approved for HPS.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Refractory <span class=\"customMeta\" data-dictid=\"bc817d72fd1692777188eee18d7f64\">hepatopulmonary</span> syndrome.</li>\n<li>Severe post-transplant hypoxemia.</li>\n<li>Post-transplant portopulmonary hypertension.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following laboratory findings does not typically indicate alcoholic hepatitis?", "options": [{"label": "A", "text": "Serum bilirubin more than 3 mg/dL", "correct": false}, {"label": "B", "text": "Elevated aspartate aminotransferase (AST) to 50 U/L - 400 U/L", "correct": false}, {"label": "C", "text": "AST:ALT (alanine aminotransferase) ratio of more than 1.5", "correct": false}, {"label": "D", "text": "Absolute value of AST/ALT greater than 600 U/L", "correct": true}], "correct_answer": "D. Absolute value of AST/ALT greater than 600 U/L", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What amount of alcohol consumption is generally considered to significantly increase the risk of developing alcoholic hepatitis?", "options": [{"label": "A", "text": "More than 125 grams per day", "correct": false}, {"label": "B", "text": "More than 150 grams per day", "correct": false}, {"label": "C", "text": "More than 200 grams per day", "correct": false}, {"label": "D", "text": "More than 100 grams per day", "correct": true}], "correct_answer": "D. More than 100 grams per day", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">Alcoholic</span> Hepatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal liver <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> with few symptoms.Mild <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of liver enzymes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">Alcoholic</span> Hepatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased liver <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> with symptoms such as jaundice, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain and elevated liver enzymes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">Alcoholic</span> Hepatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant inflammation, liver failure, and complications like coagulopathy, ascites, and encephalopathy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cirrhosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term consequence of repeated episodes of <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> leading to <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> liver damage and <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> (cirrhosis).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old man with a history of heavy alcohol consumption presents with jaundice, abdominal pain, and fatigue. A liver biopsy is performed to assess the extent of liver damage. Which of the following findings is most characteristic of this condition? Histopathology image given below:", "options": [{"label": "A", "text": "Russell bodies", "correct": false}, {"label": "B", "text": "Dutcher bodies", "correct": false}, {"label": "C", "text": "Mallory-Denk bodies", "correct": true}, {"label": "D", "text": "Kamino bodies", "correct": false}], "correct_answer": "C. Mallory-Denk bodies", "question_images": ["https://image.prepladder.com/notes/uLVZvswRs199FtbMlp0s1744762772.png"], "explanation_images": ["https://image.prepladder.com/notes/hXhbvKqEIPx3E2jk35dF1744762972.png", "https://image.prepladder.com/notes/v5aBLWYtscQMl4J8k04Q1744763043.png", "https://image.prepladder.com/notes/aqyx4cm2E7FWK3MXUTLo1744763118.png", "https://image.prepladder.com/notes/9urhYB10VPOy8zAT0BYs1744763181.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alcohol Metabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ethanol is primarily metabolized in the liver by enzymes, particularly <span class=\"customMeta\" data-dictid=\"4c1279cdf1169277718118b18c10ab\">alcohol dehydrogenase</span> (ADH) and <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> P450 2E1 (CYP2E1).</li>\n<li>This <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> produces acetaldehyde, a toxic intermediate, which can cause <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxidative Stress</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of alcohol generates <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> oxygen species (ROS) and increases <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress within liver cells.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> damage leads to <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> peroxidation, protein modifications, and DNA damage, contributing to <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> injury and inflammation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammatory Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Alcohol consumption stimulates the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of immune cells (e.g., Kupffer cells) leading to the release of pro-inflammatory cytokines (TNF-α, IL-6).</li>\n<li>These cytokines promote <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and can further damage hepatocytes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Altered <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">Lipid</span> Metabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Alcohol disrupts normal <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> metabolism, leading to fat accumulation in liver cells (steatosis).</li>\n<li>This accumulation can progress to steatohepatitis, where <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and liver cell injury occur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrosis and Cirrhosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and injury stimulate the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">stellate</span> cells, which produce <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> and lead to fibrosis.</li>\n<li>Over time, repeated injury can result in cirrhosis, characterized by <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> and loss of normal liver architecture.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male with a history of heavy alcohol use presents with jaundice and altered sensorium. Laboratory tests reveal elevated bilirubin, AST &amp;gt; ALT, hypoalbuminemia, and prolonged PT/INR. Which of the following findings is most suggestive of the presence of hepatic encephalopathy in this patient?", "options": [{"label": "A", "text": "Asterixis", "correct": true}, {"label": "B", "text": "Hyperbilirubinemia", "correct": false}, {"label": "C", "text": "Ascites", "correct": false}, {"label": "D", "text": "Gynaecomastia", "correct": false}], "correct_answer": "A. Asterixis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ONyifDX7m8DTwDIdlgZj1744763281.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually asymptomatic</li>\n<li>Fever, malaise, jaundice, history of alcohol <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> + (at least within last 8 weeks before symptom onset)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdominal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain, tender hepatomegaly, splenomegaly, ascites</li>\n<li><strong>Caput medusae:</strong> enlarged veins radiating from the umbilicus</li>\n<li>Bleeding <span class=\"customMeta\" data-dictid=\"c3b47c6c6b16927772018ebcc5b5a9\">varices</span> (portal hypertension)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Spider angioma</strong>, <strong>palmar erythema</strong>, ecchymosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reproductive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gynaecomastia, gonadal atrophy, loss of libido, amenorrhea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Peripheral neuropathy: <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> and <span class=\"customMeta\" data-dictid=\"a6a2c6342d1692777193c3414d0cc8\">numbness</span> usually over feet</li>\n<li><strong>Wernicke-Korsakoff syndrome:</strong> Ophthalmoplegia, confusion, <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> + <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">anterograde</span> amnesia</li>\n<li><strong>Hepatic encephalopathy:</strong> <strong>Asterixis (most prominent finding)</strong>, altered sensorium, sleep disturbances, lethargy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dupuytren’s contracture</strong>, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> muscle wasting, <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> enlargement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with a long history of heavy alcohol use presents with fatigue, jaundice, and abdominal distension. Physical examination reveals hepatomegaly, spider angiomas, and ascites. What is the most specific investigation to diagnose his condition?", "options": [{"label": "A", "text": "γ-glutamyl transferase assay (GGT)", "correct": false}, {"label": "B", "text": "PT/INR", "correct": false}, {"label": "C", "text": "Serum bilirubin", "correct": false}, {"label": "D", "text": "AST/ALT ratio", "correct": true}], "correct_answer": "D. AST/ALT ratio", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:521px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AST (Aspartate aminotransferase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-specific ; ↑ (&lt;300-400)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ALT (Alanine aminotransferase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specific for liver injury ; ↑ (&lt;300-400)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AST/ALT ratio: ≥ 2: 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specific for ALD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ALP (Alkaline phosphatase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated in <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> pathologies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GGT (γ-glutamyl transferase)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-specific marker of ALD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5’-Nucleotidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specific marker for <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> pathologies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>S.Bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually normal/mildly ↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>S.Albumin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓ in chronic liver disease (cirrhosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carbohydrate deficient <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> (CDT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> marker for <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> liver disease.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male patient succumbed to death, history revealed that the patient was admitted for liver failure 1 week back. Biopsy done is as shown below. What type of inclusions are seen in the biopsy, and what is the likely diagnosis?", "options": [{"label": "A", "text": "Intracytoplasmic - ALD", "correct": true}, {"label": "B", "text": "Intranuclear - ALD", "correct": false}, {"label": "C", "text": "Intracytoplasmic - Viral hepatitis", "correct": false}, {"label": "D", "text": "Intranuclear - Viral hepatitis", "correct": false}], "correct_answer": "A. Intracytoplasmic - ALD", "question_images": ["https://image.prepladder.com/notes/MnN7oAraoCsnTeJozO9H1744763374.png"], "explanation_images": ["https://image.prepladder.com/notes/f721hoBC4oqVj8gwx00D1744763486.png", "https://image.prepladder.com/notes/BnwVh0WIGZsw9CHBD8wO1744763570.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver function tests (LFT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>AST/ALT ratio: ≥ 2: 1: Most specific for ALD</li>\n<li>GGT (γ-glutamyl transferase): Non-specific marker of ALD</li>\n<li>S.Bilirubin: Usually normal/mildly ↑</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>USG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased liver span, altered echotexture</li>\n<li><strong>Reversal seen in <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> flow (Portal hypertension)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coagulation profile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PT/INR: Elevated</li>\n<li><strong>(All <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> factors are synthesized in liver except factor-VIII)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RFT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>S.Creatinine: May be elevated in later stages (Hepato-renal syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neutrophils <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> with ballooned hepatocytes</li>\n<li><strong>Malory-Denk bodies: <span class=\"customMeta\" data-dictid=\"45e0bd1529169277719054d85830ce\">Intracytoplasmic</span> <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> inclusions</strong></li>\n<li>Bilirubin <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">Stasis</span> &amp; ductular reaction</li>\n<li><strong>Chicken wire <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (later stages)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Alcoholic hepatitits answer\" data-author=\"Arab, Juan &amp; Roblero, Juan &amp; Altamirano, José &amp; Bessone, Fernando &amp; Araujo, Roberta &amp; Higuera-de la Tijera, Fatima &amp; Restrepo, Juan &amp; Aldo, Torre-Delgadillo &amp; Urzúa, Álvaro &amp; Simonetto, Douglas &amp; Abraldes, Juan &amp; Méndez-Sánchez, Nahum &amp; Contreras, Fernando &amp; Lucey, Michael &amp; Shah, Vijay &amp; Cortez-Pinto, Helena &amp; Bataller, Ramon. \" data-hash=\"10410\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Characteristic-histological-findings-in-alcoholic-hepatitis-Macrovesicular-steatosis-is_fig3_332755946\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/f721hoBC4oqVj8gwx00D1744763486.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following are components of the MELD 3.0 score? 1) Male sex 2) Albumin 3) Creatinine 4) AST 5) INR 6) Serum Na+", "options": [{"label": "A", "text": "1,2,3,5,6", "correct": false}, {"label": "B", "text": "2,3,5,6", "correct": true}, {"label": "C", "text": "1,3,4,5,6", "correct": false}, {"label": "D", "text": "2,3,4,5", "correct": false}], "correct_answer": "B. 2,3,5,6", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MELD:</strong> (Model of End-stage Liver Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Creatinine <strong>(3)</strong></li>\n<li>Bilirubin</li>\n<li>INR <strong>(5)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MELD 3.0 : </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Female sex</li>\n<li>S. Bilirubin</li>\n<li>S. <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">Albumin</span> <strong>(2)</strong></li>\n<li>S.Sodium <strong>(6)</strong></li>\n<li>INR</li>\n<li>S.Creatinine</li>\n</ul>\n<p>(mnemonic: FBASIC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maddrey’s Discriminant function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4.6 (PT<sub>PATIENT </sub> - PT<sub>CONTROL</sub>) + S.bilirubin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glasgow <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">Alcoholic</span> <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">Hepatitis</span> score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age</li>\n<li>WBC count</li>\n<li>BUN (Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> nitrogen)</li>\n<li>S. Bilirubin</li>\n<li>INR</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications to start treatment for ALD:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MELD ≥ 21</li>\n<li>Discriminant function ≥ 32</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient who is a known alcoholic presented to OPD with jaundice and malaise. Her initial reports were PT: 24 sec (N: 11-14sec); AST: 70 Units/L (N: 10-40 U/L) ; ALT: 70 Units/L (N: 8-55 U/L); Bilirubin: 2 mg/dL (N: 0.2-1.3 mg/dL). What is the preferred management of choice?", "options": [{"label": "A", "text": "Only lifestyle modifications", "correct": false}, {"label": "B", "text": "Oral steroids", "correct": true}, {"label": "C", "text": "Zinc + Vit-E supplements", "correct": false}, {"label": "D", "text": "Liver transplant", "correct": false}], "correct_answer": "B. Oral steroids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steatosis </strong></p>\n<p><strong>(DF &lt; 32 &amp; MELD &lt; 21)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only lifestyle modifications:</p>\n<ul>\n<li>Alcohol abstinence</li>\n<li>Dietary changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steato-Hepatitis </strong></p>\n<p><strong>(DF ≥ 32 / MELD ≥ 21)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">Prednisolone</span> 32 mg/day for 4 weeks</strong></li>\n<li>Check S.Bilirubin levels 1 week after starting steroids</li>\n<li>Other drugs: N-acetyl cysteine, Pentoxifylline, anti-TNFα agents</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cirrhosis (Organ failure/ <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> hypertension)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver transplant</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is not a component of Liver FibroTest?", "options": [{"label": "A", "text": "Haptoglobin", "correct": false}, {"label": "B", "text": "Hyaluronic acid", "correct": true}, {"label": "C", "text": "γ-GT (GGT)", "correct": false}, {"label": "D", "text": "Total bilirubin", "correct": false}], "correct_answer": "B. Hyaluronic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cirrhosis </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>APRI (AST to <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> Ratio Index)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>AST, <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">Platelet</span> count</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ELF (Enhanced Liver Fibrosis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age</li>\n<li>Hyaluronic acid</li>\n<li>MMP-3 (Metalloproteinase)</li>\n<li>TIMP (Tissue <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">Inhibitor</span> of Metalloproteinase)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 9.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FIB – 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age, AST, ALT, <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 3.25</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FibroTest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Haptoglobin <strong>(Option A)</strong></li>\n<li>α2- macroglobulin</li>\n<li>Apolipoprotein A1</li>\n<li>γ-GT (GGT) <strong>(Option C)</strong></li>\n<li>Total <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 0.63</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TE (Transient Elastography/ Fibrosure/ Fibroscan)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wave speed generated by <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> through liver tissue is measured</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt; 8 kPa (Fibrosis)</strong></p>\n<p><strong>&gt; 12.5 kPa (Cirrhosis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ARFT [Acoustic Radiation force imaging]</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wave speed generated by <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> radiation through liver tissue is measured</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 1.87 m/s</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Forn index</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Platelet count, GGT, Age, Cholesterol</p>\n<ul>\n<li><strong>Forn Index</strong> = 7.811 − (3.131 × log (Platelets)) + (0.781 × log (GGT)) + (3.467 × log (Age)) − (0.014×Cholesterol)</li>\n<li>Interpretation:\n\t\t\t\t<ul>\n<li>Low Forn Index (&lt;4.2): Low <span class=\"customMeta\" data-dictid=\"f52ac1410416927771969ba21fcb63\">probability</span> of significant fibrosis.</li>\n<li>High Forn Index (≥4.2): High <span class=\"customMeta\" data-dictid=\"f52ac1410416927771969ba21fcb63\">probability</span> of significant <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> or cirrhosis.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;4.2</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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Laboratory tests reveal elevated bilirubin levels, with a higher proportion of unconjugated bilirubin. The infant’s mother mentions that the jaundice has been present since birth and that the infant has not shown any signs of hemolysis. What is the most likely underlying cause of this infant's condition related to bilirubin metabolism?", "options": [{"label": "A", "text": "Impaired uptake of bilirubin by hepatocytes", "correct": false}, {"label": "B", "text": "Defective conjugation of bilirubin due to UGT1A1 mutation", "correct": true}, {"label": "C", "text": "Reduced biliary excretion of bilirubin due to MRP2 mutation", "correct": false}, {"label": "D", "text": "Increased production of bilirubin due to hemolysis", "correct": false}], "correct_answer": "B. Defective conjugation of bilirubin due to UGT1A1 mutation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/InUMnXvLi2DydNYyjKk21744710600.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-year-old male presents to the clinic for a routine check-up. His laboratory tests reveal serum bilirubin levels of 45 μmol/L (2.6 mg/dL) with normal liver function tests. He reports occasional mild jaundice, particularly after periods of stress and fasting. There is no history of hemolysis or liver disease. The patient has been asymptomatic otherwise. What is the most likely diagnosis for this patient based on the provided information?", "options": [{"label": "A", "text": "Crigler-Najjar Syndrome Type I", "correct": false}, {"label": "B", "text": "Crigler-Najjar Syndrome Type II", "correct": false}, {"label": "C", "text": "Dubin-Johnson Syndrome", "correct": false}, {"label": "D", "text": "Gilbert Syndrome", "correct": true}], "correct_answer": "D. Gilbert Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gilbert Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gilbert Syndrome (GS) is a common, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> condition with<strong> mild unconjugated <span class=\"customMeta\" data-dictid=\"cab274fa4f1692777189f9b6dad514\">hyperbilirubinemia</span> and normal liver function tests</strong>, affecting up to 8% of people, more common in males.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> UGT1A1 <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> activity (10–35% of normal), often due to a TA <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> in the UGT1A1 <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> (A[TA]7TAA).</li>\n<li>Inheritance is typically autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> with the <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> variant; some cases show <span class=\"customMeta\" data-dictid=\"18e7ddb7841692777186f7e78b2206\">dominant inheritance</span> with other mutations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> &lt;51 μmol/L (&lt;3 mg/dL), fluctuating with stress, fasting, alcohol, or illness; <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> may occur during elevations.</li>\n<li>Most patients are asymptomatic, though <strong>jaundice</strong> can occur during episodes of elevated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels.</li>\n<li>Often diagnosed incidentally in <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> or adulthood.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels are intermittently high, with Normal <strong>liver function tests and <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> histology</strong>.</li>\n<li><strong>UGT1A1 </strong>gene testing may reveal the A[TA]7TAA <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> variant.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually no treatment is needed. Lifestyle adjustments, such as avoiding alcohol and maintaining regular <span class=\"customMeta\" data-dictid=\"5f526a682c16927771831cac5b3711\">calorie</span> intake, may help manage <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels.</li>\n<li>Phenobarbital can normalize <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels if required.</li>\n<li>Caution with drugs metabolized by UGT1A1 (e.g., irinotecan, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> <span class=\"customMeta\" data-dictid=\"fe13bbded1169277719694883c6ba4\">protease</span> inhibitors) due to risk of toxicity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-week-old infant is brought to the emergency department due to jaundice. The mother reports that the infant’s skin has become increasingly yellow since birth. Laboratory tests reveal a serum bilirubin level of 450 μmol/L (26 mg/dL), and the infant appears lethargic. There are no signs of hemolysis, and a physical examination shows no other abnormalities. What is the most likely diagnosis for this infant based on the provided information?", "options": [{"label": "A", "text": "Crigler-Najjar Syndrome Type I", "correct": true}, {"label": "B", "text": "Crigler-Najjar Syndrome Type II", "correct": false}, {"label": "C", "text": "Dubin-Johnson Syndrome", "correct": false}, {"label": "D", "text": "Rotor Syndrome", "correct": false}], "correct_answer": "A. Crigler-Najjar Syndrome Type I", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:758px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperbilirubinemia syndromes </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Crigler-Najjar Syndrome <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">Type I</span> (CN-I)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gene: </strong>UGT1A1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology: </strong>Complete <strong>absence</strong> of <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <strong>UDP-glucuronosyltransferase </strong>(UDPGT) activity;</p>\n<p>No <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <span class=\"customMeta\" data-dictid=\"5bf9387ee91692777185685e187e76\">conjugation</span> occurs, leading to severe unconjugated hyperbilirubinemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> from <strong>birth</strong></li>\n<li>extreme <strong>hyperbilirubinemia</strong> (&gt;342 μmol/L or &gt;20 mg/dL)</li>\n<li>high risk of <strong>kernicterus</strong>, with neurological damage.</li>\n<li>Often fatal without intervention.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n<ul>\n<li>Increased <strong>unconjugated</strong> <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> + conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> absent</li>\n<li>No signs of excessive hemolysis</li>\n<li>No <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> UDPGT activity– <strong>no response to phenobarbital</strong></li>\n<li>No <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> glucuronides in <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> (bile is pale or colorless).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n<ul>\n<li>Requires lifelong phototherapy;</li>\n<li>Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> is often <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> in preventing neurological damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Crigler-Najjar Syndrome <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">Type II</span> (CN-II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gene: </strong>UGT1A1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology: </strong>Marked reduction <strong>(≤10% of normal)</strong> in <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <strong>UDPGT</strong> activity</p>\n<p>partial <span class=\"customMeta\" data-dictid=\"5bf9387ee91692777185685e187e76\">conjugation</span> of <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> occurs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<ul>\n<li><strong>Moderate</strong> <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> with <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels of 103–428 μmol/L (6–25 mg/dL)</li>\n<li>kernicterus is possible under <strong>stress</strong> conditions (illness or surgery)</li>\n<li>Usually presents in <strong>infancy</strong> or <strong>childhood</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n<ul>\n<li>Increased <strong>unconjugated</strong> <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> + conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> present</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> UDPGT activity;\n\t\t\t\t<ul>\n<li>Unconjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels decrease significantly in response to phenobarbital;</li>\n</ul>\n</li>\n<li>Bile contains <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> monoglucuronide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n<ul>\n<li>Phenobarbital therapy to induce <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> UDPGT activity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Dubin-Johnson Syndrome (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gene: </strong>ABCC2 gene</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology: </strong>Mutations in the MRP2 (ABCC2) gene disrupt <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <span class=\"customMeta\" data-dictid=\"ed6dc0698216927771889e8a118c4f\">glucuronide</span> transport across the canalicular membrane, causing <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> accumulation in hepatocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<ul>\n<li>Asymptomatic or with mild symptoms</li>\n<li>Mild to moderate <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> that can darken with age</li>\n<li>Hepatocytes accumulate dark <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> but liver function is normal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n<ul>\n<li>Increased conjugated bilirubin</li>\n<li><strong>Darkly pigmented</strong> liver on biopsy</li>\n<li><strong>Positive <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"0a74553845169277718571f94964fb\">coproporphyrin</span> I</strong> levels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n<ul>\n<li>Usually, no treatment is required; manage <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> as needed</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Rotor syndrome (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gene: </strong>SLCO1B1 and SLCO1B3 gene</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology: </strong>Affect the <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">reuptake</span> system (OATP1B1 and OATP1B3) for <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> glucuronides, causing some <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> to re-enter the circulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<ul>\n<li>Mild to moderate jaundice;</li>\n<li>No dark liver <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> as in Dubin-Johnson</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n<ul>\n<li>Direct hyperbilirubinemia</li>\n<li>I<strong>ncreased <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"0a74553845169277718571f94964fb\">coproporphyrin</span> I and III levels</strong></li>\n<li>Liver is not <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> on biopsy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n<ul>\n<li>Usually no treatment required; manage <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> as needed</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents to the clinic with intermittent jaundice that worsens during her menstrual cycle and when taking oral contraceptives. Laboratory tests reveal elevated conjugated bilirubin levels, but her liver function tests are otherwise normal. A liver ultrasound shows no significant abnormalities, and she has no history of significant liver disease. What is the most likely diagnosis for this patient based on the provided information?", "options": [{"label": "A", "text": "Dubin-Johnson Syndrome", "correct": true}, {"label": "B", "text": "Rotor Syndrome", "correct": false}, {"label": "C", "text": "Budd-Chiari Syndrome", "correct": false}, {"label": "D", "text": "Crigler-Najjar Syndrome Type II", "correct": false}], "correct_answer": "A. Dubin-Johnson Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:695px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Dubin-Johnson Syndrome (DJS)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>About</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Rare, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> disorder with low-grade, predominantly conjugated hyperbilirubinemia.</li>\n<li>Bilirubin levels may fluctuate widely, especially with <span class=\"customMeta\" data-dictid=\"affd7d04861692777190f53415de53\">intercurrent</span> illness, oral contraceptives, or pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Caused by <strong>defective MRP2 (ABCC2) transporter</strong>, affecting <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> and certain <span class=\"customMeta\" data-dictid=\"74473c1f791692777181d324db5e69\">anionic</span> compounds.</li>\n<li>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> inheritance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Jaundice with elevated conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels.</li>\n<li>Typically asymptomatic; occasional vague symptoms or <span class=\"customMeta\" data-dictid=\"2f1f6627791692777188591ac9de0e\">hepatosplenomegaly</span> may occur.</li>\n<li><strong>Cardinal feature</strong>- Liver appears black due to black, <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> accumulation in lysosomes of <span class=\"customMeta\" data-dictid=\"2287afab0416927771845999a48e25\">centrilobular</span> hepatocytes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Investigations</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Elevated conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> with bilirubinuria.</li>\n<li>Normal liver function tests, except for bilirubin.</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"0a74553845169277718571f94964fb\">coproporphyrin</span> <span class=\"customMeta\" data-dictid=\"d30d92f8841692777190c688cd1feb\">isomer</span> I &gt;80% (diagnostic feature).</li>\n<li><strong>Bromsulphthalein (BSP) test:</strong> Shows <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> of conjugated BSP into <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> at 90 minutes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Generally, no treatment is required due to its <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> nature.</li>\n<li>Awareness of triggers (e.g., pregnancy, oral contraceptives) that may exacerbate jaundice.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old man presents to the clinic with intermittent jaundice and dark urine. His laboratory tests show elevated conjugated bilirubin levels and urine tests reveal bilirubinuria. An ultrasound of the liver is unremarkable, and a cholecystography shows a normal gallbladder. The patient has no significant past medical history and is otherwise asymptomatic. What is the most likely diagnosis for this patient based on the provided information?", "options": [{"label": "A", "text": "Crigler-Najjar Syndrome Type I", "correct": false}, {"label": "B", "text": "Gilbert Syndrome", "correct": false}, {"label": "C", "text": "Rotor Syndrome", "correct": true}, {"label": "D", "text": "Dubin-Johnson Syndrome", "correct": false}], "correct_answer": "C. Rotor Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rotor Syndrome (RS)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>About</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Rare, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder with clinical similarity to <span class=\"customMeta\" data-dictid=\"491b8531981692777186260c141212\">Dubin-Johnson Syndrome</span> (DJS).</li>\n</ul>\n<ul>\n<li>Major <span class=\"customMeta\" data-dictid=\"4ed693de911692777195bb9630f513\">phenotypic</span> difference: liver appears normal with no increased pigmentation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Caused by <strong>deficiency of OATP1B1 (SLCO1B1) and OATP1B3 (SLCO1B3) transporters.</strong></li>\n</ul>\n<ul>\n<li>Results in <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">reuptake</span> of conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> from <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> circulation, leading to bilirubinuria.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Jaundice due to elevated conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels; <span class=\"customMeta\" data-dictid=\"2bd8774d9216927771835d8665fe7a\">bilirubinuria</span> is present.</li>\n</ul>\n<ul>\n<li>Gallbladder visualised on oral <span class=\"customMeta\" data-dictid=\"ab81743078169277718497e4584f78\">cholecystography</span> (unlike DJS).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Investigations</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Elevated conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> with bilirubinuria.</li>\n</ul>\n<ul>\n<li>Increased total <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"0a74553845169277718571f94964fb\">coproporphyrin</span> with <span class=\"customMeta\" data-dictid=\"0a74553845169277718571f94964fb\">coproporphyrin</span> I &lt;70% (compared to ≥80% in DJS).</li>\n</ul>\n<ul>\n<li><strong>Bromsulphthalein (BSP) test</strong>: Delayed clearance, but no <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> of conjugated BSP into circulation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"a4a589776216927771991b881f95b1\">specific treatment</span> is required due to its <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> nature.</li>\n</ul>\n<ul>\n<li>Awareness of <span class=\"customMeta\" data-dictid=\"6bd54dfc48169277718674cd08e586\">differential</span> diagnosis from DJS for appropriate management.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents to the emergency department with abdominal pain, severe ascites, and jaundice that developed over the past month. On examination, she has hepatomegaly and splenomegaly. Laboratory tests show elevated liver enzymes and bilirubin levels. A Doppler ultrasound of the abdomen reveals occlusion of multiple hepatic veins. What is the most likely diagnosis for this patient based on the provided information?", "options": [{"label": "A", "text": "Dubin-Johnson Syndrome", "correct": false}, {"label": "B", "text": "Budd-Chiari Syndrome", "correct": true}, {"label": "C", "text": "Gilbert Syndrome", "correct": false}, {"label": "D", "text": "Rotor Syndrome", "correct": false}], "correct_answer": "B. Budd-Chiari Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Budd Chiari Syndrome (BCS)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>About</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Uncommon disorder with <strong>hepatic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction.</strong></li>\n<li><strong>Primary BCS: </strong>Caused by <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> processes like <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> or phlebitis.</li>\n<li><strong>Secondary BCS: </strong>Caused by external <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> or invasion (e.g., malignancy).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Single <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> is usually silent; <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of 2 veins causes <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and liver <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> stretching (painful).</li>\n<li>Sinusoidal <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> and <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> fluid <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> lead to liver <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and ascites.</li>\n<li>Thrombosis and <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> cause <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and decreased liver blood flow, leading to hypoxic injury in <span class=\"customMeta\" data-dictid=\"2287afab0416927771845999a48e25\">centrilobular</span> hepatocytes.</li>\n<li>Acute cases: Can cause liver failure; chronic cases may lead to ascites, hepatomegaly, and eventual cirrhosis.</li>\n<li><strong>Caudate <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> hypertrophy</strong> occurs due to direct shunting into the IVC.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Disease Duration: <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> (weeks), <span class=\"customMeta\" data-dictid=\"159e1426d61692777199d9361738d0\">subacute</span> (months), chronic (with cirrhosis), and <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> (rapid liver failure, no <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> collaterals).</li>\n<li><strong>Common Triad: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain, ascites, hepatomegaly.</strong></li>\n<li><strong>Acute/Subacute:</strong> Ascites, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, jaundice, hepatomegaly, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> encephalopathy.</li>\n<li><strong>Chronic:</strong> Progressive <span class=\"customMeta\" data-dictid=\"a1146fb9d8169277718250cf1224a8\">ascites</span> without jaundice; possible <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n<li>Rare Presentation: Tender hepatomegaly, <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> liver failure, jaundice, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n<li>Physical Exam: Jaundice, ascites, hepatomegaly, splenomegaly, <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> oedema, and <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> ulcerations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman presents with 2 months of progressive abdominal pain and distension. On examination, she has spider angiomas, hepatomegaly, and moderate ascites. Laboratory studies show haemoglobin 18.2 g/dL, WBC 13,000/μL, platelets 650,000/μL, and normal liver enzymes. Doppler ultrasound reveals hepatic vein thrombosis. Which of the following is the most common cause of the suspected condition?", "options": [{"label": "A", "text": "Myeloproliferative disorders", "correct": true}, {"label": "B", "text": "Vitamin B12 deficiency", "correct": false}, {"label": "C", "text": "Inflammatory bowel disease", "correct": false}, {"label": "D", "text": "Chronic hepatitis C", "correct": false}], "correct_answer": "A. Myeloproliferative disorders", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specific Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myeloproliferative Disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Polycythemia vera</li>\n<li> Essential thrombocythemia</li>\n<li>Primary myelofibrosis</li>\n<li>Occult MPD</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~50%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated blood counts</li>\n<li>Splenomegaly</li>\n<li>Thrombotic events</li>\n<li>Pruritus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypercoagulable States</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Factor V Leiden</li>\n<li>Antiphospholipid syndrome</li>\n<li>Protein C/S deficiency</li>\n<li>Antithrombin deficiency</li>\n<li>PNH</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent thrombosis</li>\n<li>Young age</li>\n<li>Family history</li>\n<li>Multiple sites</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormonal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Oral contraceptives</li>\n<li> Pregnancy</li>\n<li> Hormone replacement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~20%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Female gender</li>\n<li>Reproductive age</li>\n<li>Recent medication changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Hepatocellular carcinoma</li>\n<li> Renal cell carcinoma</li>\n<li> Adrenal tumors</li>\n<li> Lymphoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~10%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Mass lesions</li>\n<li> Weight loss</li>\n<li> Constitutional symptoms</li>\n<li> Paraneoplastic features</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with 3 weeks of progressive abdominal pain and ascites. Laboratory studies show elevated LFTs and a prolonged PT. Doppler ultrasound reveals hepatic vein thrombosis. After initial diagnosis, which of the following represents the most appropriate sequential management approach?", "options": [{"label": "A", "text": "Proceed directly to liver transplantation", "correct": false}, {"label": "B", "text": "Initiate anticoagulation, followed by assessment for predisposing causes and TIPS if needed", "correct": true}, {"label": "C", "text": "Start diuretics alone and monitor symptoms", "correct": false}, {"label": "D", "text": "Perform surgical shunting as primary therapy", "correct": false}], "correct_answer": "B. Initiate anticoagulation, followed by assessment for predisposing causes and TIPS if needed", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:697px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong> Classical triad:</strong>\n<ul>\n<li> Abdominal pain</li>\n<li> Ascites</li>\n<li> Hepatomegaly</li>\n</ul>\n</li>\n<li> May have jaundice</li>\n<li> Spider angiomas</li>\n<li> splenomegaly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute: rapid onset (&lt;2 weeks), no collaterals</li>\n<li>Chronic: gradual onset, established collaterals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Imaging studies</li>\n<li> Laboratory tests</li>\n<li> Diagnostic paracentesis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Doppler US: first line (85-90% sensitivity)</li>\n<li> CT/MRI if needed</li>\n<li> LFTs, <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> profile</li>\n<li> Ascitic fluid: high protein, <span class=\"customMeta\" data-dictid=\"d3185ca21e169277719836a0dcdaf0\">SAAG</span> &gt;1.1</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiologic Workup</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> MPD evaluation</li>\n<li> Hypercoagulable testing</li>\n<li> Other investigations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> JAK2 <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> testing</li>\n<li>Thrombophilia workup</li>\n<li> Pregnancy test</li>\n<li> Screen for malignancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Anticoagulation</li>\n<li>Supportive care</li>\n<li> Treatment of cause</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> LMWH → Warfarin</li>\n<li> Manage ascites</li>\n<li> Treat underlying condition</li>\n<li> Monitor response</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step-up Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Interventional procedures</li>\n<li> Advanced options</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Thrombolysis if acute</li>\n<li>TIPS for failed medical therapy</li>\n<li>Angioplasty/stenting</li>\n<li>Surgical shunts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Transplantation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Indications:\n\t\t\t\t<ul>\n<li>Fulminant failure</li>\n<li>Failed other therapy</li>\n<li>Advanced cirrhosis</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>3-year survival ~85%</li>\n<li>Need lifelong anticoagulation</li>\n<li>Regular monitoring</li>\n<li>Consider early in <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true regarding how the Bromsulphthalein test helps distinguish between Rotor syndrome and Dubin-Johnson syndrome?", "options": [{"label": "A", "text": "Dubin johnson syndrome - prolonged retention of BSP in the bloodstream Rotor syndrome - BSP is rapidly cleared.", "correct": false}, {"label": "B", "text": "Dubin Johnson syndrome - delayed excretion with prolonged retention of BSP occurs, Rotor syndrome - early excretion with no delayed retention.", "correct": true}, {"label": "C", "text": "Both Rotor syndrome and DJS show prolonged retention of BSP, making the test ineffective in differentiation.", "correct": false}, {"label": "D", "text": "Dubin Johnson syndrome - BSP is taken up slowly by the liver but is excreted rapidly, Rotor syndrome - BSP is taken up rapidly by the liver but is excreted slowly", "correct": false}], "correct_answer": "B. Dubin Johnson syndrome - delayed excretion with prolonged retention of BSP occurs, Rotor syndrome - early excretion with no delayed retention.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/xnjSDiPdGZ72gn97RudF1744715553.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 19 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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He is diagnosed with acute variceal bleeding. Which of the following is the most appropriate initial management step for this patient?", "options": [{"label": "A", "text": "Administer intravenous terlipressin followed by prophylactic intravenous antibiotics", "correct": true}, {"label": "B", "text": "Start intravenous antibiotics and perform urgent endoscopy for band ligation", "correct": false}, {"label": "C", "text": "Administer intravenous vasopressin and initiate fresh frozen plasma transfusion", "correct": false}, {"label": "D", "text": "Begin intravenous corticosteroids and monitor for signs of hepatic encephalopathy", "correct": false}], "correct_answer": "A. Administer intravenous terlipressin followed by prophylactic intravenous antibiotics", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male with a history of alcohol abuse and long-term hypertension presents with hematemesis, abdominal distension, and splenomegaly. He is hypotensive and tachycardic, with elevated liver enzymes, low platelets, and a high INR. Endoscopy reveals esophageal varices. Which of the following most likely explains the development of this condition?", "options": [{"label": "A", "text": "Portal venous thrombosis leads to increased collateral circulation", "correct": false}, {"label": "B", "text": "Increased portal blood flow to the liver", "correct": false}, {"label": "C", "text": "Increased portal pressure forcing blood into collateral vessels", "correct": true}, {"label": "D", "text": "Reduced portal vascular resistance", "correct": false}], "correct_answer": "C. Increased portal pressure forcing blood into collateral vessels", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/wivKJIWqBU9YsEbk7cA91746005756.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old man with alcoholic cirrhosis presents to the emergency department with confusion, disorientation, and asterixis. His family reports increasing drowsiness and difficulty concentrating over the past few days. Investigations reveal normal electrolytes and elevated ammonia levels. What is the most appropriate initial treatment to lower ammonia?", "options": [{"label": "A", "text": "Increase the protein intake", "correct": false}, {"label": "B", "text": "Zinc supplementation", "correct": false}, {"label": "C", "text": "Rifaximin", "correct": false}, {"label": "D", "text": "Lactulose", "correct": true}], "correct_answer": "D. Lactulose", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:684px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hepatic Encephalopathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is a<strong> <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of chronic liver disease</strong> that leads to impaired brain function<strong> as a result of liver failure.</strong></li>\n<li>It is also called as <strong>portosystemic encephalopathy.</strong></li>\n<li>Ammonia is a <strong>gut-derived neurotoxin</strong> that is not detoxified into <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> and <strong>bypasses the liver</strong> due to <strong>portosystemic shunting</strong> <strong>and decreased</strong> <strong>hepatic mass</strong>, allowing it to enter the <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> and impact the brain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type A </strong>is caused by<strong> <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure</strong> &amp; <strong>cerebral oedema is a common <span class=\"customMeta\" data-dictid=\"79506a117416927771988bbe7a8302\">side effect</span> of this type. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type B</strong> is caused by <strong>portosystemic shunting</strong> (can be<strong> due to <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">TIPS</span> also</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type C</strong> is due to <strong>chronic liver failure.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 0 - alterations are seen in neuropsychological tests, </strong>but only <strong>minimal <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> changes </strong>are evident in</p>\n<ul>\n<li>Short-term memory,</li>\n<li>Reaction time or</li>\n<li>Concentration.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 1:</strong></p>\n<ul>\n<li>Mood changes like anxiety, euphoria;</li>\n<li>Memory trouble,</li>\n<li>Trivial lack of awareness,</li>\n<li>Difficulty with addition and subtraction,</li>\n<li>Impaired sleep pattern.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 2:</strong></p>\n<ul>\n<li>Personality changes</li>\n<li>Lethargy &amp; apathy</li>\n<li>Behavior changes</li>\n<li>Dysarthria</li>\n<li>Disorientation for time</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 3:</strong></p>\n<ul>\n<li>Severe confusion, delirium</li>\n<li>Disorientation to place</li>\n<li>Drowsiness</li>\n<li>Bizarre behavior</li>\n<li>Asterixis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 4: </strong>Coma (total loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 0,1 are considered convert or minimal <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> encephalopathy, and grades 2,3,4 are overt <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">encephalopathy</span> with evident symptoms.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Psychometric tests</li>\n<li>Complete clinical evaluation</li>\n<li>Blood investigations like LFT</li>\n<li>Doppler <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> to evaluate the liver</li>\n<li>EEG &amp; <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> to assess brain activity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lactulose</strong></li>\n<li><strong>Rifaximin </strong><strong>(Option C)</strong> reduces <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> production; it is an adjunctive therapy in patients who do not tolerate lactulose.</li>\n<li><strong>Neomycin</strong> is an alternative to Rifaximin.</li>\n<li><strong>Branched-chain <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong> and <strong>probiotics</strong></li>\n<li><strong>Zinc supplementation</strong>, used as <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> therapy<strong> (Option B)</strong></li>\n<li><strong>Restricted protein intak</strong>e was used in the past but is not commonly used due to its risk of <span class=\"customMeta\" data-dictid=\"cbd2d1fd521692777191d00c1a4ede\">malnutrition</span> outweighs the benefits <strong>(Option A)</strong></li>\n<li><strong>IV hydration</strong> is a vital supportive measure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman with decompensated cirrhosis due to hepatitis B presents for evaluation of liver transplantation. All the following are indications for liver transplantation except?", "options": [{"label": "A", "text": "Autoimmune hepatitis", "correct": false}, {"label": "B", "text": "Caroli’s disease", "correct": false}, {"label": "C", "text": "Fulminant hepatitis", "correct": false}, {"label": "D", "text": "Portal vein thrombosis", "correct": true}], "correct_answer": "D. Portal vein thrombosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contraindications for Liver Transplantation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Absolute</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Relative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Active sepsis</li>\n<li>Uncontrolled extra <span class=\"customMeta\" data-dictid=\"8cee6e043d1692777188350a4ab7dd\">hepatobiliary</span> infection</li>\n<li>Life-limiting <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies</li>\n<li>Substance abuse</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"0f0e2f0fe91692777183bfa6c6a156\">cardiopulmonary</span> condition</li>\n<li>Extra <span class=\"customMeta\" data-dictid=\"8cee6e043d1692777188350a4ab7dd\">Hepatobiliary</span> <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (excluding non-melanoma <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> skin cancer)</li>\n<li>Metastasis of Liver Cancer</li>\n<li>Cholangiocarcinoma (excluding tumours fitting into the protocol)</li>\n<li>AIDS</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disorders</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elderly age (&gt; 70)</li>\n<li>History of extensive <span class=\"customMeta\" data-dictid=\"8cee6e043d1692777188350a4ab7dd\">hepatobiliary</span> surgery</li>\n<li>Renal failure, which is not due to liver disease</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> or malnutrition,</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> cancer</li>\n<li>Non-compliant with medicines</li>\n<li>Seropositive <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> with CD4 &lt;100/μL</li>\n<li>Intrahepatic sepsis</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> HTN</li>\n<li>Uncontrolled psychiatric disorder</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lobe preferred in donor for harvesting. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>To an adult recipient</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right lobe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>To a child recipient</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> or a part of it.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with a history of cirrhosis due to chronic hepatitis C presents with worsening abdominal distension, jaundice, and decreased urine output over the past week. He exhibits signs of confusion and ascites resistant to diuretics. Laboratory tests reveal a serum creatinine level of 2.5 mg/dL. Given this presentation, which of the following is the most definitive management of this condition?", "options": [{"label": "A", "text": "Hemodialysis", "correct": false}, {"label": "B", "text": "Liver transplantation", "correct": true}, {"label": "C", "text": "Vasoconstrictor therapy with Terlipressin", "correct": false}, {"label": "D", "text": "Albumin infusion", "correct": false}], "correct_answer": "B. Liver transplantation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/fKo13H2ymCL3mqbBdWW51745649005.png", "https://image.prepladder.com/notes/aFN1BaMTaT89jGyNlBH11745649084.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:767px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hepatorenal Syndrome (HRS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A functional <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure resulting from advanced <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure without any underlying <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pathology.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasodilatory prostaglandins (<strong>PGE2 and PGI2</strong>) enhance <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and increase <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> rate to maintain perfusion, while in hepatosplenomegaly:</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\" AKI mechanism\" data-author=\"\" data-hash=\"11337\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/fKo13H2ymCL3mqbBdWW51745649005.png\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>The cirrhotic liver produces <strong>endothelin-1</strong>, resulting in <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury, as:</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"Endothelin 1 action\" data-author=\"\" data-hash=\"11338\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/aFN1BaMTaT89jGyNlBH11745649084.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Criteria </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Refractory <span class=\"customMeta\" data-dictid=\"a1146fb9d8169277718250cf1224a8\">ascites</span> (predispose to HRS)</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> &gt;1.5 mg% (progressive rise)</li>\n<li>Stop diuretics (causes dehydration)</li>\n<li>Volume expansion (volume given along with <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> will increase <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output)</li>\n<li>No shock (but vitals monitoring is required)</li>\n<li>No <span class=\"customMeta\" data-dictid=\"0834e545c9169277719383768d0ff2\">nephrotoxic</span> drug exposure</li>\n<li>No history of parenchymal disease (ruled out by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> like ultrasound)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">HRS</span> or HRS-Acute <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Injury (AKI)</strong></p>\n<ul>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"a37e635d211692777194eb7748e0cf\">oliguria</span> (renal function impairment) <strong>(Option B) </strong></li>\n<li>Rapid rise of the <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> creatinine</li>\n<li>Very poor prognosis</li>\n</ul>\n<p><strong>Type II <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">HRS</span> or <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">HRS</span> Non-Acute <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Injury (NAKI)</strong></p>\n<ul>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> ascites</li>\n<li>Gradual increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> (moderate and stable)</li>\n<li>Better prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>History of chronic liver disease</li>\n<li>Ascites (refractory or tense).</li>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> (shortness of breath)</li>\n<li>Variceal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (hematemesis)</li>\n<li>Deranged vitals</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output or anuria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Definitive treatment: <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">Orthoptic</span> liver transplant (OLT)</strong></li>\n<li><strong>Pharmacological treatment:</strong> Following drugs can be used\n\t\t\t\t<ul>\n<li>Albumin <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> with vasoconstrictors (terlipressin, octreotide, midodrine)<strong> (Option C &amp; D)</strong></li>\n<li>Norepinephrine can also be used.</li>\n<li>Hemodialysis is not used mostly as it does not improve the outcome of the condition <strong>(Option A)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old female with diabetes, obesity, and recent laparoscopic surgery presents to the emergency department with high fever, chills, rapid heart rate, extreme fatigue, and worsening abdominal pain. The physician suspects Systemic Inflammatory Response Syndrome (SIRS) and decides to perform an investigation as part of the diagnostic criteria. Which investigation should be performed?", "options": [{"label": "A", "text": "Blood culture", "correct": false}, {"label": "B", "text": "Urine culture", "correct": false}, {"label": "C", "text": "Urine routine microscopy", "correct": false}, {"label": "D", "text": "Complete blood count", "correct": true}], "correct_answer": "D. Complete blood count", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Component </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Range </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temperature (fever)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperthermia (fever) &gt;38°C (&gt;100.4°F) or</p>\n<p>Hypothermia &lt;36°C (&lt;96.8°F)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leukocyte (white blood cell) count </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leukocytosis &gt;12,000/μL</p>\n<p>Leukopenia &lt;4000/μL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory rate or <span class=\"customMeta\" data-dictid=\"218fc9685d1692777180b8b609dd48\">ABG</span> showing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea (&gt;20 breaths per minute) or <span class=\"customMeta\" data-dictid=\"a66961ad3a16927771941f00c5ed57\">partial pressure</span> of CO2 less than 32 mmHg, respectively.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia (&gt;90 breaths per minute)</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1991/2003 Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2016 criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sepsis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SIRS + suspected/known infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 2 points on SOFA score + suspected/known infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Septic shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sepsis + persistent arterial hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sepsis + sustained hypotension, not responding to fluids, requiring <span class=\"customMeta\" data-dictid=\"a7a960ea3e1692777201d2255a63f1\">vasopressor</span> therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with malnutrition and alcoholic liver disease presents with increasing abdominal distension, shortness of breath, fever, and significant weight loss. The ascitic fluid shows a neutrophil count greater than 250/μL. Which of the following statements about this condition are true? 1. Ascitic fluid appears transparent 2. Most commonly caused by Escherichia coli 3. Cefotaxime can be used for treatment 4. Norfloxacin administration may help to prevent it", "options": [{"label": "A", "text": "1, 2, 3", "correct": false}, {"label": "B", "text": "1, 2, 4", "correct": false}, {"label": "C", "text": "2, 3, 4", "correct": true}, {"label": "D", "text": "1, 2, 3, 4", "correct": false}], "correct_answer": "C. 2, 3, 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:760px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A severe <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of ascites, characterised by <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> infection of the <span class=\"customMeta\" data-dictid=\"2a9ff5941c1692777182f4c00d6f69\">ascitic fluid</span> without an <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> source.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong><em>Escherichia coli</em></strong><strong> (most common)</strong> and other gut bacteria <strong>(Statement 2)</strong></li>\n<li>Gram-positive bacteria (<em>Streptococcus viridans, <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> aureus</em>, and <em>Enterococcus</em>)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Source of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Worsening of ascites</li>\n<li>Fever, nausea, vomiting</li>\n<li>Increase in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> girth</li>\n<li>Encephalopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ascitic fluid analysis shows:</p>\n<ul>\n<li><strong>Turbid appearance</strong> <strong>(Statement 1)</strong></li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"SBP &lt;span class=\" custommeta\"=\"\" data-dictid=\"041edcb25a169277720127cf5266ac\"/>Turbid ascitic fluid\" data-author=\"Piña-Pedraza, J.P. &amp; Álvarez-Avalos, L &amp; Vargas-Espinosa, J.M. &amp; Salcedo-Gómez, A &amp; Carranza-Madrigal, Jaime\" data-hash=\"10419\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-Ascitic-fluid-with-a-turbid-aspect-obtained-from-the-first-paracentesis-B-Ascitic_fig4_281194792\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/h25bGkoT98SgRGRpL82m1744764985.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Neutrophil count &gt;250/μL</strong></li>\n<li>Culture and <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> satins reveal the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organisms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV 3rd generation cephalosporins (cefotaxime) for 5 days <strong> </strong><strong>(Statement 3)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Paracentesis within 12 hours of hospital admission </strong></li>\n<li><strong>Norfloxacin administration</strong> (cirrhotic patients with an episode of SBP) <strong>(Statement 4)</strong></li>\n<li>Quinolone <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> (recurrent episodes of <span class=\"customMeta\" data-dictid=\"29e7d0f8b21692777198c303b6dc41\">SBP</span> in <span class=\"customMeta\" data-dictid=\"d4607865bb1692777201a35341db81\">variceal</span> bleeding).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male with a history of congestive heart failure, hypertension, and chronic kidney disease is scheduled for a procedure as depicted in the image below. What is the name of the procedure?", "options": [{"label": "A", "text": "Pericardiocentesis", "correct": false}, {"label": "B", "text": "Thoracentesis", "correct": false}, {"label": "C", "text": "Paracentesis", "correct": true}, {"label": "D", "text": "Diagnostic peritoneal lavage", "correct": false}], "correct_answer": "C. Paracentesis", "question_images": ["https://image.prepladder.com/notes/RToJ4grNUhCEUJpiXuTM1744764572.png"], "explanation_images": ["https://image.prepladder.com/notes/bNFjQRc63kCmxRGBj5wv1744764658.png", "https://image.prepladder.com/notes/xas65SZZMw0AmRMLlHMX1744764788.png", "https://image.prepladder.com/notes/QKCFXb2HTj5PDNQfm9us1744764883.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old female with chronic alcoholism, hepatitis C, and hypertension presents with abdominal distension, shortness of breath while lying flat, and fatigue. Ultrasound shows splenomegaly and an increased amount of peritoneal fluid. What are the expected serum-ascites albumin gradient (SAAG) and ascitic protein levels in this case?", "options": [{"label": "A", "text": "&amp;lt;1.1 g/dL and &amp;lt;2.5 g/dL", "correct": false}, {"label": "B", "text": "≥1.1 g/dL and &amp;lt;2.5 g/dL", "correct": true}, {"label": "C", "text": "&amp;lt;1.1 g/dL and ≥2.5 g/dL", "correct": false}, {"label": "D", "text": "≥1.1 g/dL and ≥2.5 g/dL", "correct": false}], "correct_answer": "B. ≥1.1 g/dL and &lt;2.5 g/dL", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/aKPyGgCdFtc0rqZUTdlq1745648920.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with chronic liver disease, hepatitis C, and diabetes presents to the emergency department with worsening abdominal distension, shortness of breath, and fatigue. His swelling has worsened despite cutting sodium intake and increasing diuretics, and a fluid thrill is noted on examination. Which of the following medications is contraindicated in this case?", "options": [{"label": "A", "text": "Clonidine", "correct": false}, {"label": "B", "text": "Amiloride", "correct": false}, {"label": "C", "text": "Midodrine", "correct": false}, {"label": "D", "text": "Propranolol", "correct": true}], "correct_answer": "D. Propranolol", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/cqTWcUITIiDMt5FuCiSW1745648799.png", "https://image.prepladder.com/notes/uRECTAjXb7mvaYW4AJ7A1745648849.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old man with chronic hepatitis and alcohol use presents with abdominal distension, discomfort, shortness of breath, and a weight gain of 5 kg over two weeks. Physical examination reveals thrombocytopenia, splenomegaly, and ascites. With approximately 120 mL of peritoneal fluid, which physical examination sign is most likely to be observed?", "options": [{"label": "A", "text": "Fluid thrill", "correct": false}, {"label": "B", "text": "Shifting dullness", "correct": false}, {"label": "C", "text": "Puddle sign", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. Puddle sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/cbRtARQsX0iWmGWE5cag1744389029.png", "https://image.prepladder.com/notes/e4mpvLm8SdgcNLUzkOAZ1744389154.png", "https://image.prepladder.com/notes/XmrHVbkg3IbyuHrW8Kub1745648716.png", "https://image.prepladder.com/notes/epDmPj3g9rHMK47N2EkM1744389404.png", "https://image.prepladder.com/notes/yKTPZ0QmDCjIFhiYeD0h1744389502.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old male presents with progressive fatigue, abdominal distension, and worsening jaundice over the past three months. Examination reveals ascites, spider angiomata, and palmar erythema. Laboratory tests show elevated liver enzymes with a significantly elevated AST/ALT ratio, and an ultrasound indicates a nodular liver. What role do kupffer cells play in the pathogenesis of this condition?", "options": [{"label": "A", "text": "Activate CYP2E1", "correct": false}, {"label": "B", "text": "Increase the fatty acid uptake", "correct": false}, {"label": "C", "text": "Convert acetaldehyde to acetate", "correct": false}, {"label": "D", "text": "Induce cytokine production", "correct": true}], "correct_answer": "D. Induce cytokine production", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/vz9gUNN1FvMo2JhQou9X1744385986.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:430px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes of Cirrhosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"d1067dfbcb1692777192b85600f542\">Micronodular</span> Cirrhosis: </strong>Characterised by uniform nodules &lt;3 mm in size. Commonly associated with:</p>\n<ul>\n<li>Alcoholic Liver Disease</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">Biliary</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> and Cholangitis:\n\t\t\t\t<ul>\n<li>Primary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">Biliary</span> <span class=\"customMeta\" data-dictid=\"dd9fbecbed1692777184ab44e1624c\">Cholangitis</span> (PBC)</li>\n<li>Secondary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">Biliary</span> Cholangitis</li>\n</ul>\n</li>\n<li>Hemochromatosis</li>\n<li>Non-cirrhotic <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">Fibrosis</span> (NCPF)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>2. <span class=\"customMeta\" data-dictid=\"866d89cd5516927771916d5134111d\">Macronodular</span> Cirrhosis: </strong>Characterised by variable nodules &gt;3 mm in size. Associated with:</p>\n<ul>\n<li>Viral Hepatitis:</li>\n<li>Hepatitis B</li>\n<li>Hepatitis C</li>\n<li>Hepatitis D</li>\n<li>Autoimmune Hepatitis</li>\n<li>Non-alcoholic <span class=\"customMeta\" data-dictid=\"2cc5f172eb169277719960d4fef6e2\">steatohepatitis</span> (NASH) (linked to <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> syndrome)</li>\n<li>Wilson Disease</li>\n<li>Alpha-1 Antitrypsin Deficiency</li>\n<li>Cystic Fibrosis</li>\n<li>Cryptogenic Cirrhosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a history of alcohol use and chronic hepatitis presents with abdominal swelling, fatigue, difficulty eating, dark stools, and black vomitus. Examination shows splenomegaly, ascites and dilated veins around the umbilicus. Which of the following is the investigation of choice for this condition?", "options": [{"label": "A", "text": "CT imaging", "correct": false}, {"label": "B", "text": "Blood counts", "correct": false}, {"label": "C", "text": "Endoscopy", "correct": false}, {"label": "D", "text": "Doppler ultrasound", "correct": true}], "correct_answer": "D. Doppler ultrasound", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Purpose/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasonography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visualises features like <span class=\"customMeta\" data-dictid=\"b3eb52fe3b1692777199de8465eea8\">splenomegaly</span> and <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> vessels; can identify causes like liver disease or <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Doppler Ultrasound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation of choice</strong> to measure pressure gradient.</p>\n<p>Hepatic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> (HVPG)<strong> &gt; 5 mm</strong> <strong>Hg</strong> indicates <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Counts (CBC) </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First biochemical sign is <span class=\"customMeta\" data-dictid=\"fc28c74bb716927772003aee4aa43c\">thrombocytopenia</span> (due to hypersplenism). </strong><br/>\n\t\t\tIt also shows <span class=\"customMeta\" data-dictid=\"dc24e08a2816927771910356dd6dd7\">leukopenia</span> and anaemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopy</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to check for gastro-oesophageal varices.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT and <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> Scan (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess the extent of <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and evaluate <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> patency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HVPG Measurement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is rarely performed by <span class=\"customMeta\" data-dictid=\"a8eaf87aaa1692777190add0bad040\">interventional radiology</span> to measure <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> directly.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old obese female with a history of DVT and recent appendectomy presents with worsening abdominal pain, swelling, fatigue, dark stools, and leg swelling. Examination reveals splenomegaly and findings, which are shown in the image below. Which of the following pathologies is most likely responsible for this condition?", "options": [{"label": "A", "text": "Constrictive pericarditis", "correct": false}, {"label": "B", "text": "Veno-occlusive disease", "correct": false}, {"label": "C", "text": "Portal vein thrombosis", "correct": true}, {"label": "D", "text": "Inferior vena caval webs", "correct": false}], "correct_answer": "C. Portal vein thrombosis", "question_images": ["https://image.prepladder.com/notes/Mr6AmOpNgbXAc6Zgl40l1744388378.png"], "explanation_images": ["https://image.prepladder.com/notes/APA3Mgwl1fJ0XflnQdVL1744388563.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes of <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> Hypertension</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pre-hepatic causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hepatic causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Post-hepatic causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Portal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> <strong>(OptionC)</strong></li>\n<li>Splenic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li><strong>Banti syndrome</strong> (characterised by massive <span class=\"customMeta\" data-dictid=\"b3eb52fe3b1692777199de8465eea8\">splenomegaly</span> of <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> origin and is more commonly observed in Japan).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pre-sinusoidal </strong>\n<ul>\n<li>Schistosomiasis</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> fibrosis</li>\n</ul>\n</li>\n<li><strong>Sinusoidal </strong>\n<ul>\n<li>Cirrhosis</li>\n<li>Alcoholic hepatitis</li>\n</ul>\n</li>\n<li><strong>Post-sinusoidal </strong>\n<ul>\n<li>Veno-occlusive disease (hepatic <span class=\"customMeta\" data-dictid=\"00e480945216927771982870470f92\">sinusoidal</span> obstruction) <strong> (Option B) </strong></li>\n<li>Radiation</li>\n<li>Herbal tea</li>\n<li>Endemic ascites</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Budd Chiari Syndrome</li>\n<li><strong>Inferior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> webs </strong><strong>(Option D)</strong></li>\n<li>Restrictive cardiomyopathy</li>\n<li><strong>Constrictive <span class=\"customMeta\" data-dictid=\"607e653eef1692777195e56becea2c\">pericarditis</span> </strong>(reduced compliance) <strong>(Option A)</strong></li>\n<li>Severe congestive heart failure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male with a history of chronic alcohol use presents with worsening abdominal swelling, fatigue, dizziness, increased abdominal size, and loss of appetite. Examination shows a hepatic venous pressure gradient (HVPG) of over 5 mm Hg. What is one of the earliest signs of this condition?", "options": [{"label": "A", "text": "Puddle sign", "correct": false}, {"label": "B", "text": "Splenomegaly", "correct": true}, {"label": "C", "text": "Coffee ground vomitus", "correct": false}, {"label": "D", "text": "Caput medusae", "correct": false}], "correct_answer": "B. Splenomegaly", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/s3NLUpcfxz8ztXcXahy61744388281.png", "https://image.prepladder.com/notes/Mr6AmOpNgbXAc6Zgl40l1744388378.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tributaries of <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tributaries of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Associated Clinical Condition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Esophagus (lower end)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Esophageal veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Esophageal <span class=\"customMeta\" data-dictid=\"c3b47c6c6b16927772018ebcc5b5a9\">varices</span> (esophageal veins)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rectum (lower end)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior rectal vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Middle and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> rectal veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rectal haemorrhoids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Umbilicus </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paraumbilical vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Above: </strong></p>\n<ul>\n<li>Superior epigastric vein</li>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> vein</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Below: </strong></p>\n<ul>\n<li>Superficial epigastric vein</li>\n<li>Inferior epigastric vein</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Sides:</strong></p>\n<ul>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> and <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> vein</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caput medusae: </strong><strong>Dilated veins present around the umbilicus. </strong><strong>(Option D) </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Caput medusae\" data-author=\"Dr. Gannavarapu Narasimhamurthy\" data-hash=\"9521\" data-license=\"CC BY SA 4.0\" data-source=\"https://te.wikipedia.org/wiki/%E0%B0%A6%E0%B0%B8%E0%B1%8D%E0%B0%A4%E0%B1%8D%E0%B0%B0%E0%B0%82:%E0%B0%89%E0%B0%A6%E0%B0%B0%E0%B0%95%E0%B1%81%E0%B0%A1%E0%B1%8D%E0%B0%AF%E0%B0%82%E0%B0%B2%E0%B1%8B_%E0%B0%89%E0%B0%AC%E0%B1%8D%E0%B0%AC%E0%B1%81%E0%B0%B8%E0%B0%BF%E0%B0%B0%E0%B0%B2%E0%B1%81_(_Caput_Medusae_).jpeg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Mr6AmOpNgbXAc6Zgl40l1744388378.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n\t\t\t \n\n\t\t\t<p><strong><em>NOTE</em></strong><strong>:</strong></p>\n<p>Dilated veins may also be present exclusively above (superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> thrombosis) or below (inferior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> thrombosis) the umbilicus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdominal wall (posterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Splenic vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bare area of liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Portal radicles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diaphragmatic vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not seen with the naked eye</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Falciform <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paraumbilical vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diaphragmatic vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ligamentum venosum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left branch of <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> venosus of liver</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old male with chronic hepatitis presents with fatigue, mild abdominal discomfort, decreased appetite, and occasional jaundice over the past few months but denies significant weight loss or night sweats. A liver biopsy showed fibrosis with expansion of most portal zones and occasional bridging. What Metavir fibrosis stage does this indicate?", "options": [{"label": "A", "text": "F1", "correct": false}, {"label": "B", "text": "F2", "correct": true}, {"label": "C", "text": "F3", "correct": false}, {"label": "D", "text": "F4", "correct": false}], "correct_answer": "B. F2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>METAVIR <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> scale</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>METAVIR score </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage of fibrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>F0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>F1 <strong>(Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Portal zone <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (few)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>F2 <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Portal zone <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and occasional (few) bridging.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>F3 <strong>(Option C) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Portal zone fibrosis, marked bridging, and occasional nodules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>F4 <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cirrhosis</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ishak <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> scale</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ishak Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage of fibrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Some <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> zone <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> with short <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> septa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> zone <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> with short <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> septa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> zone <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> with an occasional portal-to-portal (P-P) bridging</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> zone <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> with marked portal-to-portal (P-P) as well as portal-central (P-C) bridging</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked portal-to-portal (P-P) and/or portal-central (P-C) <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> with occasional nodules (incomplete cirrhosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete cirrhosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old woman with a history of non-alcoholic fatty liver disease (NAFLD) presents for routine follow-up. She reports mild fatigue but denies significant abdominal pain or jaundice. On examination, she has no stigmata of chronic liver disease. The physician wants to assess the degree of liver fibrosis. Which of the following is the best non-invasive test to evaluate liver stiffness?", "options": [{"label": "A", "text": "Computed tomography", "correct": false}, {"label": "B", "text": "Abdominal ultrasound", "correct": false}, {"label": "C", "text": "Magnetic resonance imaging", "correct": false}, {"label": "D", "text": "Transient elastography", "correct": true}], "correct_answer": "D. Transient elastography", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-invasive investigations for <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">Cirrhosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrotest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This test assesses specific blood markers to determine cirrhosis,</li>\n<li>Blood markers:\n\t\t\t\t<ul>\n<li>Bilirubin</li>\n<li>Gamma-glutamyl <span class=\"customMeta\" data-dictid=\"2288cbf3741692777200318d2f5b39\">transferase</span> (GGT)</li>\n<li>Haptoglobin</li>\n<li>Apolipoprotein A</li>\n<li>α2 - Macroglobulin,</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum electrophoresis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In chronic liver disease, this shows <strong>decreased <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> and elevated γ Globulin.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Live function test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>LFTs are commonly used for screening liver health.</li>\n<li>In chronic hepatitis, both <span class=\"customMeta\" data-dictid=\"2f5467ff0116927771811fdf3e9911\">ALT</span> and <span class=\"customMeta\" data-dictid=\"b53d9f77801692777182738019ba62\">AST</span> are elevated, with <span class=\"customMeta\" data-dictid=\"2f5467ff0116927771811fdf3e9911\">ALT</span> typically greater than AST<strong> (ALT &gt; AST). </strong></li>\n<li>These tests also evaluate vital parameters such as <strong>bilirubin and <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> </strong>to assess liver function.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old female with a history of chronic hepatitis C and cirrhosis presents with increasing abdominal distension, jaundice, and fatigue. On examination, she has ascites and spider nevi. Laboratory tests reveal elevated bilirubin levels, low albumin, and elevated liver enzymes. All of the following are criteria for Child-Pugh score classification except?", "options": [{"label": "A", "text": "Ascites", "correct": false}, {"label": "B", "text": "Albumin", "correct": false}, {"label": "C", "text": "Bilirubin", "correct": false}, {"label": "D", "text": "AST/ALT", "correct": true}], "correct_answer": "D. AST/ALT", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Child-Pugh classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Encephalopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade 1-2</p>\n<p>(Minimal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade 3-4</p>\n<p>(Advanced)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mildly controlled</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poorly controlled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilirubin (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 - 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Albumin (g/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 - 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 3.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 1.7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.7 - 2.3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 2.3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with cirrhosis presents to the emergency department with upper gastrointestinal bleeding and a Child-Pugh score of 10. Which scoring system is most appropriate for assessing his mortality risk related to liver disease?", "options": [{"label": "A", "text": "PELD score", "correct": false}, {"label": "B", "text": "Rockall risk score", "correct": false}, {"label": "C", "text": "Forrest classification system", "correct": false}, {"label": "D", "text": "MELD score", "correct": true}], "correct_answer": "D. MELD score", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/k4PJJxmk00uLnKqMuBJb1744388018.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:483px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class Ia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spurting haemorrhage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class Ib</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oozing haemorrhage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class IIa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-bleeding visible vessel</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class IIb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adherent clot</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class IIc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flat <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> spot</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clean <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> base</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man with a history of cirrhosis presents with increased fatigue, and examination reveals multiple vascular lesions on the skin. His liver function tests show significant elevations in AST and ALT. What is the primary pathophysiological mechanism responsible for the formation of these lesions in cirrhosis?", "options": [{"label": "A", "text": "Due to engorged superficial veins", "correct": false}, {"label": "B", "text": "Chronic Hypoxia", "correct": false}, {"label": "C", "text": "Because of platelet-derived growth factor", "correct": false}, {"label": "D", "text": "Increased vascularity due to estrogen", "correct": true}], "correct_answer": "D. Increased vascularity due to estrogen", "question_images": ["https://image.prepladder.com/notes/hb7dce3IlLi4SfCb9l0M1744386101.png"], "explanation_images": ["https://image.prepladder.com/notes/sKNnU3s0ZhwRhhIp7Tlg1744386224.png", "https://image.prepladder.com/notes/kUkKVDV97Vou3a7xqbQb1744763916.png", "https://image.prepladder.com/notes/gqcl1qCn11JlXUyq0tgs1744387017.png", "https://image.prepladder.com/notes/izlIdV1QaUsH7FEfAdiN1744387113.png", "https://image.prepladder.com/notes/2zWQHo8GdfghjCIk1idt1744387215.png", "https://image.prepladder.com/notes/cHPC6jUPtmANAdlHHkV31744387668.png", "https://image.prepladder.com/notes/gKzDSCgSNCqhps2iJWeX1744387844.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical signs &amp; symptoms of Cirrhosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vague symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal pain (in the right upper quadrant)</li>\n<li>Fever</li>\n<li>Nausea</li>\n<li>Vomiting</li>\n<li>Diarrhea</li>\n<li>Anorexia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmar erythema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is characterised by <strong>reddening of the palms due to increased <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> levels </strong>from impaired liver function, which leads to <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> and increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and serves as an important clinical indicator of liver dysfunction.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Palmar erythema\" data-author=\"Jmarchn\" data-hash=\"9489\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Palmar_erythema.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/sKNnU3s0ZhwRhhIp7Tlg1744386224.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dupuytren's contracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It happens due to <strong>thickening and shortening of the <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> fascia. It can start on the <span class=\"customMeta\" data-dictid=\"3095f536db1692777197c4502be897\">ring finger</span> and </strong>involve the little finger.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Dupuytrens contracture\" data-author=\"Frank C. Müller, Baden-Baden\" data-hash=\"10412\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Morbus_dupuytren_1_(fcm).jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/kUkKVDV97Vou3a7xqbQb1744763916.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clubbing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Platelet-derived growth factor</strong> (PDGF) can be released, leading to <strong>tissue <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> at the base of the nail. </strong><strong>(Option C)</strong></li>\n<li>This results in a <span class=\"customMeta\" data-dictid=\"fe824aa5561692777183e979333339\">bulbous</span> appearance, and it is not very specific as can be seen in other conditions.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Nail Clubbing\" data-author=\"Desherinka\" data-hash=\"9498\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dedos_con_acropaquia.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/gqcl1qCn11JlXUyq0tgs1744387017.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parotid enlargement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Especially in <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> cirrhosis, due to<strong> fat deposition in <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> glands</strong>, <strong>bilateral <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> can be appreciated.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Parotid Enlargement\" data-author=\"Garcia, Davi &amp; Filho, Ivo.\" data-hash=\"9501\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Patient-with-bilateral-parotid-enlargement-and-liposubstitution-seen-upon-MRI_fig3_236740215\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/izlIdV1QaUsH7FEfAdiN1744387113.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testicular atrophy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This can result from a combination of increased estrogen, decreased <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> production and altered hormonal regulation</li>\n<li>Other manifestations in male patients:\n\t\t\t\t<ul>\n<li>Gynecomastia,</li>\n<li>Decreased body hair</li>\n<li>Muscle wasting.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This occurs due to the <strong>liver's impaired ability to process and <span class=\"customMeta\" data-dictid=\"350d30aa5316927771874442f8874c\">excrete</span> bilirubin</strong>, resulting in its accumulation in the bloodstream.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kayser–Fleischer rings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> caused by <strong>Wilson’s disease,</strong> they are <strong>greenish-brown deposits of coppe</strong>r that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> in the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> due to affected <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> metabolism.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Kayser Fleischer ring\" data-author=\"Herbert L. Fred, MD, Hendrik A. van Dijk\" data-hash=\"9503\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Kayser-Fleischer_ring.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/2zWQHo8GdfghjCIk1idt1744387215.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asterixis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is <strong>flapping tremors of the hand</strong> commonly associated with <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> encephalopathy.</p>\n<p style=\"text-align:center\"><img alt=\"Flapping Tremor Asterixis\" data-author=\"\" data-hash=\"9512\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/cHPC6jUPtmANAdlHHkV31744387668.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caput medusae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is the <strong>appearance of <span class=\"customMeta\" data-dictid=\"2b87f64333169277718751772e06ef\">engorged</span> <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> veins on the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</strong> and is a clinical sign of <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> often seen in cirrhosis.<strong> (Option A)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Caput medusae\" data-author=\"Pei-Ming Yang, M.D., Ph.D., and Ding-Shinn Chen, M.D.\" data-hash=\"9514\" data-license=\"CC BY SA\" data-source=\"https://commons.wikimedia.org/wiki/File:Caput_medusae.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/gKzDSCgSNCqhps2iJWeX1744387844.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old male with chronic hepatitis C presents with severe fatigue, confusion, and increasing abdominal girth. Examination reveals jaundice, asterixis, and bilateral oedema. Laboratory tests show elevated bilirubin, transaminases, prolonged prothrombin time, and thrombocytopenia. An endoscopy shows the presence of non-bleeding varices. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Compensated cirrhosis", "correct": false}, {"label": "B", "text": "Alcoholic hepatitis", "correct": false}, {"label": "C", "text": "Acute liver failure", "correct": false}, {"label": "D", "text": "Decompensated cirrhosis", "correct": true}], "correct_answer": "D. Decompensated cirrhosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<thead>\n<tr>\n<td colspan=\"2\" style=\"vertical-align:top\">\n<p><strong>Type of cirrhosis</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p><strong>Varices</strong></p>\n</td>\n<td style=\"vertical-align:top\">\n<p><strong>Death by 1 year</strong></p>\n</td>\n</tr>\n<tr>\n<th rowspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Compensated cirrhosis</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Stage 1</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>No</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>No</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>1%</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Stage 2</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>No</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Yes</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>3%</p>\n</th>\n</tr>\n<tr>\n<th rowspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Decompensated </strong></p>\n<p><strong>cirrhosis</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Stage 3</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Yes</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Yes</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>20<span style=\"display:none\"> </span>%</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Stage 4</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Yes</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Yes (+/- Bleeding)</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>57%</p>\n</th>\n</tr>\n</thead>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 29 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "The work-up of a 25-year-old hotel worker shows the following profile: HbsAg = Negative Anti HBsAg= Negative HBeAg = Negative Anti Hbe = Negative Total anti-HBc = IgG positive What is the diagnosis?", "options": [{"label": "A", "text": "Chronic hepatitis B", "correct": false}, {"label": "B", "text": "Inactive carrier", "correct": false}, {"label": "C", "text": "Hepatitis B in remote past", "correct": true}, {"label": "D", "text": "Window period/ Gap period", "correct": false}], "correct_answer": "C. Hepatitis B in remote past", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zE85TBlv6tEs3Kdo9yrR1744969802.png", "https://image.prepladder.com/content/dggZqeKaLinIbUMIIeeR1745924491.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Phase/Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>HBsAg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>HBeAg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBc </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute HBV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Window Phase </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> </strong><strong>(Option A)</strong><strong>/ <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">Infective</span> carrier </strong>(High infectivity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic HBV/ Healthy carrier </strong>(Low infectivity) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Remote infection </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>IgG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recovery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunized</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Nil</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What clinical examination is being performed in the image?", "options": [{"label": "A", "text": "Shifting dullness", "correct": false}, {"label": "B", "text": "Ascites", "correct": false}, {"label": "C", "text": "Puddle sign", "correct": false}, {"label": "D", "text": "Fluid thrill", "correct": true}], "correct_answer": "D. Fluid thrill", "question_images": ["https://image.prepladder.com/content/FKuPXhGL31xurWi9YotH1747047657.png"], "explanation_images": ["https://image.prepladder.com/content/5DKr08fsat5WHxL7jG141747047689.png", "https://image.prepladder.com/content/4KRCusGf52ZtJXRtfbAF1747047689.png", "https://image.prepladder.com/content/pwa9yo46NXMlSWtcgC431747047689.png", "https://image.prepladder.com/content/ElpppcRzB6FtCx57e20c1747047689.png", "https://image.prepladder.com/content/itQqB5gxa12eGv0AuspP1747047689.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 40-year-old man whose lab reports indicate positive IgG Anti-HBc and negative HBsAg?", "options": [{"label": "A", "text": "Recovering from hepatitis B", "correct": false}, {"label": "B", "text": "Hepatitis B in the remote past", "correct": true}, {"label": "C", "text": "Immunization with HBsAg", "correct": false}, {"label": "D", "text": "Both B &amp;amp; C", "correct": false}], "correct_answer": "B. Hepatitis B in the remote past", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ceCubdVsJqD520sSFmh91747046970.png", "https://image.prepladder.com/content/jjAZtju1nKDyJ3XsyRgn1747046970.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Phase/Condition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>HBsAg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Anti-HBs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>HBeAg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Anti-HBe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Anti-HBc</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Acute HBV </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Window Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chronic HBV/ Infective carrier </strong>(High infectivity)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chronic HBV/Healthy carrier </strong>(Low infectivity)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<p><strong>+</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Remote infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>IgG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Recovery</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<p><strong>+</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Immunised</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 53-year-old patient was brought to the emergency room with a history of alcohol abuse, altered sensorium, and rapid shallow breathing. His abdomen is distended with palpable hepatomegaly and splenomegaly and sclerae are icteric. The other examination findings are given below. Laboratory tests show that the AST: ALT ratio is 3:1. What is the most likely cause of this patient’s presentation?", "options": [{"label": "A", "text": "Alcoholic liver disease", "correct": true}, {"label": "B", "text": "Acute viral hepatitis", "correct": false}, {"label": "C", "text": "Autoimmune hepatitis", "correct": false}, {"label": "D", "text": "Acetaminophen poisoning", "correct": false}], "correct_answer": "A. Alcoholic liver disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alcohol Metabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ethanol is primarily metabolized in the liver by enzymes, particularly <span class=\"customMeta\" data-dictid=\"4c1279cdf1169277718118b18c10ab\">alcohol dehydrogenase</span> (ADH) and <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> P450 2E1 (CYP2E1).</li>\n<li>This <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> produces acetaldehyde, a toxic intermediate, which can cause <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oxidative Stress</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of alcohol generates <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> oxygen species (ROS) and increases <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress within liver cells.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> damage leads to <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> peroxidation, protein modifications, and DNA damage, contributing to <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> injury and inflammation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inflammatory Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcohol consumption stimulates the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of immune cells (e.g., Kupffer cells) leading to the release of pro-inflammatory cytokines (TNF-α, IL-6).</li>\n<li>These cytokines promote <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and can further damage hepatocytes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Altered <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">Lipid</span> Metabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcohol disrupts normal <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> metabolism, leading to fat accumulation in liver cells (steatosis).</li>\n<li>This accumulation can progress to steatohepatitis, where <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and liver cell injury occur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fibrosis and Cirrhosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and injury stimulate the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">stellate</span> cells, which produce <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> and lead to fibrosis.</li>\n<li>Over time, repeated injury can result in cirrhosis, characterized by <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> and loss of normal liver architecture.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>General</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Usually asymptomatic</li>\n<li>Fever, malaise, jaundice, history of alcohol <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> + (at least within last 8 weeks before symptom onset)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Abdominal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain, tender hepatomegaly, splenomegaly, ascites</li>\n<li><strong>Caput medusae:</strong> enlarged veins radiating from the umbilicus</li>\n<li>Bleeding <span class=\"customMeta\" data-dictid=\"c3b47c6c6b16927772018ebcc5b5a9\">varices</span> (portal hypertension)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Spider angioma</strong>, <strong>palmar erythema</strong>, ecchymosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reproductive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gynaecomastia, gonadal atrophy, loss of libido, amenorrhea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral neuropathy: <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> and <span class=\"customMeta\" data-dictid=\"a6a2c6342d1692777193c3414d0cc8\">numbness</span> usually over feet</li>\n<li><strong>Wernicke-Korsakoff syndrome:</strong> Ophthalmoplegia, confusion, <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> + <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">anterograde</span> amnesia</li>\n<li><strong>Hepatic encephalopathy:</strong> <strong>Asterixis (most prominent finding)</strong>, altered sensorium, sleep disturbances, lethargy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dupuytren’s contracture</strong>, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> muscle wasting, <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> enlargement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:521px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>AST (Aspartate aminotransferase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Non-specific ; ↑ (&lt;300-400)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALT (Alanine aminotransferase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specific for liver injury ; ↑ (&lt;300-400)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>AST/ALT ratio: ≥ 2: 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Specific for ALD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALP (Alkaline phosphatase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated in <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> pathologies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GGT (γ-glutamyl transferase)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-specific marker of ALD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5’-Nucleotidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specific marker for <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> pathologies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S.Bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually normal/mildly ↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S.Albumin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ in chronic liver disease (cirrhosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carbohydrate-deficient <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> (CDT)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> marker for <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> liver disease.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presents with unsteady gait, forgetfulness, and labile moods. During a physical exam, the neurologist notices the findings shown in the image below. The most likely diagnosis is:", "options": [{"label": "A", "text": "Neurofibromatosis 2", "correct": false}, {"label": "B", "text": "Wilson’s disease", "correct": true}, {"label": "C", "text": "Neurofibromatosis 1", "correct": false}, {"label": "D", "text": "Cataract", "correct": false}], "correct_answer": "B. Wilson’s disease", "question_images": ["https://image.prepladder.com/content/Fo7LhGhfQFkC4M6IObxU1747045034.png"], "explanation_images": ["https://image.prepladder.com/content/Hr33GW2mYm2p8J9CIngC1747982276.png", "https://image.prepladder.com/content/1s3fue7rh4nom73G0ubO1747982315.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the child-Turcotte-Pugh class for the patient who has a serum bilirubin 2.5 mg/dl, serum albumin 3 g/dl, prothrombin time 5 seconds (INR =2), no encephalopathy, and mild ascites?", "options": [{"label": "A", "text": "Class A", "correct": false}, {"label": "B", "text": "Class B", "correct": true}, {"label": "C", "text": "Class C", "correct": false}, {"label": "D", "text": "Class D", "correct": false}], "correct_answer": "B. Class B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Child-Turcotte-Pugh Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Encephalopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grade 1-2</p>\n<p>(Minimal)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grade 3-4</p>\n<p>(Advanced)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mildly controlled</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poorly controlled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bilirubin (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 - 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Albumin (g/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 - 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 3.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>INR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 1.7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.7 - 2.3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 2.3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic alcoholic male patient presented with abdominal distension, reduced urine output, and pedal oedema. His serum creatinine was 1.6 mg/dL. What is the next line of management for this patient?", "options": [{"label": "A", "text": "Methylprednisolone", "correct": false}, {"label": "B", "text": "Heparin", "correct": false}, {"label": "C", "text": "Torsemide", "correct": false}, {"label": "D", "text": "Octreotide plus albumin", "correct": true}], "correct_answer": "D. Octreotide plus albumin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of <span class=\"customMeta\" data-dictid=\"9d718b233816927771881fe77e3390\">Hepatorenal</span> syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Discontinue diuretics</li>\n<li>Albumin infusion- 1 g/kg per day</li>\n<li>Vasoconstrictors-Terlipressin, Low-dose Norepinephrine</li>\n<li>Midodrine (an α-agonist), along with<strong> <span class=\"customMeta\" data-dictid=\"e705e1d6aa1692777194f6571628c6\">octreotide</span> and <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> albumin</strong></li>\n<li>The best therapy for <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">HRS</span> is liver transplantation; recovery of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function is typical in this setting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions leads to the development of wing beating tremor?", "options": [{"label": "A", "text": "Wilson’s disease", "correct": true}, {"label": "B", "text": "Huntington’s chorea", "correct": false}, {"label": "C", "text": "Parkinsonism", "correct": false}, {"label": "D", "text": "Sydenham’s chorea", "correct": false}], "correct_answer": "A. Wilson’s disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features of Wilson's Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hepatic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic Hepatitis: <strong>Jaundice,</strong> hepatomegaly, elevated liver enzymes due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the liver.</li>\n<li>Cirrhosis: <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> hypertension, <strong>variceal bleeding</strong> as a result of long-term <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation and fibrosis.</li>\n<li>Acute Liver Failure<strong>: Coagulopathy,</strong> jaundice, <strong>encephalopathy.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurological Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Movement Disorders: Tremors (flapping or wind-beating tremor), </strong>dystonia, ataxia, <span class=\"customMeta\" data-dictid=\"faa6bb18b11692777186c6a26198e2\">dysarthria</span> due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</li>\n<li><strong>Parkinsonism-like symptoms :</strong> Rigidity, bradykinesia, <span class=\"customMeta\" data-dictid=\"42b8208bad1692777185be9de842a0\">cogwheel rigidity</span> from <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</li>\n<li><strong>Psychiatric:</strong> Depression, personality changes, cognitive decline.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ocular Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Kayser-Fleischer Rings:</strong> Brown/greenish rings in the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> deposition in <strong>Descemet's membrane</strong>.</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Sunflower Cataract: </strong>Rare, (copper deposition in the lens).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> (Fanconi Syndrome): </strong>Due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematologic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hemolytic Anemia: </strong>Copper-induced red cell damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skeletal Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Osteopenia, osteoporosis, joint arthropathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which benzodiazepine is suitable for the safe administration to a 40-year-old chronic alcoholic experiencing withdrawal symptoms, based on the liver function tests that indicated AST levels of 140 IU/L, ALT levels of 110 IU/L, and GGT levels of 500 IU/L?", "options": [{"label": "A", "text": "Diazepam", "correct": false}, {"label": "B", "text": "Alprazolam", "correct": false}, {"label": "C", "text": "Clonazepam", "correct": false}, {"label": "D", "text": "Lorazepam", "correct": true}], "correct_answer": "D. Lorazepam", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presented with a history of yellowing of the skin and eyes for 11 weeks, but he does not have any other symptoms. He had a viral infection 10 days ago and experienced a similar episode of yellowing 2 years ago for 2 weeks. Upon further questioning, he mentioned having long hours of basketball practice 2 years ago, which left him physically exhausted. His current blood tests show a serum bilirubin level of 2.4 mg/dL, with unconjugated bilirubin at 2.1 mg/dL and conjugated bilirubin at 0.3 mg/dL. His liver enzyme levels (AST and ALT) are normal. Based on these findings, what is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Dubin-Johnson syndrome", "correct": false}, {"label": "B", "text": "Crigler-Najjar type 1 syndrome", "correct": false}, {"label": "C", "text": "Gilbert syndrome", "correct": true}, {"label": "D", "text": "Rotor syndrome.", "correct": false}], "correct_answer": "C. Gilbert syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gilbert Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gilber <strong>Gilbert Syndrome </strong>(GS) is a common, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> condition with<strong> mild unconjugated <span class=\"customMeta\" data-dictid=\"cab274fa4f1692777189f9b6dad514\">hyperbilirubinemia</span> and normal liver function tests</strong>, affecting up to 8% of people, more common in males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Caused by<strong> <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> UGT1A1 enzyme</strong> <strong>activity </strong>(10–35% of normal), often due to a TA <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> in the UGT1A1 <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> (A[TA]7TAA).</li>\n<li>Inheritance is typically <strong>autosomal recessive</strong> with the <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> variant; some cases show <span class=\"customMeta\" data-dictid=\"18e7ddb7841692777186f7e78b2206\">dominant inheritance</span> with other mutations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Serum <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> &lt;51 μmol/L (&lt;3 mg/dL), fluctuating with stress, </strong>fasting, alcohol, or illness; <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> may occur during elevations.</li>\n<li>Most patients are asymptomatic, though <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> can occur during episodes of elevated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels.</li>\n<li>Often diagnosed incidentally in <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> or adulthood.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels are intermittently high, with Normal liver function tests and <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> histology.</li>\n<li>UGT1A1 gene testing may reveal the A[TA]7TAA <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> variant.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lifestyle adjustments, such as avoiding alcohol and maintaining regular <span class=\"customMeta\" data-dictid=\"5f526a682c16927771831cac5b3711\">calorie</span> intake, may help manage <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels.</li>\n<li><strong>Phenobarbital </strong>can normalize <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels if required.</li>\n<li>Caution with drugs metabolized by <strong>UGT1A1 </strong>(e.g., irinotecan, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> <span class=\"customMeta\" data-dictid=\"fe13bbded1169277719694883c6ba4\">protease</span> inhibitors) due to risk of toxicity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of Child-Pugh scoring?", "options": [{"label": "A", "text": "Albumin", "correct": false}, {"label": "B", "text": "Bilirubin", "correct": false}, {"label": "C", "text": "Prothrombin Time", "correct": false}, {"label": "D", "text": "LFT", "correct": true}], "correct_answer": "D. LFT", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - LFT</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Child-Pugh classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Encephalopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Grade 1-2</p>\n<p style=\"text-align: center;\">(Minimal)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Grade 3-4</p>\n<p style=\"text-align: center;\">(Advanced)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Mildly controlled</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Poorly controlled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bilirubin (mg/dL) (Option B Ruled Out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 - 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Albumin (g/dL) (Option A Ruled Out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">3 - 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 3.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>INR (Option C Ruled Out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 1.7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1.7 - 2.3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 2.3</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Child-Pugh Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Child-Turcotte-Pugh Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1-Year Survival Rate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">5-6 (Compensated cirrhosis)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">7-9 (Decompensated cirrhosis)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">81%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 10</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">45%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male is found to be positive for HBsAg and HBeAg and is diagnosed with chronic hepatitis B. The viral load of the patient was 2 x 100,000, and SGPT is found to be doubled. What is the appropriate management in this patient?", "options": [{"label": "A", "text": "Lamivudine for 30+ weeks", "correct": false}, {"label": "B", "text": "Tenofovir for &amp;gt;40 weeks", "correct": true}, {"label": "C", "text": "Pegylated interferon for 52 weeks", "correct": false}, {"label": "D", "text": "Combined pegylated interferon with lamivudine", "correct": false}], "correct_answer": "B. Tenofovir for &gt;40 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\"&gt;Tenofovir&lt;/span&gt; for &amp;gt;40 week\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old patient presents with right upper quadrant discomfort and grade Il steatohepatitis of the liver. He has a history of regular intake of 2-3 alcoholic drinks daily and has a BMI of 29. What will be the most appropriate advice to the patient?", "options": [{"label": "A", "text": "Lifestyle modification + Regular exercise", "correct": true}, {"label": "B", "text": "Lifestyle modification + vitamin E + Ursodeoxycholic acid", "correct": false}, {"label": "C", "text": "Lifestyle modification + Pioglitazone", "correct": false}, {"label": "D", "text": "Lifestyle modification", "correct": false}], "correct_answer": "A. Lifestyle modification + Regular exercise", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steatosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Only lifestyle modifications: </strong></p>\n<ul>\n<li><strong>Alcohol abstinence</strong></li>\n<li>Dietary changes</li>\n<li><strong>Exercise </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steato-Hepatitis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">Prednisolone</span> 32 mg/day for 4 weeks</li>\n<li>Check S.Bilirubin levels 1 week after starting steroids</li>\n<li>Other drugs: N-acetyl cysteine, Pentoxifylline, anti-TNFα agents</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cirrhosis (Organ failure/ <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> hypertension)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver transplant</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most appropriate next step in managing a 55-year-old male with chronic alcoholism, who presented to the emergency department with unconsciousness and hypotension, the last intake of alcohol being 7 days ago, showing liver with coarse echotexture and mild portal vein dilatation on ultrasound?", "options": [{"label": "A", "text": "Administer lactulose and wait for stool passage.", "correct": true}, {"label": "B", "text": "Perform emergency endoscopy to assess for varices.", "correct": false}, {"label": "C", "text": "Initiate treatment with thiamine and chlordiazepoxide.", "correct": false}, {"label": "D", "text": "Conduct a CT scan of the brain.", "correct": false}], "correct_answer": "A. Administer lactulose and wait for stool passage.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Administer &lt;span class=\"customMeta\" data-dictid=\"a03905bbbe1692777191c66ee744b7\"&gt;lactulose&lt;/span&gt; and wait for &lt;span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\"&gt;stool&lt;/span&gt; passag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male chronic smoker presents to the AIIMS OPD with fever, fatigue, yellow-colored urine, and clay-colored stools. For the past few days, he has developed an aversion to cigarette smoking. On examination icterus was present. Liver function test results are given below: Total Bilirubin - 18.5 Direct Bilirubin — 7.5 SGOT - 723 SGPT-812 Which investigations would you advise to rule out acute viral hepatitis?", "options": [{"label": "A", "text": "HBsAg, lgM antiHBC, AntiHCV, AntiHEV", "correct": false}, {"label": "B", "text": "AntiHAV, HBsAg, lgM antiHBc, AntiHCV", "correct": true}, {"label": "C", "text": "HBsAg, lgM antiHBc, AntiHDV, AntiHCV, Anti HEV", "correct": false}, {"label": "D", "text": "AntiHAV, lgM antiHBc, AntiHCV, AntiHEV", "correct": false}], "correct_answer": "B. AntiHAV, HBsAg, lgM antiHBc, AntiHCV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - AntiHAV, HBsAg, lgM antiHBc, AntiHCV\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most specific marker for alcoholism?", "options": [{"label": "A", "text": "ALT", "correct": false}, {"label": "B", "text": "GGT", "correct": true}, {"label": "C", "text": "ALP", "correct": false}, {"label": "D", "text": "LDH", "correct": false}], "correct_answer": "B. GGT", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - GGT\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of child pugh classification?", "options": [{"label": "A", "text": "SGOT", "correct": true}, {"label": "B", "text": "Bilirubin", "correct": false}, {"label": "C", "text": "Albumin", "correct": false}, {"label": "D", "text": "Prothrombin time", "correct": false}], "correct_answer": "A. SGOT", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - SGOT\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate next step in the evaluation of a 6-year-old patient who has been experiencing fever for the past 3 days and complains of pain in the right upper abdomen , and upon examination, tenderness is observed in the right upper quadrant ?", "options": [{"label": "A", "text": "USG", "correct": true}, {"label": "B", "text": "Serology", "correct": false}, {"label": "C", "text": "LFT", "correct": false}, {"label": "D", "text": "CT abdomen", "correct": false}], "correct_answer": "A. USG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - USG (Ultrasonography)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is considered a post-hepatic cause of portal hypertension?", "options": [{"label": "A", "text": "Budd Chiari syndrome", "correct": true}, {"label": "B", "text": "Banti disease", "correct": false}, {"label": "C", "text": "Portal vein thrombosis", "correct": false}, {"label": "D", "text": "Schistosomiasis", "correct": false}], "correct_answer": "A. Budd Chiari syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Budd Ch\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pre-Hepatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hepatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Post-Hepatic</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Portal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Splenic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Banti syndrome (massive splenomegaly)\n\t\t\t\t<ul>\n<li>Idiopathic and more common in Japan</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pre-sinusoidal\n\t\t\t\t<ul>\n<li>Schistosomiasis</li>\n</ul>\n</li>\n<li>Sinusoidal\n\t\t\t\t<ul>\n<li>Cirrhosis</li>\n</ul>\n</li>\n<li>Post sinusoidal\n\t\t\t\t<ul>\n<li>Veno <span class=\"customMeta\" data-dictid=\"3cd09dcb0e1692777194e41a18d184\">occlusive</span> disease</li>\n<li>Radiation, <span class=\"customMeta\" data-dictid=\"040570886616927771884f5b87b36c\">Herbal</span> tea</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Budd Chiari Syndrome</li>\n<li>Inferior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> webs</li>\n<li>Restrictive cardio myopathy</li>\n<li>Constrictive <span class=\"customMeta\" data-dictid=\"607e653eef1692777195e56becea2c\">pericarditis</span> (compliance will reduced)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "AFP is a tumour marker for which of the following?", "options": [{"label": "A", "text": "Hepatocellular carcinoma", "correct": true}, {"label": "B", "text": "Renal cell carcinoma", "correct": false}, {"label": "C", "text": "Oncocytoma", "correct": false}, {"label": "D", "text": "Chordoma", "correct": false}], "correct_answer": "A. Hepatocellular carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hepatocellu\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Carcinoma/Cancer</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Associated Tumor Marker</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (HCC)</p>\n</td>\n<td>\n<p>Alpha-fetoprotein (AFP)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Colorectal carcinoma</p>\n</td>\n<td>\n<p>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pancreatic carcinoma</p>\n</td>\n<td>\n<p>Carbohydrate <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> 19-9 (CA 19-9)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ovarian carcinoma</p>\n</td>\n<td>\n<p>Cancer <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> 125 (CA 125)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Breast carcinoma</p>\n</td>\n<td>\n<p>Estrogen <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> (ER), <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">Progesterone</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> (PR), Human <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> growth factor <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> 2 (HER2/neu)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Prostate carcinoma</p>\n</td>\n<td>\n<p>Prostate-specific <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (PSA)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lung carcinoma</p>\n</td>\n<td>\n<p>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA), <span class=\"customMeta\" data-dictid=\"bc3875332b1692777185e2c8163a73\">Cytokeratin</span> 19 fragment (CYFRA 21-1), Neuron-specific <span class=\"customMeta\" data-dictid=\"92417be2b316927771877be984d041\">enolase</span> (NSE)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Testicular carcinoma</p>\n</td>\n<td>\n<p>Alpha-fetoprotein (AFP), Human <span class=\"customMeta\" data-dictid=\"6d72527c991692777184af095c6f14\">chorionic gonadotropin</span> (hCG), <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> (LDH)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thyroid carcinoma</p>\n</td>\n<td>\n<p>Thyroglobulin, Calcitonin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bladder carcinoma</p>\n</td>\n<td>\n<p>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA), <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> tumor <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (BTA), Nuclear <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> protein 22 (NMP22)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Neuroendocrine tumors</p>\n</td>\n<td>\n<p>Chromogranin A, Synaptophysin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antiretroviral drug is not utilized in cases of concurrent HIV and hepatitis B infection?", "options": [{"label": "A", "text": "Tenofovir", "correct": false}, {"label": "B", "text": "Abacavir", "correct": true}, {"label": "C", "text": "Lamivudine", "correct": false}, {"label": "D", "text": "Emtricitabine", "correct": false}], "correct_answer": "B. Abacavir", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Abacav\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with hepatitis and progressive neurological degeneration. A picture of his eye has been provided below . Among the following options, what would be the initial step regarding the investigations done for this child’s diagnosis?", "options": [{"label": "A", "text": "Serum ceruloplasmin levels", "correct": true}, {"label": "B", "text": "Serum copper levels", "correct": false}, {"label": "C", "text": "Enzyme assay", "correct": false}, {"label": "D", "text": "Karyotyping", "correct": false}], "correct_answer": "A. Serum ceruloplasmin levels", "question_images": ["https://image.prepladder.com/content/iqcR61gdyK7i48dI5uk71691499730.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\"&gt;Serum&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d0297935661692777184085cf7e86f\"&gt;ceruloplasmin&lt;/span&gt; lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cryoglobulinemia is associated with:", "options": [{"label": "A", "text": "Hepatitis C", "correct": true}, {"label": "B", "text": "Ovarian cancer", "correct": false}, {"label": "C", "text": "Diabetes", "correct": false}, {"label": "D", "text": "Leukaemia", "correct": false}], "correct_answer": "A. Hepatitis C", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\"&gt;Hepatitis&lt;/span&gt; C: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is incorrect?", "options": [{"label": "A", "text": "Components of MELD (model for end stage liver disease) scoring system are creatinine, bilirubin, international normalized ratio (INR), serum sodium (mEq/L)", "correct": false}, {"label": "B", "text": "Components of CTP (Child Turcotte Pugh) score are albumin, bilirubin, INR, ascites and encephalopathy", "correct": false}, {"label": "C", "text": "Components of CTP (child Turcotte Pugh) are creatinine, bilirubin, international normalized ratio (INR)", "correct": true}, {"label": "D", "text": "MELD score is used to assess and prioritize patients awaiting liver transplantation", "correct": false}], "correct_answer": "C. Components of CTP (child Turcotte Pugh) are creatinine, bilirubin, international normalized ratio (INR)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Acute auto-graft rejection occurs within?", "options": [{"label": "A", "text": "Few hours", "correct": false}, {"label": "B", "text": "&amp;lt; 10 days", "correct": false}, {"label": "C", "text": "&amp;lt; 6 months", "correct": true}, {"label": "D", "text": "&amp;gt;24 months", "correct": false}], "correct_answer": "C. &lt; 6 months", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the leading viral cause of End Stage Liver Disease?", "options": [{"label": "A", "text": "HBV", "correct": false}, {"label": "B", "text": "HCV", "correct": true}, {"label": "C", "text": "HDV", "correct": false}, {"label": "D", "text": "HEV", "correct": false}], "correct_answer": "B. HCV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - HCV\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following serological status is noted in a patient: HbsAg positive and HbeAg positive . Diagnosis is?", "options": [{"label": "A", "text": "Carrier", "correct": false}, {"label": "B", "text": "Chronic viral hepatitis", "correct": false}, {"label": "C", "text": "Acute viral hepatitis with infectivity", "correct": true}, {"label": "D", "text": "Remote infection", "correct": false}], "correct_answer": "C. Acute viral hepatitis with infectivity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Acute &lt;span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\"&gt;viral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\"&gt;hepatitis&lt;/span&gt; with infectivity: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with acute hepatitis B has recovered from the infection. Identify the serological marker marked in the image:", "options": [{"label": "A", "text": "Anti-HBc Ab", "correct": true}, {"label": "B", "text": "Anti-HBs Ab", "correct": false}, {"label": "C", "text": "Anti-HBe Ab", "correct": false}, {"label": "D", "text": "HBs Ag", "correct": false}], "correct_answer": "A. Anti-HBc Ab", "question_images": ["https://image.prepladder.com/content/dlWShp1sXziIOGRkp79m1694692403.png"], "explanation_images": ["https://image.prepladder.com/content/XAEq6ERPdnAyJzxX26t21684918135.png"], "explanation": "<p>Correct Option A - Anti-HBc A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presented with a 1 weak history of yellow skin and sclerae but is otherwise asymptomatic . He gives a history of viral upper respiratory infection 10 days ago, which resolved 2 days back. There is a history of a similar episode of icterus 2 years back when the patient had long hours of basketball practice . The current serum bilirubin is 2.4 mg/dl, unconjugated bilirubin is 2.1mg/dl, and conjugated bilirubin is 0.3mg/dl. Serum AST and ALT levels are normal . Which of the following is the most likely diagnosis ?", "options": [{"label": "A", "text": "Dubin-Johnson syndrome", "correct": false}, {"label": "B", "text": "Criggler-Najar type 1 syndrome", "correct": false}, {"label": "C", "text": "Gilbert syndrome", "correct": true}, {"label": "D", "text": "Rotor syndrome", "correct": false}], "correct_answer": "C. Gilbert syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - G\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Syndrome</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Inheritance</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Hyperbilirubinemia Type</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Serum <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">Bilirubin</span> Levels</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Serum AST/ALT Levels</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Other Features</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dubin-Johnson syndrome</p>\n</td>\n<td>\n<p>Autosomal recessive</p>\n</td>\n<td>\n<p>Conjugated</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n<td>\n<p>May be elevated</p>\n</td>\n<td>\n<p>Chronic jaundice, dark urine, liver <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> shows <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> accumulation in hepatocytes</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Criggler-Najar type 1</p>\n</td>\n<td>\n<p>Autosomal</p>\n<p>recessive</p>\n</td>\n<td>\n<p>Unconjugated</p>\n</td>\n<td>\n<p>Severely increased</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n<td>\n<p>Recurrent episodes of <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> and <span class=\"customMeta\" data-dictid=\"34fea2624516927771905a0047f439\">kernicterus</span> in infancy, neurological damage</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Criggler-Najar type 2</p>\n</td>\n<td>\n<p>Autosomal</p>\n<p>recessive</p>\n</td>\n<td>\n<p>Unconjugated</p>\n</td>\n<td>\n<p>Mildly to moderately increased</p>\n</td>\n<td>\n<p>Normal to mildly elevated</p>\n</td>\n<td>\n<p>Chronic unconjugated hyperbilirubinemia, no neurological damage, responds to <span class=\"customMeta\" data-dictid=\"0e1abbb47d169277719507b78b56e6\">phenobarbital</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gilbert syndrome</p>\n</td>\n<td>\n<p>Autosomal</p>\n<p>recessive</p>\n</td>\n<td>\n<p>Unconjugated</p>\n</td>\n<td>\n<p>Mildly increased</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n<td>\n<p>Intermittent episodes of <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by fasting, dehydration, stress</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rotor syndrome</p>\n</td>\n<td>\n<p>Autosomal</p>\n<p>recessive</p>\n</td>\n<td>\n<p>Conjugated</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n<td>\n<p>May be elevated</p>\n</td>\n<td>\n<p>Chronic jaundice, dark urine, liver <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> shows <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> accumulation in hepatocyte</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 39 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 27 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old patient presents with elevated liver enzymes and is suspected to have Hepatitis C. Which of the following statements regarding the investigations for Hepatitis C is correct?", "options": [{"label": "A", "text": "Antibodies appear within 1-2 weeks.", "correct": false}, {"label": "B", "text": "Hepatitis C RNA confirms active infection.", "correct": true}, {"label": "C", "text": "Biopsy is essential for all diagnoses.", "correct": false}, {"label": "D", "text": "Genotype 1 has higher spontaneous clearance.", "correct": false}], "correct_answer": "B. Hepatitis C RNA confirms active infection.", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:567px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatitis B surface antigen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects co-infection with <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">Hepatitis</span> B.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatitis C antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirms exposure to <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">Hepatitis</span> C.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoantibodies (ANA, SMA, AMA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> liver disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunoglobulins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects elevated IgG, indicating autoimmunity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ferritin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Screens for iron overload.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>α1-antitrypsin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifies α1-antitrypsin deficiency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caeruloplasmin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Screens for Wilson's disease.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hepatitis C Virus is most commonly associated with which of the following?", "options": [{"label": "A", "text": "SLE", "correct": false}, {"label": "B", "text": "Scleroderma", "correct": false}, {"label": "C", "text": "Cryoglobulinemia", "correct": true}, {"label": "D", "text": "Polyarteritis Nodosa", "correct": false}], "correct_answer": "C. Cryoglobulinemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding Occult Hepatitis B Infection is false?", "options": [{"label": "A", "text": "OBI can lead to hepatitis B transmission through blood products.", "correct": false}, {"label": "B", "text": "Individuals with seropositive OBI have detectable HBsAg in their serum", "correct": true}, {"label": "C", "text": "OBI may lead to reactivation of HBV in immunocompromised patients.", "correct": false}, {"label": "D", "text": "OBI can contribute to the development of HCC.", "correct": false}], "correct_answer": "B. Individuals with seropositive OBI have detectable HBsAg in their serum", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents with gas gangrene and signs of acute liver injury. Which of the following management strategies is most appropriate for this patient?", "options": [{"label": "A", "text": "Initiate antiviral therapy with acyclovir and provide supportive care.", "correct": false}, {"label": "B", "text": "Start high-dose intravenous penicillin and perform aggressive surgical débridement.", "correct": true}, {"label": "C", "text": "Administer a combination of ampicillin, gentamicin, and metronidazole.", "correct": false}, {"label": "D", "text": "Implement hyperbaric oxygen therapy and monitor for bleeding complications.", "correct": false}], "correct_answer": "B. Start high-dose intravenous penicillin and perform aggressive surgical débridement.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Condition/Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supportive Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fluid replacement and shock management</li>\n<li>Address organ dysfunction</li>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output and blood pressure</li>\n<li>Severe cases may require blood transfusions, <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> expanders, or peritoneal dialysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gas Gangrene</strong>: High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> penicillin, clindamycin; alternatives: cephalosporins, metronidazole</li>\n<li><strong>Pyogenic Liver Abscess</strong>: Initial <span class=\"customMeta\" data-dictid=\"988bd8e7c71692777197b9f1d5d5ca\">regimen</span> of ampicillin, gentamicin, and metronidazole; <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> or <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> for large/unresponsive abscesses <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Débridement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recommended for gas <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> alongside <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiviral Therapy </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acyclovir for severe <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> simplex virus (HSV) infections; immediate treatment for <span class=\"customMeta\" data-dictid=\"17df0c44e116927771897deca1bbf4\">HSV</span> encephalopathy</li>\n<li>Foscarnet for acyclovir-resistant cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Treatments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperbaric oxygen for gas <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> (efficacy debated) <strong>(Option D ruled out)</strong></li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> fever due to <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of Specific Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Viral Hemorrhagic Fevers</strong>: Supportive care; strict infection control measures</li>\n<li><strong>Leptospirosis</strong>: Supportive care</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the emergency department with jaundice, fatigue, and right upper quadrant pain. He has a history of heavy alcohol use, and reports increased consumption over the past month. Laboratory tests show elevated aminotransferases and bilirubin levels. Which of the following investigations is most appropriate to determine the cause of his acute liver injury?", "options": [{"label": "A", "text": "Liver Biopsy", "correct": false}, {"label": "B", "text": "Ultrasound of the abdomen", "correct": false}, {"label": "C", "text": "Toxicology Screen", "correct": false}, {"label": "D", "text": "Viral Hepatitis Serology", "correct": true}], "correct_answer": "D. Viral Hepatitis Serology", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman presents to the emergency department with complaints of fatigue, nausea, and right upper quadrant discomfort. O/E, she appears mildly jaundiced with yellowing of the sclera. She is drowsy but can be easily aroused. Her family reports that she has been more irritable than usual, displaying some behavioural changes. She denies any recent travel or known infections but admits to consuming alcohol excessively over the past month. Which of the following signs or symptoms is most characteristic of the severity of her condition?", "options": [{"label": "A", "text": "Elevated serum bilirubin levels", "correct": true}, {"label": "B", "text": "Normal liver function tests", "correct": false}, {"label": "C", "text": "Increased appetite", "correct": false}, {"label": "D", "text": "Significant weight loss", "correct": false}], "correct_answer": "A. Elevated serum bilirubin levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Viral hepatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infections (A, B, E) that target the liver, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Alcoholic liver disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resulting from excessive alcohol consumption, it can present acutely with <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> due to hepatitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autoimmune hepatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The immune system attacks liver cells, presenting acutely with jaundice.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medications (e.g., paracetamol, halothane) and <span class=\"customMeta\" data-dictid=\"040570886616927771884f5b87b36c\">herbal</span> remedies can lead to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Poisons</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mushroom <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> (Amanita phalloides) is a known cause of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes Wilson's disease, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> liver of pregnancy, Budd–Chiari syndrome, and more.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mild/Moderate <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Liver Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abnormal liver function tests (LFTs) <strong>(Option B ruled out)</strong></li>\n<li>Non-specific symptoms (e.g., fatigue), many asymptomatic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Liver Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Jaundice: Yellowing of skin and eyes.</li>\n<li>Signs of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure: Rapid decline in liver function, potential <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> encephalopathy.</li>\n<li>Cerebral disturbances: Often subtle and episodic in early stages.</li>\n<li>Early signs of encephalopathy: <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> alertness, poor concentration, behavioural abnormalities.</li>\n<li>Progression of encephalopathy: Drowsiness, coma, cerebral oedema (unequal pupils, bradycardia, hyperventilation).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>General Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weakness</li>\n<li>Nausea and vomiting</li>\n<li>Right hypochondrial discomfort</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:534px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May not be present initially.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fetor hepaticus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A sweet, musty odour to the breath.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Liver Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually normal or smaller; <span class=\"customMeta\" data-dictid=\"08b6b28bdd1692777188bad018e4e9\">hepatomegaly</span> is unusual.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Splenomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncommon and never prominent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ascites and Oedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Late developments, often a consequence of fluid therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a history of cirrhosis presents to the hospital with confusion and altered mental status. On examination, he is disoriented to time and space, exhibits lethargy, is somnolent but arousable, and displays bizarre behavior. According to the West Haven Criteria, what is the appropriate grade of his hepatic encephalopathy?", "options": [{"label": "A", "text": "Grade 1", "correct": false}, {"label": "B", "text": "Grade 2", "correct": false}, {"label": "C", "text": "Grade 3", "correct": true}, {"label": "D", "text": "Grade 4", "correct": false}], "correct_answer": "C. Grade 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>West Haven Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abnormal results of established psychometric or neuropsychological tests without clinical manifestations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade I <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oriented in time and space</li>\n<li>Trivial lack of awareness</li>\n<li>Euphoria or anxiety</li>\n<li>Shortened attention span</li>\n<li>Impairment of addition or subtraction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade II <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Disorientation for time</li>\n<li>Lethargy or apathy</li>\n<li>Obvious personality change</li>\n<li>Inappropriate behavior</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade III <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Disoriented also for space</li>\n<li>Somnolence to semi-stupor</li>\n<li>Responsive to stimuli</li>\n<li>Confused</li>\n<li>Bizarre behavior</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade IV <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Do not respond even to pain stimuli</li>\n<li>Coma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with a history of heavy alcohol consumption presents to the emergency department with fatigue, jaundice, and right upper quadrant abdominal pain. Laboratory tests reveal elevated direct bilirubin, alkaline phosphatase, and lactate dehydrogenase levels. His reticulocyte count is high, and the Coombs test is negative. The clinical features are consistent with Zieve syndrome. Which of the following is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Initiate corticosteroid therapy", "correct": false}, {"label": "B", "text": "Recommend immediate liver transplantation", "correct": false}, {"label": "C", "text": "Advise complete abstinence from alcohol", "correct": true}, {"label": "D", "text": "Start intravenous fluids and monitor in the hospital", "correct": false}], "correct_answer": "C. Advise complete abstinence from alcohol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old woman with a BMI of 32 kg/m² presents to the clinic with fatigue and mild abdominal discomfort. Laboratory tests reveal elevated liver transaminases, and an abdominal ultrasound shows hepatic steatosis. To further evaluate her condition, it is essential to exclude other potential causes of liver disease. Which of the following investigations should be performed first to rule out other liver diseases?", "options": [{"label": "A", "text": "Liver biopsy", "correct": false}, {"label": "B", "text": "Blood tests for viral hepatitis markers", "correct": true}, {"label": "C", "text": "CT scan of the abdomen", "correct": false}, {"label": "D", "text": "NAFLD Fibrosis Score", "correct": false}], "correct_answer": "B. Blood tests for viral hepatitis markers", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male with a history of obesity and type 2 diabetes presents for a routine check-up. His liver function tests show mildly elevated transaminases, and an ultrasound of the abdomen reveals fatty infiltration of the liver. He denies any alcohol consumption. His BMI is 35 kg/m², and his blood pressure is 145/90 mmHg. Based on these findings, he is diagnosed with non-alcoholic fatty liver disease (NAFLD). Which of the following is the most likely initiating factor in the pathogenesis of NAFLD in this patient?", "options": [{"label": "A", "text": "Hepatitis C infection", "correct": false}, {"label": "B", "text": "Alcohol consumption", "correct": false}, {"label": "C", "text": "Insulin resistance", "correct": true}, {"label": "D", "text": "Autoimmune hepatitis", "correct": false}], "correct_answer": "C. Insulin resistance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contributing Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sedentary lifestyle and diet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leads to <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> and <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> of fat, cholesterol, calories, refined carbs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contributes to NAFLD development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PNPLA3 gene is associated with both <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> and non-alcoholic liver disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ethnicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher <span class=\"customMeta\" data-dictid=\"51930ddfeb169277719982af86ec99\">steatosis</span> <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in Hispanics, followed by whites, then blacks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>White males are more affected than white females.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Age and comorbidities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age &gt; 45, diabetes, <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> (BMI &gt; 30), and <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> are independent risk factors for NAFLD progression.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male with chronic Hepatitis B presents with symptoms of fatigue, jaundice, and abdominal discomfort. Laboratory tests reveal elevated liver transaminases and the presence of Hepatitis D virus (HDV). His viral load is moderately elevated, and liver biopsy shows moderate fibrosis. The patient has no contraindications to antiviral therapy. Which of the following is the most appropriate treatment option for Hepatitis D in this patient?", "options": [{"label": "A", "text": "Entecavir", "correct": false}, {"label": "B", "text": "Lamivudine", "correct": false}, {"label": "C", "text": "Pegylated Interferon-α", "correct": true}, {"label": "D", "text": "Hepatitis B Immunoglobulin", "correct": false}], "correct_answer": "C. Pegylated Interferon-α", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hepatitis B Vaccine (Engerix)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides <span class=\"customMeta\" data-dictid=\"a32fb5674c16927771805d995ab97e\">active immunity</span> in 95% of individuals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recommended for</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parenteral drug users, <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> who have sex with men, close contacts of infected individuals, patients on haemodialysis, chronic liver disease patients, healthcare workers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hepatitis B <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> (HBIg)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate protection, given within 48 hours of exposure to infected blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Active-Passive Immunisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combined vaccine and HBIg for immediate and long-term protection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Neonatal Immunisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Given at birth with <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> for neonates born to infected mothers.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with a history of chronic Hepatitis B virus (HBV) infection presents to the clinic with new-onset fatigue and abdominal discomfort. Laboratory tests reveal the presence of high titers of IgM antibodies against Hepatitis D virus (HDV). Based on the information provided, which of the following statements is true regarding the serological response to HDV infection in this patient?", "options": [{"label": "A", "text": "The delta antigen is consistently present in the blood during the infection.", "correct": false}, {"label": "B", "text": "The presence of IgM anti-HDV indicates a simultaneous infection with HBV and HDV.", "correct": true}, {"label": "C", "text": "Anti-HDV antibodies are not necessary for diagnosing HDV infection.", "correct": false}, {"label": "D", "text": "The patient will develop IgG anti-HDV antibodies immediately after infection.", "correct": false}], "correct_answer": "B. The presence of IgM anti-HDV indicates a simultaneous infection with HBV and HDV.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Infection Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antibody Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simultaneous <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> and <span class=\"customMeta\" data-dictid=\"9061331654169277718853c55b61a9\">HDV</span> Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low titers of <strong>IgM anti-HDV</strong> appear shortly after onset, may persist in some patients; usually disappear within 2 months.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicates recent infection; antibodies decline post-recovery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superinfection of Chronic HBV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initially high titers of <strong>IgM anti-HDV</strong>, transitioning to <strong>IgG anti-HDV</strong>.<strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May lead to a <strong>chronic dual infection</strong> with consistently high anti-HDV levels.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old intravenous drug user presents to the clinic with fatigue and jaundice. Testing reveals infection with Hepatitis D virus (HDV). Which of the following statements about HDV transmission is true?", "options": [{"label": "A", "text": "HDV is an independent RNA virus.", "correct": false}, {"label": "B", "text": "HDV is commonly transmitted via close personal contact in non-endemic regions.", "correct": false}, {"label": "C", "text": "Effective Hepatitis B vaccination indirectly prevents HDV infection.", "correct": true}, {"label": "D", "text": "Mother-to-child transmission is the primary route of HDV spread globally.", "correct": false}], "correct_answer": "C. Effective Hepatitis B vaccination indirectly prevents HDV infection.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exposure through infected blood, especially via shared needles (e.g., <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> drug use).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Close personal contact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> regions (Mediterranean basin, Africa, South America). <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertical transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mother-to-child transmission is possible but less frequent. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sexual transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible in HBV-infected individuals due to shared transmission routes with HBV.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old patient with Hepatitis C genotype 1 seeks treatment. Which statement about Hepatitis C therapy is correct?", "options": [{"label": "A", "text": "Pre-2011 therapy achieved an SVR of 70% for genotype 1 after 6 months.", "correct": false}, {"label": "B", "text": "DAAs offer effective, well-tolerated interferon-free regimens.", "correct": true}, {"label": "C", "text": "Ribavirin is free of major side effects like anemia or teratogenicity.", "correct": false}, {"label": "D", "text": "Liver transplantation eliminates the risk of reinfection and cirrhosis in grafts.", "correct": false}], "correct_answer": "B. DAAs offer effective, well-tolerated interferon-free regimens.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Before 2011</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Since 2011</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Standard Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pegylated <span class=\"customMeta\" data-dictid=\"89929d835916927771904a3bf1235c\">interferon-alfa</span> + Ribavirin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct-Acting <span class=\"customMeta\" data-dictid=\"0961725e7716927771811b32dec45d\">Antiviral</span> Agents (DAAs)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interferon Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Required</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mostly interferon-free regimens</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-specific immune modulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Targets <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> <span class=\"customMeta\" data-dictid=\"3e05409f651692777197645882d8a2\">replication</span> directly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pegylated <span class=\"customMeta\" data-dictid=\"e25285958816927771903175f9633f\">interferon</span> + ribavirin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sofosbuvir + <span class=\"customMeta\" data-dictid=\"9fd2e365d016927771914dad02c773\">Ledipasvir</span> + Ribavirin</p>\n<p>Sofosbuvir + Velpatasvir</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Efficacy (SVR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>40% for <span class=\"customMeta\" data-dictid=\"80d671c5e416927771885aa2ad297e\">genotype</span> 1 (12 months) <strong>(Option A ruled out)</strong></p>\n<p>70%+ for genotypes 2/3 (6 months)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>99% for <span class=\"customMeta\" data-dictid=\"80d671c5e416927771885aa2ad297e\">genotype</span> 1 in 12 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Interferon: flu-like symptoms, irritability, depression</p>\n<p>Ribavirin: <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia, <span class=\"customMeta\" data-dictid=\"8e016cf2891692777200f428d4b4db\">teratogenic</span> <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally well-tolerated, oral administration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 months (genotype 1)</p>\n<p>6 months (genotypes 2/3)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 weeks for most DAAs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Transplantation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for cirrhosis-related complications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Still required in advanced cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reinfection Risk After Transplant </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 15% may develop <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> in <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> within 5 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Post-transplant DAAs reduce <span class=\"customMeta\" data-dictid=\"0e0a6ab6df1692777197e8873ce077\">reinfection</span> risk</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old man presents with fatigue and mild abdominal discomfort. He reports that he recently experienced nausea and dark urine. Laboratory tests reveal elevated liver enzymes. Which of the following is the most likely finding in this patient’s blood tests?", "options": [{"label": "A", "text": "Positive HBsAg", "correct": true}, {"label": "B", "text": "Positive anti-HBs", "correct": false}, {"label": "C", "text": "Negative HBsAg", "correct": false}, {"label": "D", "text": "Positive IgG anti-HBc", "correct": false}], "correct_answer": "A. Positive HBsAg", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YZuNibzLEM6CmWm3dwtb1744355492.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>First <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> to appear 2-6 weeks before symptom onset.</li>\n<li>It is either spherical or tubular.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Disappears in 1-2 months after <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> onset</li>\n<li>May last 3-4 weeks and can persist for up to 5 months.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic Infection Indicator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Persistence of <span class=\"customMeta\" data-dictid=\"53b3b9ae5816927771883fd8a43fb7\">HBsAg</span> for longer than 6 months indicates<strong> chronic infection</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute Liver Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>HBsAg may be negative due to <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> clearance</li>\n<li>Recent infection indicated by the presence of <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> anti-HBc.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Reliable marker for <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection</li>\n<li>Detectable before liver damage is evident.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Interpretation of Results</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Negative <span class=\"customMeta\" data-dictid=\"53b3b9ae5816927771883fd8a43fb7\">HBsAg</span> suggests <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection is very unlikely <strong>(Option C ruled out)</strong></li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"53b3b9ae5816927771883fd8a43fb7\">HBsAg</span> during the <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> phase indicates<strong> active infection.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Associated Antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Anti-HBs indicates <strong>(Option B ruled out)</strong>\n<ul>\n<li><strong>Previous infection </strong>(with <span class=\"customMeta\" data-dictid=\"56b19f1891169277718126f915fff0\">anti-HBc</span> present)</li>\n<li><strong>Vaccination </strong>(without anti-HBc).</li>\n</ul>\n</li>\n<li>Appears 3-6 months post-infection or vaccination</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents to the outpatient clinic for routine screening. He admits to a history of injection drug use. Which of the following is the most likely mode of Hepatitis C transmission in this patient?", "options": [{"label": "A", "text": "Sexual contact", "correct": false}, {"label": "B", "text": "Vertical transmission from mother to child", "correct": false}, {"label": "C", "text": "Sharing needles and injecting equipment", "correct": true}, {"label": "D", "text": "Blood transfusion with screened blood products", "correct": false}], "correct_answer": "C. Sharing needles and injecting equipment", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:585px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mode of Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk Estimate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood transfusions (historical) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unscreened blood products (pre-screening era)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N/S</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertical transmission </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>From mother to child</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~3%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sexual transmission </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Needlestick injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Healthcare-related exposure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~3%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sharing personal items</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Razors, toothbrushes (contact with blood)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low risk</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with symptoms of nausea, jaundice, and abdominal pain after returning from a trip to a region with poor sanitation. He has no significant medical history. His liver function tests show elevated bilirubin, ALT, and AST levels. HEV IgM antibodies are positive. What is the most appropriate treatment plan for this patient?", "options": [{"label": "A", "text": "Ribavirin therapy", "correct": false}, {"label": "B", "text": "Peginterferon", "correct": false}, {"label": "C", "text": "Supportive care with hydration and rest", "correct": true}, {"label": "D", "text": "Both A and C", "correct": false}], "correct_answer": "C. Supportive care with hydration and rest", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/3zihOpWm4yaRMVsPPSxq1744385397.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:507px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hepatitis E Virus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Icosahedral, nonenveloped, single-stranded <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> virus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genus <em>Orthohepevirus </em>of the<em> Hepeviridae</em> family.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mode of transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Commonly via fecal-oral route.</strong></p>\n<p><strong>Others- blood transfusion.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>28 to 40 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>After ingestion, the virus is absorbed through the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> into the <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> to reach the liver and replicate in the liver.</p>\n<p>HEV <span class=\"customMeta\" data-dictid=\"3e05409f651692777197645882d8a2\">replication</span> does not occur in tissues other than the liver.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymptomatic.</p>\n<p>Acute <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> hepatitis.</p>\n<p>Malaise, anorexia, nausea, vomiting, jaundice, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</p>\n<p>Hepatomegaly.</p>\n<p>Acute <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> hepatitis.</p>\n<p>High mortality in pregnant females.</p>\n<p>Chronic <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> in immunosuppressed patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"70a866c94016927771889d6a186d3e\">HEV</span> IgM.</strong></p>\n<p><strong>Definitive diagnosis:</strong> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">Detection</span> of <span class=\"customMeta\" data-dictid=\"70a866c94016927771889d6a186d3e\">HEV</span> in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> or <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> by <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> chain reaction (PCR).</p>\n<p><strong>LFT: </strong>Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> bilirubin, <span class=\"customMeta\" data-dictid=\"7f4e6edbc91692777181c6fa295ae7\">alanine</span> <span class=\"customMeta\" data-dictid=\"c011dc417616927771816fef085ce1\">aminotransferase</span> (ALT), and <span class=\"customMeta\" data-dictid=\"3d988dbcc816927771821e9a2544f7\">aspartate</span> <span class=\"customMeta\" data-dictid=\"c011dc417616927771816fef085ce1\">aminotransferase</span> (AST).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually self-limiting.</p>\n<p>Supportive care. <strong>(Option C)</strong></p>\n<p>In <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> and chronic <span class=\"customMeta\" data-dictid=\"70a866c94016927771889d6a186d3e\">HEV</span> infection: anti-viral drugs <strong>(Options A &amp; B ruled out)</strong></p>\n<ul>\n<li><strong>Ribavirin</strong></li>\n<li><strong>Peginterferon</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good <span class=\"customMeta\" data-dictid=\"601fb1538a16927771987048f6e712\">sanitary</span> conditions and hygiene.</p>\n<p>Vaccines are available in China but are not FDA-approved.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with nausea, fatigue, and mild abdominal pain for the past week. He recently returned from a camping trip in a developing country. On examination, he has mild jaundice and tender hepatomegaly. His lab tests show elevated liver enzymes (ALT, AST), and positive anti-HAV IgM antibodies. What is the most likely mode of transmission for his condition?", "options": [{"label": "A", "text": "Sharing needles", "correct": false}, {"label": "B", "text": "Fecal-oral route", "correct": true}, {"label": "C", "text": "Sexual contact", "correct": false}, {"label": "D", "text": "Respiratory droplets", "correct": false}], "correct_answer": "B. Fecal-oral route", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/wsVH229iCwr31FhpPuKi1744385268.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn infant is delivered to an HBsAg-positive mother. What is the most appropriate post-exposure prophylaxis for this infant?", "options": [{"label": "A", "text": "Hepatitis B vaccine only", "correct": false}, {"label": "B", "text": "Hepatitis B Immune Globulin (HBIG) only", "correct": false}, {"label": "C", "text": "HBIG and Hepatitis B vaccine", "correct": true}, {"label": "D", "text": "No intervention is necessary", "correct": false}], "correct_answer": "C. HBIG and Hepatitis B vaccine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:314px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pre-exposure Vaccination</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Target group</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recombivax-HB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All the age groups</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Engerix-B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All the age groups</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heplisav-B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults (≥18 years)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old female with a 5-year history of chronic Hepatitis B presents for evaluation. Her most recent lab results show HBsAg positive, HBeAg positive, ALT at 200 IU/L, and total bilirubin at 1.2 mg/dL. She is experiencing fatigue and mild abdominal discomfort. She has a history of taking herbal supplements for liver health and consumes alcohol occasionally. Which of the following is not an appropriate treatment plan for this patient?", "options": [{"label": "A", "text": "Start tenofovir or entecavirir", "correct": false}, {"label": "B", "text": "Consider lamivudine as a second-line treatment", "correct": false}, {"label": "C", "text": "Stop alcohol completely", "correct": false}, {"label": "D", "text": "Continue herbal supplements for liver support", "correct": true}], "correct_answer": "D. Continue herbal supplements for liver support", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presents to the emergency department with acute jaundice, fever, fatigue, and right upper quadrant pain. He has a history of heavy alcohol use. On examination, he has icterus of the sclera and tenderness in the right upper. His laboratory results are as follows: HBsAg: Positive HBeAg: Positive ALT: 150 IU/L AST: 120 IU/L Total Bilirubin: 3.0 mg/dL Alkaline Phosphatase: 100 IU/L Which management strategy is most appropriate?", "options": [{"label": "A", "text": "Start entecavir therapy immediately", "correct": false}, {"label": "B", "text": "Begin tenofovir therapy immediately", "correct": false}, {"label": "C", "text": "Supportive care and stop alcohol", "correct": true}, {"label": "D", "text": "Both A and C", "correct": false}], "correct_answer": "C. Supportive care and stop alcohol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with acute Hepatitis B presents with the following lab results: ALT 4100 IU/L AST 3900 IU/L Total bilirubin 60 μmol/L (3.5 mg/dL) Despite the very high aminotransferase levels, his bilirubin remains moderately elevated. What does this suggest about the severity of liver cell damage?", "options": [{"label": "A", "text": "Severe liver cell damage causing acute liver failure", "correct": false}, {"label": "B", "text": "The severity of damage cannot be determined from ALT levels alone", "correct": true}, {"label": "C", "text": "Mild liver cell damage causing fulminant hepatitis", "correct": false}, {"label": "D", "text": "Transition to chronic Hepatitis B with moderate liver damage", "correct": false}], "correct_answer": "B. The severity of damage cannot be determined from ALT levels alone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Liver Function Tests (LFT) in <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">Hepatitis</span> B</strong></p>\n<p>Liver damage and clinical course depend on the <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> to HBV, not the level of circulating HBsAg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aminotransferase levels (AST/ALT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase during the prodromal phase and before <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> rises.</p>\n<p><strong>Levels do not correlate with liver cell damage severity. (Option B)</strong></p>\n<p><strong>Peak levels (~400–4000 IU or more) are seen during clinical jaundice.</strong></p>\n<p>Levels decrease during recovery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilirubin levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Total <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> is divided into conjugated and unconjugated forms.</p>\n<p>Levels &gt;340 μmol/L (20 mg/dL) suggest severe disease.</p>\n<p><strong>Jaundice in the <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> and skin is visible when <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> &gt;43 μmol/L (2.5 mg/dL).</strong></p>\n<p>Bilirubin may continue to rise even as <span class=\"customMeta\" data-dictid=\"c011dc417616927771816fef085ce1\">aminotransferase</span> levels fall.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline phospahatse (ALP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A fourfold rise in <span class=\"customMeta\" data-dictid=\"4228218c971692777181ed18105c0d\">ALP</span> levels is suggestive of obstructive jaundice.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Comorbid conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In patients with <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anaemia (G6PD <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> or sickle cell anaemia), high <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> (&gt;513 μmol/L or 30 mg/dL) may result from <span class=\"customMeta\" data-dictid=\"c2b082746716927771888f0933941d\">hemolysis</span> and <strong>is not always a poor <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> sign.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents to the clinic for routine screening. He reports no recent illness but has a history of multiple sexual partners. He is concerned about Hepatitis B infection due to a friend’s recent diagnosis. Laboratory tests are conducted to assess his Hepatitis B status. Test Result HBsAg Negative Anti-HBs Positive HBeAg Negative Anti-HBe Negative Anti-HBc Negative What does this lab profile indicate about the patient’s Hepatitis B status?", "options": [{"label": "A", "text": "Has an active acute Hepatitis B infection.", "correct": false}, {"label": "B", "text": "Has recovered from a previous Hepatitis B infection.", "correct": false}, {"label": "C", "text": "Is a healthy carrier of Hepatitis B.", "correct": false}, {"label": "D", "text": "Has been immunized against Hepatitis B.", "correct": true}], "correct_answer": "D. Has been immunized against Hepatitis B.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Phase/Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>HBsAg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>HBeAg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBc </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Window Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic HBV/ <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">Infective</span> carrier </strong>(High infectivity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic HBV/Healthy carrier </strong>(Low infectivity) <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p> </p>\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Remote infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IgG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recovery </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p> </p>\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunized</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A public health nurse is conducting an educational session on Hepatitis B transmission in a community with a high prevalence of the virus. During the session, she discusses various transmission routes and their associated risks for chronic infection. Which of the following statements about Hepatitis B transmission is incorrect?", "options": [{"label": "A", "text": "Vertical transmission occurs from an HBsAg-positive mother to her infant.", "correct": false}, {"label": "B", "text": "Risk of chronic infection is higher in individuals infected at a younger age.", "correct": false}, {"label": "C", "text": "Sharing needles among drug users is a common mode of transmission.", "correct": false}, {"label": "D", "text": "Chronic infection is primarily associated with sexual transmission in adults.", "correct": true}], "correct_answer": "D. Chronic infection is primarily associated with sexual transmission in adults.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Transmission Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Chronic Infection Risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Horizontal Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Injection drug use/Needle stick injury (most common) <strong>(Option C)</strong></li>\n<li>Infected unscreened blood products</li>\n<li>Tattoos/acupuncture needles</li>\n<li>Sexual transmission</li>\n<li>Close living quarters/playground play\n\t\t\t\t<ul>\n<li>Especially in toddlers</li>\n<li>Higher rates in Africa)</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vertical Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>HBsAg-positive mother <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>90%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old man presents with complaints of fatigue, loss of appetite, and mild abdominal discomfort. His partner recently tested positive for Hepatitis B. Laboratory tests reveal mildly elevated liver enzymes. Which of the following findings would you least likely find in this patient?", "options": [{"label": "A", "text": "Mild splenomegaly", "correct": false}, {"label": "B", "text": "Cervical lymphadenopathy", "correct": false}, {"label": "C", "text": "Tender liver", "correct": false}, {"label": "D", "text": "Caput medusae", "correct": true}], "correct_answer": "D. Caput medusae", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prodromal symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Non-specific:</strong> headache, myalgia, arthralgia, nausea, anorexia</li>\n<li>1-2 weeks before jaundice</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gastrointestinal symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Vomiting and <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> may occur</li>\n<li>Abdominal discomfort is common.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Urine and <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and pale stools may precede the onset of jaundice.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Physical signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Few physical signs</li>\n<li>The liver may be tender and minimally enlarged <strong>(Option C)</strong></li>\n<li>Occasional mild <span class=\"customMeta\" data-dictid=\"b3eb52fe3b1692777199de8465eea8\">splenomegaly</span> and <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"344bcb4e391692777191307c1e0074\">lymphadenopathy</span> <strong>(Option A, B)</strong>\n<ul>\n<li>more common in children or with <span class=\"customMeta\" data-dictid=\"e4f6b2922d16927771865030175a86\">EBV</span> infection.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptom duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Symptoms typically last 3-6 weeks</li>\n<li>Complications are rare.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presents to the clinic for evaluation of elevated liver enzymes. He reports feeling fatigued and has noticed some jaundice. His medical history is significant for recent unprotected sexual contact with a partner who is Hepatitis B positive. Laboratory tests reveal that HBsAg is positive, and further testing shows the presence of HBeAg. Which of the following does the presence of HBeAg indicate in this patient?", "options": [{"label": "A", "text": "Low viral replication and reduced infectivity", "correct": false}, {"label": "B", "text": "Active viral replication and high infectivity", "correct": true}, {"label": "C", "text": "Recovery from a previous Hepatitis B infection", "correct": false}, {"label": "D", "text": "Chronic infection with no active viral replication", "correct": false}], "correct_answer": "B. Active viral replication and high infectivity", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Appears shortly after HBsAg</strong></li>\n<li>Secreted by infected hepatocytes into circulation</li>\n<li>Indicating active infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Infectivity Indicator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Reflects the <span class=\"customMeta\" data-dictid=\"4a221e3c0a1692777190dc3efa5207\">infectivity</span> rate</strong></li>\n<li><strong>Indicates high <span class=\"customMeta\" data-dictid=\"4a221e3c0a1692777190dc3efa5207\">infectivity</span> and active <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> replication.</strong></li>\n<li>High transmissibility and poorer prognosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibody Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>The presence of anti-HBe indicates a decrease in infectivity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"29035f96b2169277718884a6a6c643\">HBeAg</span> usually suggests low <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> <span class=\"customMeta\" data-dictid=\"3e05409f651692777197645882d8a2\">replication</span> <strong>(Option A ruled out)</strong></li>\n<li>Except in HBeAg-negative chronic <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B<strong> (\"pre-core mutant\").</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents to the clinic with fatigue, loss of appetite, and mild jaundice. She reports that she had a recent exposure to a friend who was diagnosed with Hepatitis B. Laboratory tests reveal that HBsAg is negative, but her liver enzymes are elevated. Which of the following is the most likely finding in this patient’s blood tests?", "options": [{"label": "A", "text": "Positive anti-HBs only", "correct": false}, {"label": "B", "text": "Positive IgM anti-HBc", "correct": true}, {"label": "C", "text": "Positive IgG anti-HBc", "correct": false}, {"label": "D", "text": "Positive HBcAg", "correct": false}], "correct_answer": "B. Positive IgM anti-HBc", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> is located inside the core and is <strong>not detected in the blood.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibody Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Antibodies (anti-HBc) are produced early in the illness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types of Anti-HBc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>IgM:</strong>\n<ul>\n<li>Appears early</li>\n<li>IgM <span class=\"customMeta\" data-dictid=\"56b19f1891169277718126f915fff0\">anti-HBc</span> may be the sole ⊕ marker of infection during window period.</li>\n<li>Indicates acute/recent <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection.</li>\n</ul>\n</li>\n<li><strong>IgG:</strong>\n<ul>\n<li>Forms in the long-term</li>\n<li>Persists after the <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> phase.</li>\n<li>Chronic infection/prior exposure <strong>(Option C ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Anti-HBc (IgM) can indicate <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> infection when <span class=\"customMeta\" data-dictid=\"53b3b9ae5816927771883fd8a43fb7\">HBsAg</span> is negative and before <span class=\"customMeta\" data-dictid=\"dfdf643c7f16927771810e70b09259\">anti-HBs</span> develop.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 37 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 13 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 25-year-old male presents with fatigue, tremors, jaundice, and cognitive impairment. On examination, hepatomegaly is noted, and an ophthalmologic evaluation reveals a distinctive finding. Laboratory tests show elevated liver enzymes and increased copper levels. What is the underlying pathological mechanism causing this condition?", "options": [{"label": "A", "text": "Reduced renal filtration of copper", "correct": false}, {"label": "B", "text": "Increased degradation of ceruloplasmin", "correct": false}, {"label": "C", "text": "Defective biliary excretion of copper", "correct": true}, {"label": "D", "text": "Impaired hepatic metabolism of ceruloplasmin", "correct": false}], "correct_answer": "C. Defective biliary excretion of copper", "question_images": ["https://image.prepladder.com/notes/GTxIpj74qHF5mFDPnPD71744364584.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lab parameters of Wilson’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Change</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Free Copper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>⬆️ Increased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unbound <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> elevated due to impaired binding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Copper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>⬆️ Increased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accumulation due to <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> excretion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urinary Copper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>⬆️ Increased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overflow from the liver leads to high excretion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total Copper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>⬇️ Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mainly composed of ceruloplasmin-bound copper.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Ceruloplasmin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>⬇️ Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defective <span class=\"customMeta\" data-dictid=\"7bc107ea09169277719095466ee864\">incorporation</span> of <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> into ceruloplasmin.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-month-old pediatric patient presents with hypotonia, seizures, and delays in achieving developmental milestones. The child exhibits characteristic facial features, including a prominent forehead, sparse eyebrows, and distinct hair appearance. Laboratory results reveal decreased levels of copper and ceruloplasmin. What is the pattern of inheritance for this condition?", "options": [{"label": "A", "text": "Autosomal recessive", "correct": false}, {"label": "B", "text": "Mitochondrial inheritance", "correct": false}, {"label": "C", "text": "X-linked recessive", "correct": true}, {"label": "D", "text": "Autosomal dominant", "correct": false}], "correct_answer": "C. X-linked recessive", "question_images": ["https://image.prepladder.com/notes/6NGwff90nETmLFNuduZa1744364646.png"], "explanation_images": ["https://image.prepladder.com/notes/6NGwff90nETmLFNuduZa1744364646.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Developmental delay</strong>, <span class=\"customMeta\" data-dictid=\"b6a968ad961692777189ce6955627a\">hypotonia</span> (poor muscle tone), seizures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hair Abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brittle, sparse hair with a \"kinky\" or twisted appearance under a microscope.</p>\n<figure class=\"caption_element\"><img alt=\"Menkes disease\" data-author=\"Datta AK, Ghosh T, Nayak K, Ghosh M\" data-hash=\"9273\" data-license=\"CC BY 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Menkes_disease4.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/6NGwff90nETmLFNuduZa1744364646.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Failure to Thrive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor feeding, vomiting, and lack of weight gain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Connective Tissue Issues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weak bones<strong> (osteopenia)</strong>, <span class=\"customMeta\" data-dictid=\"a90325236016927771917309c2e917\">loose skin</span> and joints due to lack of copper-dependent enzymes involved in <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> cross-linking</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sagging cheeks, depressed <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bridge</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Vessel Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fragile arteries,</strong> leading to complications like <span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\">subdural</span> hemorrhage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents with symptoms of fatigue, jaundice, and abdominal pain. He also exhibits neurological manifestations, including tremors, dystonia, and personality changes. Laboratory investigations reveal elevated free serum copper levels, and liver function tests show increased ALT and AST. Based on these findings, which area of the brain is primarily implicated in the neurological symptoms of this condition?", "options": [{"label": "A", "text": "Corpus callosum", "correct": false}, {"label": "B", "text": "Basal ganglia", "correct": true}, {"label": "C", "text": "Cerebellum", "correct": false}, {"label": "D", "text": "Hippocampus", "correct": false}], "correct_answer": "B. Basal ganglia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features of Wilson's Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chronic Hepatitis: </strong>Jaundice, hepatomegaly, elevated liver enzymes due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the liver.</li>\n<li><strong>Cirrhosis:</strong> <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> hypertension, <span class=\"customMeta\" data-dictid=\"d4607865bb1692777201a35341db81\">variceal</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> as a result of long-term <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation and fibrosis.</li>\n<li><strong>Acute Liver Failure: </strong>Coagulopathy, jaundice, encephalopathy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Movement Disorders: </strong>Tremors (flapping or wind-beating tremor), dystonia, ataxia, <span class=\"customMeta\" data-dictid=\"faa6bb18b11692777186c6a26198e2\">dysarthria</span> due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</li>\n<li><strong>Parkinsonism:</strong> Rigidity, bradykinesia, <span class=\"customMeta\" data-dictid=\"42b8208bad1692777185be9de842a0\">cogwheel rigidity</span> from <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</li>\n<li><strong>Psychiatric:</strong> Depression, personality changes, cognitive decline.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Kayser-Fleischer Rings:</strong> Brown/greenish rings in the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> deposition in <strong>Descemet's membrane</strong>.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Sunflower Cataract: </strong>Rare, (copper deposition in the lens).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> (Fanconi Syndrome): </strong>Due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematologic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemolytic Anemia: </strong>Copper-induced red cell damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skeletal Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteopenia, osteoporosis, joint arthropathy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During an eye camp, an elderly patient presented with a distinct ring around the cornea, as given below. The patient was referred to a higher centre for further evaluation. Several weeks later, the patient returned from the higher centre, reporting a progressive loss of vision. Upon examination, it was noted that a cataract had developed. Based on the initial observation and the current condition. Which of the following types of cataracts is most likely to be observed in this patient?", "options": [{"label": "A", "text": "Stellate cataract", "correct": false}, {"label": "B", "text": "Snowflake cataract", "correct": false}, {"label": "C", "text": "Oil droplet cataract", "correct": false}, {"label": "D", "text": "Sunflower cataract", "correct": true}], "correct_answer": "D. Sunflower cataract", "question_images": ["https://image.prepladder.com/notes/GTxIpj74qHF5mFDPnPD71744364584.png"], "explanation_images": ["https://image.prepladder.com/notes/Yij30tno5lSL3vEu9qyK1744364937.png", "https://image.prepladder.com/notes/2mDYqPIJRSBE0irUMMf61744364975.png", "https://image.prepladder.com/notes/Yaw6fqECrI0rWmZOGzAU1744365010.png", "https://image.prepladder.com/notes/rX1hvfTQju4hLA5iI2JG1744365054.png", "https://image.prepladder.com/notes/t2Hz4xvd7QusSV9S3UT61744365090.png", "https://image.prepladder.com/notes/NQbWgrWgVxA9TI21UoB81744365177.png", "https://image.prepladder.com/notes/478OOcj7diDVUYwx3Sgr1744365135.png", "https://image.prepladder.com/notes/iis4roZkKC90W31Nbwye1744365224.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Cataract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sunflower <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> </strong></p>\n<p><strong>(Option D)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Sunflower cataract\" data-author=\"Imrankabirhossain\" data-hash=\"9276\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Sunflower_cataract.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Yij30tno5lSL3vEu9qyK1744364937.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wilson's disease (copper accumulation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rosette/ <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">Stellate</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Rosette cataract\" data-author=\"Imrankabirhossain\" data-hash=\"9277\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Rosette_cataract.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/2mDYqPIJRSBE0irUMMf61744364975.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Snowflake Cataract</strong><strong> </strong></p>\n<p><strong>(Option B)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Snowflake Cataract\" data-author=\"Brad.H.Feldman.DEC\" data-hash=\"9278\" data-license=\"NA\" data-source=\"https://eyewiki.org/File:Diabetic_Snowflake.jpeg#filelinks\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Yaw6fqECrI0rWmZOGzAU1744365010.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diabetes mellitus, certain <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oil <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">Droplet</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> </strong></p>\n<p><strong>(Option C)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Galactosemia Oil Drop Cataract\" data-author=\"Medsinge, Anagha &amp; Nischal, Ken.\" data-hash=\"9279\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Oil-droplet-cataract-in-galactosemia_fig5_271331844\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/rX1hvfTQju4hLA5iI2JG1744365054.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Galactosemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Christmas Tree Cataract</strong></p>\n<figure class=\"caption_element\"><img alt=\"Chrismas tree cataract\" data-author=\"Imrankabirhossain\" data-hash=\"9280\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Chrismas_tree_cataract.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/t2Hz4xvd7QusSV9S3UT61744365090.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myotonic dystrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blue Dot / <span class=\"customMeta\" data-dictid=\"2246c1b17c1692777184b789644a08\">Cerulean</span> Cataract</strong></p>\n<figure class=\"caption_element\"><img alt=\"Blue Dot/Cerulean Cataract\" data-author=\"Jessica.randolph\" data-hash=\"9283\" data-license=\"CC BY NC ND 3.0\" data-source=\"https://eyewiki.org/File:Cerulean_Cataract_1.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/NQbWgrWgVxA9TI21UoB81744365177.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Down syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital Cataract</strong></p>\n<figure class=\"caption_element\"><img alt=\"Congenital Cataract\" data-author=\"CDC, Patho\" data-hash=\"9281\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Cataracts_due_to_Congenital_Rubella_Syndrome_(CRS)_PHIL_4284_lores.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/478OOcj7diDVUYwx3Sgr1744365135.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genetic disorders, <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> infections (e.g., rubella)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glassblowers Cataract</strong></p>\n<img alt=\"Glassblowers Cataract\" data-author=\"\" data-hash=\"9284\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/iis4roZkKC90W31Nbwye1744365224.png\"/><br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infrared radiation (IR), encountered during glassblowing.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following investigation parameters is not generally considered definitive for the evaluation of Wilson's disease?", "options": [{"label": "A", "text": "Serum copper levels", "correct": true}, {"label": "B", "text": "MRI of the brain", "correct": false}, {"label": "C", "text": "Liver biopsy", "correct": false}, {"label": "D", "text": "24-hour urine excretion of copper", "correct": false}], "correct_answer": "A. Serum copper levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:649px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Serum Ceruloplasmin: </strong>Decreased (&lt;20 mg/dL) - Indicates low levels of the copper-carrying protein due to <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> transport in Wilson's disease.</li>\n<li><strong>Free <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> Copper:</strong> Increased (toxic unbound copper), reflects elevated free <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> levels as it is not effectively <span class=\"customMeta\" data-dictid=\"d82fcb9d1f16927771836a9f6ccf14\">bound</span> to ceruloplasmin.</li>\n<li><strong>Note: </strong>This test is not <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> for Wilson's disease because elevated free <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> can occur in other conditions as well, such as liver disease or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> inflammation.<strong> </strong></li>\n<li><strong>24-Hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">Copper</span> Excretion:</strong> Elevated (&gt;100 µg/24h), A reliable indicator of <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> overload, often used for diagnosis and monitoring treatment. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Copper Content in Liver Tissue:</strong> Elevated (&gt;250 µg/g dry weight), <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">Definitive</span> test for Wilson's disease, measuring accumulated <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> in hepatocytes. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mutation analysis of ATP7B gene: </strong>Confirms the diagnosis; Useful in uncertain cases or for family screening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Slit-Lamp Examination: </strong>Detects Kayser-Fleischer rings, Indicates <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> deposition in the cornea.</li>\n<li><strong>MRI Brain:</strong> Shows <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia, often with the <strong>\"face of the giant panda\" sign</strong> - Typical finding associated with neurological manifestations due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> deposition. <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old patient presents with neurological symptoms such as tremors, dysarthria, and gait disturbances. An MRI of the brain is performed and reveals hyperintensities at the sites given below. Based on these findings and the clinical presentation, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Huntington's disease", "correct": false}, {"label": "B", "text": "Multiple sclerosis", "correct": false}, {"label": "C", "text": "Wilson’s disease", "correct": true}, {"label": "D", "text": "Parkinson’s disease", "correct": false}], "correct_answer": "C. Wilson’s disease", "question_images": ["https://image.prepladder.com/notes/by7vUlgVDzDA9oKD5EeI1744365358.png"], "explanation_images": ["https://image.prepladder.com/notes/tYphI80vkDeYXS7le8FX1744365410.png", "https://image.prepladder.com/notes/tOi0GxRSDUhjOvd1cWzo1744365458.png", "https://image.prepladder.com/notes/gYwA9wNS8ku6KUV5Uh5t1744365506.png", "https://image.prepladder.com/notes/BQ6Bz9GVkBvtTT2ENlFc1744365547.png", "https://image.prepladder.com/notes/jCjXCk4QtuqWA1slhVDH1744365590.png", "https://image.prepladder.com/notes/3visUN2jXJGiqwaYREN41744365633.png", "https://image.prepladder.com/notes/DvmhlW2d1kCZ9zrcMb9d1744365814.png", "https://image.prepladder.com/notes/LZkd2T7ksVwp3WEyQKpK1744365856.png", "https://image.prepladder.com/notes/1fTnpCKv1OzNanxyHjzD1744366924.png", "https://image.prepladder.com/notes/U0lAoXSumDOAQeTQZKx91744367041.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI Sign/Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiograph </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wilson’s Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Face of the Giant Panda Sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Giant panda sign\" data-author=\"Atalar, M.H., &amp; Başpınar, N.\" data-hash=\"9291\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/%E2%80%9CFace-of-the-Giant-Panda%E2%80%9D-Sign-in-Wilson-Disease-Atalar-Ba%C5%9Fp%C4%B1nar/52738a5de46c9be360a7984a2de20925e89f4ec9\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/tYphI80vkDeYXS7le8FX1744365410.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">Sclerosis</span> (MS)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dawson’s Fingers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"MS Dawsons Fingers\" data-author=\"Heba Abdelmonem\" data-hash=\"9292\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/multiple-sclerosis-dawson-fingers\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/tOi0GxRSDUhjOvd1cWzo1744365458.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Huntington’s Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Boxcar Ventricles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Huntingtons disease box car ventricles\" data-author=\"Atalar, Mehmet &amp; Salk, Ismail &amp; Egilmez, Hulusi.\" data-hash=\"9293\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Axial-T2-weighted-MR-image-showing-bilateral-atrophy-of-caudate-nuclei-and-compensatory_fig17_270003595\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/gYwA9wNS8ku6KUV5Uh5t1744365506.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parkinson’s Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Swallow Tail Sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Parkinsons Swallow Tail Sign\" data-author=\"Stefan T. Schwarz, Mohammed Afzal, Paul S. Morgan, Nin Bajaj, Penny A. Gowland, Dorothee P. Auer\" data-hash=\"9298\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Swallow_tail.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/BQ6Bz9GVkBvtTT2ENlFc1744365547.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Creutzfeldt-Jakob Disease (CJD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortical Ribboning</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"CJD Cortical ribboning\" data-author=\"Pract Neurol\" data-hash=\"9299\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Practneurol-2016-001571f02.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/jCjXCk4QtuqWA1slhVDH1744365590.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progressive <span class=\"customMeta\" data-dictid=\"5ef5f7d035169277719997649dc97a\">Supranuclear</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">Palsy</span> (PSP)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mickey Mouse Sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"PSP Mickey Mouse sign\" data-author=\"Prashant Gupta\" data-hash=\"9300\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/progressive-supranuclear-palsy-with-hummingbird-or-penguin-sign\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/3visUN2jXJGiqwaYREN41744365633.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple System Atrophy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hot Cross <span class=\"customMeta\" data-dictid=\"eeb0ec7e661692777183f957a8794b\">Bun</span> Sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"MSA Hot cross &lt;span class=\" custommeta\"=\"\" data-dictid=\"eeb0ec7e661692777183f957a8794b\"/>bun sign\" data-author=\"Assoc Prof Frank Gaillard\" data-hash=\"9301\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hot_cross_bun_sign.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/cS2GEfTlNb5KPu3bNOKk1744365672.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alzheimer’s Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Atrophy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Medial &lt;span class=\" custommeta\"=\"\" data-dictid=\"637ea4d17516927772003be2b2aae4\"/>temporal atrophy\" data-author=\"Hurford, Robert &amp; Charidimou, Andreas &amp; Werring, David &amp; Fox, Zoe &amp; Cipolotti, Lisa &amp; Jager, R\" data-hash=\"9302\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/The-medial-temporal-atrophy-MTA-visual-rating-scale-a-d-Coronal-FLAIR-images-showing_fig2_305615685\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/XcMhho9RXKK7e7Z84s0x1744365717.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wernicke’s Encephalopathy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mammillary Body Hyperintensities</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Wernickes &lt;span class=\" custommeta\"=\"\" data-dictid=\"b37b211cbc169277718725f07b5473\"/>encephalopathy mammillary body hyperintensities\" data-author=\"Samar A. Abbas, Halim Abboud, Moussa A. Chalah,Chadi Sabbagh, Samar S. Ayache\" data-hash=\"9304\" data-license=\"CC BY\" data-source=\"https://www.mdpi.com/2076-328X/8/11/104\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/GITLequcBgNXxoTUIgqU1744365755.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurocysticercosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Starry Sky Appearance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Neurocysticercosis starry sky\" data-author=\"Innocent Lule Segamwenge\" data-hash=\"9305\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Neurocysticercosis_brain_CT.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/DvmhlW2d1kCZ9zrcMb9d1744365814.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subacute Combined Degeneration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inverted V Sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"SACD Inverted V sign\" data-author=\"Omotosho, Yetunde &amp; Ying, Grace &amp; Orji, Richard &amp; Patel, Hereen\" data-hash=\"9306\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/publication/359424407_Recreational_Nitrous_Oxide-Induced_Subacute_Combined_Degeneration\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/LZkd2T7ksVwp3WEyQKpK1744365856.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glioblastoma Multiforme (GBM)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Butterfly Glioma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Butterfly glioblastoma\" data-author=\"John H. Rossmeisl, Kemba Clapp, Theresa E. Pancotto, Samantha Emch, John L. Robertson, Waldemar Debinski\" data-hash=\"9313\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Butterfly_glioblastoma.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1fTnpCKv1OzNanxyHjzD1744366924.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tuberous Sclerosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortical Tubers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Tuberous &lt;span class=\" custommeta\"=\"\" data-dictid=\"dae4dea0581692777198fdef9fa684\"/>Sclerosis Cortical tubers\" data-author=\"Hellerhoff\" data-hash=\"9314\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Tuberoese_Sklerose_1J_T2_axial2.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/D2DtmzhG4BrKLZQzc6Xa1744366961.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Central <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">Pontine</span> <span class=\"customMeta\" data-dictid=\"9c5a9dea191692777193758bcb4ce8\">Myelinolysis</span> (CPM)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trident Sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Central &lt;span class=\" custommeta\"=\"\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\"/>Pontine <span class=\"customMeta\" data-dictid=\"9c5a9dea191692777193758bcb4ce8\">Myelinolysis</span> Trident sign\" data-author=\"Jto410\" data-hash=\"9315\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:MRI_Central_Pontine_Myelinolysis_fat_sat_T2.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/q0hBMyaKNgWi6qBFH5Zn1744367003.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Meningioma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dural Tail Sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Meningioma Dural Tail Sign\" data-author=\"Daniel Lyndon, Joseph A. Lansley, Jane Evanson &amp; Anant S. Krishnan \" data-hash=\"9316\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dural_tail_sign.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/U0lAoXSumDOAQeTQZKx91744367041.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old patient presents with the following symptoms: tremors, dysarthria, irritability, and impulsive behavior, along with jaundice and the presence of Kayser-Fleischer rings on slit-lamp examination. What is the best treatment approach for this condition?", "options": [{"label": "A", "text": "Penicillamine", "correct": true}, {"label": "B", "text": "Trientine", "correct": false}, {"label": "C", "text": "Zinc acetate", "correct": false}, {"label": "D", "text": "Dimercaprol", "correct": false}], "correct_answer": "A. Penicillamine", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:433px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Element/Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chelation Therapy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lead</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>EDTA, DMSA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mercury, Arsenic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DMSA, DMPS</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iron</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deferoxamine, Deferasirox, Deferiprone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copper</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Penicillamine, Trientine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potassium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sodium bicarbonate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gold</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dimercaprol, Penicillamine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radioactive Iodine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potassium iodide</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old patient who is a known case of Wilson’s disease presents to the emergency department with acute liver failure. He has neurological symptoms and liver dysfunction. Upon evaluation, laboratory results reveal the following: Serum bilirubin: 12 mg/dL. Serum aspartate transferase (AST): 250 IU/L. Prothrombin time prolongation: 15 seconds. Based on these results, calculate the NAZER prognostic score for this patient and the next step in treatment accordingly.", "options": [{"label": "A", "text": "NAZER score of 5; no need for transplantation", "correct": false}, {"label": "B", "text": "NAZER score of 8; medical management is sufficient", "correct": false}, {"label": "C", "text": "NAZER score of 9; liver transplantation is indicated", "correct": true}, {"label": "D", "text": "NAZER score of 11; monitor the patient without intervention", "correct": false}], "correct_answer": "C. NAZER score of 9; liver transplantation is indicated", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory measurement </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score (in points) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.2-1.2 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;5.8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5.8-8.8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8.8-11.7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>11.7-17.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;17.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"3d988dbcc816927771821e9a2544f7\">aspartate</span> transferase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-35 IU/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;100</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100-150</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>151-200</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>201-300</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;300</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolongation of <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> time (seconds)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9-12</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13-20</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;20</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:521px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Factor</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Points toward total score </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>S. <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> (mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>S. <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> (g/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;3.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-3.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prothrombin time (seconds) Or<br/>\n<br/>\n\t\t\tINR</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;4</p>\n\t\t\t \n\n\t\t\t<p>&lt;1.7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-6</p>\n\t\t\t \n\n\t\t\t<p>1.7-2.3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;6</p>\n\t\t\t \n\n\t\t\t<p>&gt;2.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ascites</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Easily controlled</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poorly controlled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatic encephalopathy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Advanced</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Points </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 to 6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Well-preserved liver function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7 to 9</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate liver function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 to 15</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe liver <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> with a life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> of approximately one year</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old woman presents with symptoms of fatigue, arthralgia, and new-onset diabetes. Her family history reveals that her father was diagnosed with hemochromatosis. Further evaluations show significantly elevated serum ferritin and transferrin saturation levels and that she carries both the C282Y and H63D mutations in the HFE gene. Based on her clinical presentation and genetic findings, which type of hemochromatosis is she most likely experiencing?", "options": [{"label": "A", "text": "Type 1", "correct": true}, {"label": "B", "text": "Type 2", "correct": false}, {"label": "C", "text": "Type 3", "correct": false}, {"label": "D", "text": "Type 4", "correct": false}], "correct_answer": "A. Type 1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hereditary hemochromatosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1 </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HFE-related</li>\n<li>C282Y homozygosity</li>\n<li>C282/H63D compound heterozygosity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Iron-loading anemias</strong>\n<ul>\n<li>Thalassemia major</li>\n<li>Siderroblastioc anemia</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemias</li>\n</ul>\n</li>\n<li>Transfusion and <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">parenteral</span> iron overload</li>\n<li>Dietary iron overload</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type-2 </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-HFE related</li>\n<li>Juvenile hemochromatosis</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic liver disease</strong></p>\n<ul>\n<li>Hepatitis C</li>\n<li>Alcoholic cirrhosis</li>\n<li>Nonalcoholic steatohepatitis</li>\n<li>Porphyria cutanea tarda</li>\n<li>Dysmerabolic <span class=\"customMeta\" data-dictid=\"64bbd63a0c1692777190f0c8e06e91\">iron overload</span> syndrome</li>\n<li>Post-porta <span class=\"customMeta\" data-dictid=\"c7188521b31692777183cefe56a620\">caval</span> shunting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type-3 </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutated <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> 2 (TRF2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type-4 </strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutated <span class=\"customMeta\" data-dictid=\"1c8d5ddd3a1692777202cda4c14994\">ferroportin</span> 1 gene</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the clinic with complaints of fatigue, joint pain, and a noticeable change in skin color, described as a slate-gray hue. He reports a family history of liver disease and diabetes. Blood tests reveal elevated serum ferritin and transferrin saturation levels. Which of the following clinical features, once developed, progresses even after successful treatment of the condition?", "options": [{"label": "A", "text": "Hepatomegaly", "correct": false}, {"label": "B", "text": "Cardiac arrhythmia", "correct": false}, {"label": "C", "text": "Arthropathy", "correct": true}, {"label": "D", "text": "Hypogonadism", "correct": false}], "correct_answer": "C. Arthropathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/VVQ4n0FxDJdRF0ErE1mK1744367191.png", "https://image.prepladder.com/notes/G5tjqSpu7zDHiYyen1oi1744367225.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with fatigue, joint pain, and new-onset diabetes. He has a family history of liver disease and reports high alcohol intake. Which biochemical test would be a strong indicator of hemochromatosis in this patient?", "options": [{"label": "A", "text": "Plasma iron levels", "correct": false}, {"label": "B", "text": "Serum ferritin levels", "correct": true}, {"label": "C", "text": "Fasting serum transferrin saturation", "correct": false}, {"label": "D", "text": "Liver biopsy", "correct": false}], "correct_answer": "B. Serum ferritin levels", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/qE8Hz9cyxqLXcf1Wf8rE1744367294.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plasma iron level</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (not reliable) <strong>(vs Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> (fasting)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated: <span class=\"customMeta\" data-dictid=\"64bbd63a0c1692777190f0c8e06e91\">Iron overload</span> (may have false positives) <strong>(vs Option C)</strong></li>\n<li>&gt;45%: Risk for hemochromatosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"91d0e4c6fa16927772025f96b44b27\">ferritin</span> level<strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;1000 μg/L: Disease in C282Y homozygotes (a reliable indicator of body iron stores and is significantly elevated in hemochromatosis).</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:345px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical parameters in hemochromatosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serum iron: <strong>￪ </strong></li>\n<li>Total iron binding capacity: <strong>￪ ￪ </strong></li>\n<li>% <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> of transferrin: increased &gt;45%</li>\n<li>Serum ferritin: <strong>￪</strong> &gt;1000 μg/L<strong> </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female comes with fatigue, joint pains, and a slate-gray appearance of the skin. After evaluation and detailed history, the physician suspects hemochromatosis. Which of the following statements about screening for hemochromatosis is false?", "options": [{"label": "A", "text": "All adult first-degree relatives should be tested for C282Y and H63D mutations.", "correct": false}, {"label": "B", "text": "Genetic testing for the C282Y and H63D mutations is recommended if screening tests are abnormal.", "correct": false}, {"label": "C", "text": "Children of diagnosed individuals under 18 years old should always be screened for hemochromatosis.", "correct": true}, {"label": "D", "text": "Screening is done using transferrin saturation and ferritin levels.", "correct": false}], "correct_answer": "C. Children of diagnosed individuals under 18 years old should always be screened for hemochromatosis.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male patient with a confirmed diagnosis of hereditary hemochromatosis presents with symptoms of fatigue, diabetes, and joint pain. Laboratory tests reveal elevated serum ferritin levels of 2000 μg/dl. Which of the following is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Deferoxamine parenteral chelation therapy", "correct": false}, {"label": "B", "text": "Liver transplantation", "correct": false}, {"label": "C", "text": "Deferiprone oral chelation therapy", "correct": false}, {"label": "D", "text": "Phlebotomy", "correct": true}], "correct_answer": "D. Phlebotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 20 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 42-year-old HIV-positive male with a history of disseminated Mycobacterium avium complex (MAC) infection presents for a routine check-up. He is compliant with antiretroviral therapy (ART) and has a CD4+ count of 46 cells/μL. Which prophylactic therapy is recommended in this patient to prevent Mycobacterium avium complex?", "options": [{"label": "A", "text": "Monotherapy with azithromycin", "correct": false}, {"label": "B", "text": "Trimethoprim-sulfamethoxazole", "correct": false}, {"label": "C", "text": "Clarithromycin + ethambutol", "correct": true}, {"label": "D", "text": "Isoniazid + pyridoxine", "correct": false}], "correct_answer": "C. Clarithromycin + ethambutol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathogen </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumocystis jirovecii </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD 4+ &lt; 200/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <strong>TMP-SMX </strong><strong>(Option B)</strong></p>\n<p>Trimethoprim-sulfamethoxazole</p>\n\t\t\t \n\n\t\t\t<p><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"7583e5425a1692777185ab1b0d846b\">Dapsone</span> + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">Pyrimethamine</span> + Leucovorin</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Mycobacterium Avium Complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD 4+ &lt; 50/μL and no prior h/o MAC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">Azithromycin</span> or <span class=\"customMeta\" data-dictid=\"00c4a4fe9b1692777184136ffde6c9\">clarithromycin</span> (monotherapy)</p>\n<p><strong>(Option A)</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Alternative: </strong>Rifabutin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD 4+ &lt; 50/μL and Prior h/o MAC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <span class=\"customMeta\" data-dictid=\"00c4a4fe9b1692777184136ffde6c9\">Clarithromycin</span> + ethambutol <strong>(Option C)</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">Azithromycin</span> + ethambutol</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Toxoplasma gondii </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TOXO <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> +ve</p>\n<p>CD4+ &lt; 100/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <strong>TMP-SMX </strong><strong>(Option B)</strong></p>\n<p>Trimethoprim-sulfamethoxazole</p>\n\t\t\t \n\n\t\t\t<p><strong>Alternative</strong>:Dapsone + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">Pyrimethamine</span> + Leucovorin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>H/O <span class=\"customMeta\" data-dictid=\"0bcd1473f3169277720036fb73236d\">Toxoplasmic</span> encephalitis</p>\n<p>CD4+ &lt; 200/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <span class=\"customMeta\" data-dictid=\"8d61c0e3d516927771995457e14512\">Sulfadiazine</span> + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">Pyrimethamine</span> + Leucovorin</p>\n\t\t\t \n\n\t\t\t<p><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"1d8d8a391016927771843f2f1c40b9\">Clindamycin</span> + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">Pyrimethamine</span> + Leucovorin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PPD&gt;5 mm</p>\n<p>IGRA +ve</p>\n<p>Contact with active TB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong> : <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> + <span class=\"customMeta\" data-dictid=\"cae8cdbe581692777196bd4dec479d\">Pyridoxine</span> - x 9 months <strong>(Option D)</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"31725380cf16927771975bd3dcd1ee\">Rifabutin</span> or Rifampin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CMV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD4+ &lt; 100/μL</p>\n<p>Prior infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: Valacyclovir</p>\n\t\t\t \n\n\t\t\t<p><strong>Alternative</strong>: Foscarnet</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryptococcus </strong></p>\n<p><strong>Coccidioides </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive serology</p>\n<p>CD4+ &lt; 250/μL</p>\n<p>Endemic zone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluconazole</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histoplasmosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD4+ &lt; 150/μL</p>\n<p>Endemic zone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Itraconazole</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salmonella </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent infections</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ciprofloxacin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bartonella</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD4+ &lt; 200/μL</p>\n<p>Prior infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Doxycycline or azithromycin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with a history of hypertension and asthma presents with a persistent cough, fever, and shortness of breath. He is conscious and oriented, with a respiratory rate of 26 breaths per minute and an oxygen saturation of 92% on room air. His RT-PCR test is positive. What is the preferred oxygen delivery device for this condition?", "options": [{"label": "A", "text": "NIV mask", "correct": false}, {"label": "B", "text": "Nasal cannula", "correct": false}, {"label": "C", "text": "CPAP mask", "correct": false}, {"label": "D", "text": "Non-rebreathing face mask", "correct": true}], "correct_answer": "D. Non-rebreathing face mask", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/TrRYAdMbTYrX8GPdeiGN1744283625.png", "https://image.prepladder.com/notes/hqOdc7xWqrSfA2pXsHEo1744283666.png", "https://image.prepladder.com/notes/Ym1d2uKp00PXxSm1SOkN1744283815.png", "https://image.prepladder.com/notes/pfhInzUJwt2d598Y52Lq1744283987.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:665px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management of COVID-19</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Grade of disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild disease</strong></p>\n<p><strong>(SpO2 ≥ 94%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Isolation</li>\n<li>Strict hand hygiene</li>\n<li>Symptomatic management and adequate hydration.</li>\n<li><strong>Oral hydroxychloroquine </strong></li>\n<li>Refer to a higher center if <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate &gt;24 breaths per min and SPO2 &lt;94%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate disease</strong><br/>\n<strong>(SpO2 90% - 93%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Oxygen support</strong>\n<ul>\n<li><strong>Target SpO2: 92 - 96% (88-92% in patients with COPD)</strong></li>\n<li><strong>Preferred device: Non-rebreathing face mask (NRM)</strong> <strong>(Option D) </strong></li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Non Rebreather Mask for oxygen delivery\" data-author=\"ICUnurses \" data-hash=\"8474\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Non-rebreather_mask#/media/File:Non_Rebreather_Mask.JPG\" data-tags=\"April2025\" height=\"503\" src=\"https://image.prepladder.com/notes/TrRYAdMbTYrX8GPdeiGN1744283625.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<ul>\n<li>Awake proning for 30 to 120 minutes may be used as per the patient’s condition.</li>\n</ul>\n<ul>\n<li><strong>Anticoagulants: </strong>LMWH (low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> heparin) or UFH (unfractionated heparin), 40mg daily SC.</li>\n<li><strong>Corticosteroids </strong>\n<ul>\n<li>IV <span class=\"customMeta\" data-dictid=\"c3adf9f403169277719294351e8fb8\">Methylprednisolone</span> 0.5 – 1 mg/kg for 5 days, or</li>\n<li>IV <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">Dexamethasone</span> 0.1 -0.2 mg/kg for 5 days</li>\n</ul>\n</li>\n<li><strong>Oral hydroxychloroquine </strong></li>\n<li><strong>Remdesivir (intravenous)</strong></li>\n<li><strong>Convalescent <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> therapy</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe disease</strong><br/>\n<strong>(SpO2 &lt; 90%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Oxygenation </strong>\n<ul>\n<li><strong>CPAP (Continuous Positive <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Pressure) with <span class=\"customMeta\" data-dictid=\"d32cb1eab81692777194aa2dcd431c\">oronasal</span> mask (preferred) </strong><strong> (Option C)</strong></li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"CPAP\" data-author=\"Mikael Granberg\" data-hash=\"8475\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:CPAP_in_wheelchair.jpg\" data-tags=\"April2025\" height=\"342\" src=\"https://image.prepladder.com/notes/hqOdc7xWqrSfA2pXsHEo1744283666.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<ul>\n<li>NIV (non-invasive ventilation) with helmet <span class=\"customMeta\" data-dictid=\"ec503a687b16927771908fbd6d884c\">interface</span> <strong>(Option A)</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Non invasive Ventilation\" data-author=\"Gerrit J. Muller, Renée Hovenier, Jip Spijker, Monica van Gestel, Rozalinde Klein-Blommert, Dick G Markhorst, Coen Dirk-Jan Dijkman, Reinout Bem\" data-hash=\"8478\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/NIV-interface-application-in-the-child-NIV-provided-by-a-total-face-mask-left-panel_fig2_354111144\" data-tags=\"April2025\" height=\"190\" src=\"https://image.prepladder.com/notes/Ym1d2uKp00PXxSm1SOkN1744283815.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>HFNC (high-flow <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cannula) <strong> (Option B)</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"HFNC (high flow &lt;span class=\" custommeta\"=\"\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\"/>nasal cannula)\" data-author=\" Lou’i Al-Husinat, Basil Jouryyeh, Ahlam Rawashdeh, Abdelrahman Alenaizat, Mohammad Abushehab, Mohammad Wasfi Amir, Zaid Al Modanat, Denise Battaglini, Gilda Cinnella\" data-hash=\"8482\" data-license=\"Open access\" data-source=\"https://www.mdpi.com/2077-0383/12/20/6685\" data-tags=\"April2025\" height=\"269\" src=\"https://image.prepladder.com/notes/8RfP05xT8Hhbw9DqTB871744283905.png\" width=\"400\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Intubation of the patient</li>\n</ul>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Intubation of the patient\" data-author=\"Open Critical Care &amp; World Health Organization\" data-hash=\"8483\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Intubation#/media/File:Sagittal_cross_section_view_of_laryngoscopy_intubation_with_mac_3.png\" data-tags=\"April2025\" height=\"321\" src=\"https://image.prepladder.com/notes/pfhInzUJwt2d598Y52Lq1744283987.png\" width=\"400\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n<ul>\n<li><strong>Lung protective strategy:</strong>\n<ul>\n<li>Prone position of the patient</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume (TV)</li>\n<li>High <span class=\"customMeta\" data-dictid=\"9abcb9edc11692777195dac40cd470\">PEEP</span> (positive end-expiratory pressure)</li>\n<li>Neuromuscular blockage</li>\n</ul>\n</li>\n<li><strong>Anticoagulants (high dose)</strong>\n<ul>\n<li>LMWH OR UFH 40mg BD, subcutaneously</li>\n</ul>\n</li>\n<li><strong>Corticosteroids </strong>\n<ul>\n<li>IV <span class=\"customMeta\" data-dictid=\"c3adf9f403169277719294351e8fb8\">Methylprednisolone</span> 1– 2 mg/kg for 5-7 days, or</li>\n<li>IV <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">Dexamethasone</span> 0.2 -0.4 mg/kg for 5-7 days</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman with a history of obesity and hypertension presents with a persistent cough, fever, and moderate shortness of breath for the past four days. Her SpO2 is 90% upon examination, and her respiratory rate is 24. Her RT-PCR test result is positive. Which of the following laboratory findings are associated with this condition?", "options": [{"label": "A", "text": "Reduced D-dimer", "correct": false}, {"label": "B", "text": "Reduced IL-6", "correct": false}, {"label": "C", "text": "Elevated platelet count", "correct": false}, {"label": "D", "text": "Elevated NLR", "correct": true}], "correct_answer": "D. Elevated NLR", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Laboratory findings of COVID-19</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Elevated Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reduced parameters</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inflammatory markers (interleukin 6, tumour <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> factor α, ferritin, C-reactive protein)<strong> (Option B)</strong></li>\n<li>NLR (neutrophil-to-lymphocyte ratio) &gt;6 <strong>(Option D)</strong></li>\n<li>Prothrombin time</li>\n<li>D-dimer <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">assay</span> <strong>(Option A)</strong></li>\n<li>Pro-BNP and <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">troponin</span> I</li>\n<li>Liver enzymes and <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> dehydrogenase</li>\n<li>Creatine phosphokinase</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Platelet count (thrombocytopenia) <strong> (Option C)</strong></li>\n<li>TLC or Total <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> count (lymphopenia)</li>\n<li>Erythrocyte count (anemia)</li>\n<li>Pulmonary function test</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man with a history of asthma presents with a persistent cough, fever, and shortness of breath that started three days ago after attending a family gathering. His examination shows a SpO2 of 92% on room air and a respiratory rate of 26 breaths per minute, with the accompanying X-ray. What is the investigation of choice for this condition?", "options": [{"label": "A", "text": "HRCT chest", "correct": false}, {"label": "B", "text": "C-reactive protein", "correct": false}, {"label": "C", "text": "RT-PCR", "correct": true}, {"label": "D", "text": "Rapid antigen test", "correct": false}], "correct_answer": "C. RT-PCR", "question_images": ["https://image.prepladder.com/notes/EqXXDqv9KqT22zayH6lp1744279127.png"], "explanation_images": ["https://image.prepladder.com/notes/kfTxgpDTeSBKUL3G7OoO1744279166.png", "https://image.prepladder.com/notes/EqXXDqv9KqT22zayH6lp1744279127.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman presents to the emergency department with a persistent cough, shortness of breath, fever, and fatigue. She has a history of hypertension. Upon examination, her respiratory rate is 31, and her oxygen saturation is 88% on room air. Hospital admission is recommended. At which stage of this condition should heparin be initiated?", "options": [{"label": "A", "text": "Stage I", "correct": false}, {"label": "B", "text": "Stage II", "correct": true}, {"label": "C", "text": "Stage III", "correct": false}, {"label": "D", "text": "Stage IV", "correct": false}], "correct_answer": "B. Stage II", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/pI1IBPYH2T21sBd0vEQx1744278813.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:793px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Asymptomatic or Presymptomatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mild disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Moderate disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Severe disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Critical disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No symptoms</li>\n<li>SARS-CoV-2 test positive</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms like fever, cough, taste or smell changes</li>\n<li>No dyspnea</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>LRTI (lower <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection)</li>\n<li><strong>Oxygen saturation: &gt;94%</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Oxygen saturation: &lt;94%</strong></li>\n<li><strong>Respiratory rate: &gt;30/min</strong></li>\n<li>Lung <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> &gt;50%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Respiratory failure</li>\n<li>Shock</li>\n<li>Multi-organ failure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:764px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage I </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage II</strong><strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage III </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary phase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperinflammatory phase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild cough, throat pain, fever, diarrhoea, <span class=\"customMeta\" data-dictid=\"cc8a35010816927771819ba9cf19d8\">anosmia</span> or taste changes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shortness of breath (dyspnea)</li>\n<li>Coagulation starts<strong> (heparin has to be started)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ARDS (Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome)</li>\n<li>Sepsis</li>\n<li>MODS (multi-organ <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> syndrome)</li>\n<li>Cardiogenic shock</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt;24 breaths per min</li>\n<li><strong>&gt;30 breaths per minute (severe illness)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intubation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxygen <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&lt;94%</li>\n<li><strong>&lt;90% (severe illness)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intubation</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV </strong><strong>(Option D)</strong><strong>: </strong>Not a standard stage in most clinical <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> systems for <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> illnesses.<strong> </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man arrives at the community health clinic exhibiting symptoms such as a persistent cough, fever, and fatigue. He reports attending a large gathering a week ago, where several attendees reported similar illnesses. The rapid antigen test results are positive. Which of the following statements about this condition is true? It is caused by a virus with a single-stranded RNA genome It has an eclipse period of 4 to 5 days. It stimulates factor H Transmitted through aerosols It leads to alveolar oedema", "options": [{"label": "A", "text": "1, 2, 3", "correct": false}, {"label": "B", "text": "2, 3, 4", "correct": false}, {"label": "C", "text": "1, 4, 5", "correct": true}, {"label": "D", "text": "2, 3, 5", "correct": false}], "correct_answer": "C. 1, 4, 5", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/AegDVj5mhh5jPCTpd4nD1744276896.png", "https://image.prepladder.com/notes/IDgkwhQdxAumRdCaTH0Q1744277054.png", "https://image.prepladder.com/notes/QRjxaw0O7YtY7ob0iXWo1744277158.png", "https://image.prepladder.com/notes/eTnS7fecbJxh4fKeVbIi1744277317.png", "https://image.prepladder.com/notes/ZoYSTiNlzXToxUGAkxoa1744278336.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>COVID-19</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A single-stranded <span class=\"customMeta\" data-dictid=\"9c1194ed23169277719638b26bd86a\">positive-sense RNA</span> virus, <span class=\"customMeta\" data-dictid=\"962ef05f3f1692777198917a74dfe2\">SARS-CoV-2</span> (Severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Syndrome - coronavirus-2) <strong>(Statement 1)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"SARS-CoV-2\" data-author=\"NIAID-RML\" data-hash=\"8415\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/SARS-CoV-2#/media/File:Novel_Coronavirus_SARS-CoV-2.jpg\" data-tags=\"April2025\" height=\"362\" src=\"https://image.prepladder.com/notes/AegDVj5mhh5jPCTpd4nD1744276896.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4-5 days</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Median <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">Incubation</span> period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>11.5 days (statistical measure that represents the middle value of the <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> periods observed in a population)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eclipse period </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>10 hours (the time required to produce <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> virions) </strong><strong>(Statement 2) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aerosoles (droplets) <strong> (Statement 4) </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Aerosols (droplets) transmission\" data-author=\"James Gathany\" data-hash=\"8417\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Respiratory_droplet#/media/File:Sneeze.JPG\" data-tags=\"April2025\" height=\"200\" src=\"https://image.prepladder.com/notes/IDgkwhQdxAumRdCaTH0Q1744277054.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Alveolar oedema and <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (impaired gas exchange)</strong> <strong>(Statement 5) </strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"COVID-19-Diffuse alveolar damage\" data-author=\"Nephron \" data-hash=\"8418\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Diffuse_alveolar_damage#/media/File:Hyaline_membranes_-_very_high_mag.jpg\" data-tags=\"April2025\" height=\"268\" src=\"https://image.prepladder.com/notes/QRjxaw0O7YtY7ob0iXWo1744277158.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Endothelitis (pulmonary edema)</strong></li>\n<li><strong>Microthrmbi formation in lung vessels (inhibition of factor H and tissue factor release leads to microthrombi formation)</strong>. <strong>(Statement 3)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"COVID-19-Pathophysiology\" data-author=\"NA\" data-hash=\"8419\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"387\" src=\"https://image.prepladder.com/notes/eTnS7fecbJxh4fKeVbIi1744277317.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Perfusion Patterns of Peripheral Pulmonary Lesions\" data-author=\"Ehsan Safai Zadeh, Björn Beutel, Christoph F Dietrich, Corinna Ulrike Keber, Katharina Paulina Huber, Christian Görg, Corinna Trenker\" data-hash=\"8427\" data-license=\"CC BY-NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Histologic-changes-in-the-lung-of-patient-4-show-vasculitis-microthrombi-and_fig1_348585113\" data-tags=\"April2025\" height=\"305\" src=\"https://image.prepladder.com/notes/ZoYSTiNlzXToxUGAkxoa1744278336.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An experienced nurse is preparing to draw blood from a patient known to be HIV-positive. While handling the needle, she accidentally pricks her right thumb after the blood draw. Which of the following antiretroviral drugs is commonly included in both the NACO and CMDT regimens for the management of this case?", "options": [{"label": "A", "text": "Raltegravir", "correct": false}, {"label": "B", "text": "Emtricitabine", "correct": false}, {"label": "C", "text": "Tenofovir", "correct": true}, {"label": "D", "text": "Dolutegravir", "correct": false}], "correct_answer": "C. Tenofovir", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anti-retroviral drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dosage </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tenofovir (TDF) 300 mg + <span class=\"customMeta\" data-dictid=\"548c02a1cf1692777191e70df694f8\">Lamivudine</span> (3TC) 300 mg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 tab Immediately with 2 hours of exposure, then once daily (OD) for 4 weeks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lopinavir (200 mg) + <span class=\"customMeta\" data-dictid=\"dea585d18816927771975072308534\">Ritonavir</span> (50 mg)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 tabs Immediately within 2 hours of <span class=\"customMeta\" data-dictid=\"fb7ff97e071692777180252299cf10\">accidental</span> exposure, then 2 tabs twice daily (BD) for 4 weeks.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:561px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tenofovir (TDF) 300 mg + <span class=\"customMeta\" data-dictid=\"548c02a1cf1692777191e70df694f8\">Lamivudine</span> (3TC) 300 mg - OD (once daily)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:564px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tenofovir 300 mg + <span class=\"customMeta\" data-dictid=\"64278bcc161692777187c826ba4b9f\">Emtricitabine</span> 200 mg + <span class=\"customMeta\" data-dictid=\"992cbbccdb1692777197dbfa9c24a3\">Raltegravir</span> 400 mg (BD) twice daily</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male with HIV prefers a once-daily medication regimen to simplify his treatment and improve adherence compared to multiple pills. If he has a history of hypersensitivity to integrase inhibitors, which of the following FDC options would best meet his needs as a single-pill, once-daily regimen?", "options": [{"label": "A", "text": "Stribild (Tenofovir disoproxil fumarate + Emtricitabine + Elvitegravir + Cobicistat)", "correct": false}, {"label": "B", "text": "Genvoya (Tenofovir alafenamide + Emtricitabine + Bictegravir)", "correct": false}, {"label": "C", "text": "Atripla (Efavirenz + Emtricitabine + Tenofovir disoproxil fumarate)", "correct": true}, {"label": "D", "text": "Triumeq (Abacavir + Lamivudine + Dolutegravir)", "correct": false}], "correct_answer": "C. Atripla (Efavirenz + Emtricitabine + Tenofovir disoproxil fumarate)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fixed dose combination for once-a-day pill for HIV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Combination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Group</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atripla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Efavirenz + <span class=\"customMeta\" data-dictid=\"64278bcc161692777187c826ba4b9f\">Emtricitabine</span> + <span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\">Tenofovir</span> disoproxil fumarate</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NNRTI + 2 NRTI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biktarvy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir alafenamide + <span class=\"customMeta\" data-dictid=\"64278bcc161692777187c826ba4b9f\">emtricitabine</span> + bictegravir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 NRTI + Integrase <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complera </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir disoproxil <span class=\"customMeta\" data-dictid=\"0063169a1b1692777203ba89eb2363\">fumarate</span> + <span class=\"customMeta\" data-dictid=\"64278bcc161692777187c826ba4b9f\">emtricitabine</span> + rilpivirine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 NRTI + NNRTI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delstrigo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Doravirine +tenofovir disoproxil <span class=\"customMeta\" data-dictid=\"0063169a1b1692777203ba89eb2363\">fumarate</span> + lamivudine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NNRTI + NRTI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dovato</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dolutegravir + lamivudine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Integrase <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> +</strong></p>\n<p><strong>NRTI </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genvoya</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir alafenamide + <span class=\"customMeta\" data-dictid=\"64278bcc161692777187c826ba4b9f\">emtricitabine</span> + elvitegravir + cobicistat <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 NRTI + Integrase <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> + <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">Booster</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Odefsey</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir alafenamide + <span class=\"customMeta\" data-dictid=\"64278bcc161692777187c826ba4b9f\">emtricitabine</span> + rilpivirine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 NRTI + <span class=\"customMeta\" data-dictid=\"cb1ed03cf216927771938db7448f48\">NNRTI</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stribild</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir disoproxil <span class=\"customMeta\" data-dictid=\"0063169a1b1692777203ba89eb2363\">fumarate</span> + <span class=\"customMeta\" data-dictid=\"64278bcc161692777187c826ba4b9f\">emtricitabine</span> + elvitegravir + cobicistat<strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 NRTI + Integrase <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> + <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">Booster</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symfi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir disoproxil <span class=\"customMeta\" data-dictid=\"0063169a1b1692777203ba89eb2363\">fumarate</span> + <span class=\"customMeta\" data-dictid=\"548c02a1cf1692777191e70df694f8\">lamivudine</span> + efavirenz</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 NRTI + NNRTI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symtuza</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Darunavir + <span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\">tenofovir</span> alafenamid + <span class=\"customMeta\" data-dictid=\"64278bcc161692777187c826ba4b9f\">emtricitabine</span> +cobicistat</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protease <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> + 2 NRTI + <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triumeq</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abacavir + <span class=\"customMeta\" data-dictid=\"548c02a1cf1692777191e70df694f8\">lamivudine</span> + dolutegravir</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 NRTI + Integrase <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male with a history of IV drug use comes to the OPD due to a history of sudden weight loss, jaundice and weakness. Investigation led to a diagnosis of HIV coinfection with hepatitis B. After counselling, he was prescribed antiretroviral therapy for his HIV and HBV coinfection. Which of the following drugs is effective against both viruses?", "options": [{"label": "A", "text": "Efavirenz", "correct": false}, {"label": "B", "text": "Tenofovir", "correct": true}, {"label": "C", "text": "Abacavir", "correct": false}, {"label": "D", "text": "Ritonavir", "correct": false}], "correct_answer": "B. Tenofovir", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment for <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> and <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> co-infection </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ART containing <strong>TDF</strong> or <strong>TAF</strong> plus <strong>Emtricitabine</strong></p>\n<p><strong>Or </strong></p>\n<p>ART containing <strong>TDF</strong> or <strong>TAF</strong> plus <strong>Lamivudine</strong></p>\n<p><strong>Or </strong></p>\n<p>ART plus <strong>ETV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir Disoproxil <span class=\"customMeta\" data-dictid=\"0063169a1b1692777203ba89eb2363\">Fumarate</span> (<strong>TDF</strong>), <span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\">Tenofovir</span> Alafenamide (<strong>TAF</strong>), <span class=\"customMeta\" data-dictid=\"c1f6ef80e8169277718783cd5a61b3\">Entecavir</span> (ETV)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Drugs </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Dose </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Adverse effect </strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tenofovir </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300mg OD</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotoxicity, osteomalacia, <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">Hepatitis</span> flare-up in <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> coinfected patients who discontinue the drugs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emtricitabine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>200 mg OD</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatitis flare-up in <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> coinfected patients who discontinue the drugs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lamivudine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300 mg OD</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment for <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> and <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> co-infection </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ART containing <strong>TDF</strong> or <strong>TAF</strong> plus <strong>Emtricitabine</strong></p>\n<p><strong>Or </strong></p>\n<p>ART containing <strong>TDF</strong> or <strong>TAF</strong> plus <strong>Lamivudine</strong></p>\n<p><strong>Or </strong></p>\n<p>ART plus <strong>ETV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir Disoproxil <span class=\"customMeta\" data-dictid=\"0063169a1b1692777203ba89eb2363\">Fumarate</span> (<strong>TDF</strong>), <span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\">Tenofovir</span> Alafenamide (<strong>TAF</strong>), <span class=\"customMeta\" data-dictid=\"c1f6ef80e8169277718783cd5a61b3\">Entecavir</span> (ETV)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38 -year-old man is newly diagnosed with HIV. He is asymptomatic with a CD4 count of 650 cells/mm³; all other investigations show values within normal limits. Based on WHO recommendations, which of the following combinations of drugs should be the first line of drugs in his HAART?", "options": [{"label": "A", "text": "Zidovudine + Lamivudine + Raltegravir", "correct": false}, {"label": "B", "text": "Abacavir + Lamivudine + Lopinavir", "correct": false}, {"label": "C", "text": "Tenofovir + Lamivudine + Efavirenz", "correct": false}, {"label": "D", "text": "Tenofovir + Lamivudine + Dolutegravir", "correct": true}], "correct_answer": "D. Tenofovir + Lamivudine + Dolutegravir", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:604px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Antiretroviral therapy </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ART</strong> should include <strong>three drugs - from 2 different classes</strong> to prevent resistance and improve the <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> of the therapy</p>\n<ul>\n<li>2 NRTI + 1 NNRTI</li>\n<li>2 NRTI + 1 PI</li>\n<li>2 NRTI + 1 INI</li>\n</ul>\n<p>The only double drug therapy accepted by the FDA is <strong>Lamivudine + Dolutegravir. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Antiretroviral agents </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Side effects </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>NRTIs (Nucleoside)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abacavir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fatal <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reaction in HLA-B5701 +ve (Immediate Discontinuation of drug)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Emtricitabine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Skin discoloration </strong></li>\n<li><strong>Hepatotoxicity </strong>in <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> co-infection if the drug is stopped</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lamivudine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatotoxicity in <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> co-infection if the drug is stopped</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zidovudine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Granulocytopenia</li>\n<li>Lactic acidosis</li>\n<li><strong>Hepatotoxicity </strong></li>\n<li>Myopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Didanosine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Peripheral (stocking and glove) neuropathy</li>\n<li><strong>Pancreatitis</strong></li>\n<li>Diarrhoea</li>\n<li>Dry mouth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stavudine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lipodystrophy,</li>\n<li>Lactic acidosis</li>\n<li>Peripheral neuropathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>NRTIs (Nucleotide)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenofovir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osteomalacia</li>\n<li><strong>Nephrotoxic </strong></li>\n</ul>\n<p>Toxicity in <span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\">Tenofovir</span> disoproxil <span class=\"customMeta\" data-dictid=\"0063169a1b1692777203ba89eb2363\">fumarate</span> is less than <span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\">Tenofovir</span> alafenamide</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>NNRTIs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nevirapine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatotoxicity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Efavirenz</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Depression, <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">Lipid</span> changes and <strong>Hepatotoxicity</strong></li>\n<li>Headache</li>\n<li>Insomnia</li>\n<li>Neuropsychiatric symptoms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rilpivirine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Somnolence, <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">Vertigo</span> and <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> toxicity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Protease <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ritonavir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lipodystrophy syndrome </strong>(lipid abnormalities are prominent)</li>\n<li>Hyperglycemia and Hepatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atazanavir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nephrolithiasis, PR prolongation and <strong>Hepatotoxicity</strong></li>\n<li>Dyslipidaemia and other <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> complications are minimal with ATV</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indinavir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nephrolithiasis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Integrase <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dolutegravir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Insomnia and Hepatotoxicity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Raltegravir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CPK <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> and Rhabdomyolysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elvitegravir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Respiratory infections and GIT distress</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old immunocompromised patient presents with fever, cough, and respiratory distress. A CT scan of the chest reveals a finding, as shown in the image. Which of the following investigations would be the most sensitive to confirm a diagnosis of acute invasive aspergillosis?", "options": [{"label": "A", "text": "Serum IgE levels", "correct": false}, {"label": "B", "text": "Sputum culture for bacteria", "correct": false}, {"label": "C", "text": "Galactomannan antigen test from respiratory samples", "correct": true}, {"label": "D", "text": "HRCT", "correct": false}], "correct_answer": "C. Galactomannan antigen test from respiratory samples", "question_images": ["https://image.prepladder.com/notes/L9YoJO3NwYeqKeJWs8Rt1744271738.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 46-year-old male with a 10-year history of HIV presents for routine follow-up. He has been noncompliant with ART for the past 12 months. His labs show a CD4+ count of 198 cells/μL and a viral load of &amp;gt;100,000 copies/mL. Based on his lab values, which opportunistic infection is he at increased risk for?", "options": [{"label": "A", "text": "Toxoplasma gondii", "correct": false}, {"label": "B", "text": "Mycobacterium avium intracellulare", "correct": false}, {"label": "C", "text": "Cryptococcus neoformans", "correct": false}, {"label": "D", "text": "Pneumocystis jirovecii", "correct": true}], "correct_answer": "D. Pneumocystis jirovecii", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Opportunistic infection in <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> based on CD4+ count. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CD4+ count </strong></p>\n<p style=\"text-align: center;\"><strong>(cells/μL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathogen </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;250 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coccidioides immites</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reactive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> syndrome</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>&lt; 200 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumocystis</strong> jirovecii <strong> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pneumonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bartonella</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bartonellosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;150</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histoplasma</strong> capsulatum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reactive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> syndrome</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>&lt;100</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxoplasma</strong> gondii <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Toxoplasmosis<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryptococcus</strong> neoformans <strong> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cryptococcosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Penicillium marneffei</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Taralomycosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cytomegalovirus</strong> <strong>(CMV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CMV retinitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;50</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mycobacterium avium intracellulare</strong> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mycobacterium avium complex</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old male patient with a history of HIV arrives at the emergency room with altered mental status. He reports a week-long history of worsening headaches, fever, projectile vomiting, and confusion. His CD4+ count is 78 cells/μL. MRI and CSF microscopy reveal the following findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Progressive Multifocal leukoencephalopathy", "correct": false}, {"label": "B", "text": "Cryptococcal meningitis", "correct": true}, {"label": "C", "text": "Cerebral toxoplasmosis", "correct": false}, {"label": "D", "text": "Primary CNS Lymphoma", "correct": false}], "correct_answer": "B. Cryptococcal meningitis", "question_images": ["https://image.prepladder.com/notes/Q6oi2LmX5nx2Af6PX2dO1744275502.png", "https://image.prepladder.com/notes/afPE1mJirugeSm2YVSB51744275203.png"], "explanation_images": ["https://image.prepladder.com/notes/wKsrRjcdIVdDgjG6IYWO1744276321.png", "https://image.prepladder.com/notes/YmCZbIqteDLWjNg8EVDW1744276589.png", "https://image.prepladder.com/notes/KMo0CctI5DMwv7U4DBjs1744276736.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications of HIV/AIDS</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Central nervous system </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryptococcal meningitis</strong></p>\n<p><strong>(Option B)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Cryptococcal &lt;span class=\" custommeta\"=\"\" data-dictid=\"7d8f74eaae16927771928214d10c17\"/>meningitis MRI\" data-author=\"Frank Gaillard\" data-hash=\"8402\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/cryptococcosis\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/afPE1mJirugeSm2YVSB51744275203.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"5204097a961692777194904909b6fe\">opportunistic</span> infection by <span class=\"customMeta\" data-dictid=\"df1857b4a6169277718597e7b3325d\">Cryptococcus</span> neoformans</li>\n<li><strong>Clinical features: </strong>Headache, fever, projectile vomiting, <span class=\"customMeta\" data-dictid=\"4c49d9294a1692777193b0da95e3ce\">nuchal rigidity</span> and altered mental status.</li>\n<li><strong>Investigation:</strong>\n<ul>\n<li><strong>MRI:</strong> <strong>Soap bubble appearance </strong></li>\n<li><strong>CSF</strong>: India ink <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> positive</li>\n</ul>\n</li>\n<li><strong>Treatment</strong><strong>: <span class=\"customMeta\" data-dictid=\"2aca559df7169277718182de664e44\">Amphotericin B</span> and flucytosine</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cerebral toxoplasmosis</strong></p>\n<p><strong>(Option C)</strong></p>\n<figure class=\"caption_element\"><img alt=\"MRI showing Cerebral toxoplasmosis\" data-author=\"Jmarchn \" data-hash=\"8406\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Toxoplasmosis#/media/File:BrainToxoplasmosis_MRI_2_09.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/wKsrRjcdIVdDgjG6IYWO1744276321.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"5204097a961692777194904909b6fe\">opportunistic</span> infection by <strong>Toxoplasma gondii. </strong>(Reactivation of <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> T. gondii <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> in brain)</li>\n<li>Presents with <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> episodes of seizures</li>\n<li><strong>Investigations</strong>\n<ul>\n<li>CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> findings show multiple <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> areas with ring-enhancing lesions in the brain and <strong>Eccentric dot sign</strong> in <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia</li>\n<li>TOXO <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> positive</li>\n</ul>\n</li>\n<li><strong>Treatment:</strong> <strong>Pyrimethamine + <span class=\"customMeta\" data-dictid=\"8d61c0e3d516927771995457e14512\">Sulfadiazine</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> <span class=\"customMeta\" data-dictid=\"4bedf4cd6916927771914575b6a4b5\">leukoencephalopathy</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n<figure class=\"caption_element\"><img alt=\"MRI showing progressive &lt;span class=\" custommeta\"=\"\" data-dictid=\"225e0697ea1692777193892a2c34c7\"/>multifocal leukoencephalopathy\" data-author=\"radswiki.net \" data-hash=\"8407\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Progressive_multifocal_leukoencephalopathy#/media/File:Progressive_multifocal_leukoencephalopathy_002.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/o0ku6adk01X3IV7I3JEJ1744276390.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to the JV virus infection</li>\n<li>Presents with\n\t\t\t\t<ul>\n<li>Cognitive and motor skill dysfunction</li>\n<li>Vision problem</li>\n</ul>\n</li>\n<li>Investigations\n\t\t\t\t<ul>\n<li><strong>MRI: </strong><strong>Subcortical hyperintensity</strong> in T2 imaging</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> lymphoma</p>\n<p><strong>(Option D)</strong></p>\n<figure class=\"caption_element\"><img alt=\"MRI showing Primary &lt;span class=\" custommeta\"=\"\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\"/>CNS lymphoma\" data-author=\"Tdvorak\" data-hash=\"8408\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Tumor_PrimaryCNSLymphoma_T2.JPG\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Eh8DHeKS3Kufe6vpdsZm1744276459.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MRI shows a <strong>single </strong><strong>homogenous</strong><strong> </strong>enhancement (not Ring like as in <span class=\"customMeta\" data-dictid=\"d47433201516927772009cacb59295\">Toxoplasmosis</span> brain )<strong> large space-occupying lesion</strong> with <span class=\"customMeta\" data-dictid=\"11181a4ee0169277719515c3680afc\">perilesional</span> oedema</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gastrointestinal tract</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Candidiasis</p>\n<figure class=\"caption_element\"><img alt=\"Oral Candidiasis\" data-author=\"James Heilman, MD\" data-hash=\"8409\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Oral_candidiasis#/media/File:Human_tongue_infected_with_oral_candidiasis.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/YmCZbIqteDLWjNg8EVDW1744276589.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> and <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">Tracheal</span> candidiasis</li>\n<li>Presents with odynophagia</li>\n<li>Treatment: <strong>IV <span class=\"customMeta\" data-dictid=\"e3d616618b16927772022df400a411\">fluconazole</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Black <span class=\"customMeta\" data-dictid=\"a4789768d21692777188e77f1969cd\">hairy</span> tongue </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Black &lt;span class=\" custommeta\"=\"\" data-dictid=\"a4789768d21692777188e77f1969cd\"/>hairy tongue\" data-author=\"Zay Yar Aung, Muhammad Samar Iqbal, Abobakr Fahdawi\" data-hash=\"8412\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Black-hairy-tongue-at-first-presentation_fig1_380128100\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/sXcCfjJVAcwSLNsfnUQ01744276666.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to the Ebstein-Barr virus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic diarrhoea </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"222b7544241692777185e20e3e3c75\">Cryptosporidium</span> or <span class=\"customMeta\" data-dictid=\"90ef4b285516927771904a048947de\">Isospora</span> Belli</li>\n<li>Investigation: <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">Microscopy</span> reveals\n\t\t\t\t<ul>\n<li>Cyst &lt; 10 μm - Cryptosporidium</li>\n<li>Larger <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> - <span class=\"customMeta\" data-dictid=\"90ef4b285516927771904a048947de\">Isospora</span> belli</li>\n</ul>\n</li>\n<li>Treatment\n\t\t\t\t<ul>\n<li>Cryptosporidium: <strong>Nitazoxanide </strong></li>\n<li>Isospora: <strong>Cotrimoxazole </strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Neoplastic diseases </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kaposi sarcoma</strong></p>\n<figure class=\"caption_element\"><img alt=\"Kaposi sarcoma\" data-author=\"OpenStax College - Anatomy &amp; Physiology\" data-hash=\"8413\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Kaposi%27s_sarcoma#/media/File:Kaposis_Sarcoma_Lesions.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/KMo0CctI5DMwv7U4DBjs1744276736.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <strong>HHV-8</strong></li>\n<li>Vascular tumours on the skin, <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> or organs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Hodgkin's <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immunoblastic lymphoma</li>\n<li>Burkitt’s lymphoma</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> lymphoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Respiratory system</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumocystis <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <strong>pneumocystis jirovecii </strong></li>\n<li>Presents with non-productive cough, fever and weight loss</li>\n<li>Investigation\n\t\t\t\t<ul>\n<li>CXR: <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> <span class=\"customMeta\" data-dictid=\"b78b1bdf6c1692777195170be3d18f\">perihilar</span> opacities</li>\n<li>Beta-1,3-glucan test positive</li>\n<li>Broncho-alveolar <span class=\"customMeta\" data-dictid=\"b625b3e881169277719169ef4e1af3\">Lavage</span> (BAL): Giemsa <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> or <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> shows oval-shaped fungi.</li>\n</ul>\n</li>\n<li>Treatment: <strong>Trimethoprim-sulfamethoxazole </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Others </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HIV associated Nephropathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CVS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myocardial infarction, cardiomyopathy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman with a history of intravenous drug use is screened for HIV using EIA, which returns reactive. What is the preferred next step according to new CDC guidelines?", "options": [{"label": "A", "text": "Perform a rapid HIV test", "correct": false}, {"label": "B", "text": "Repeat the EIA", "correct": false}, {"label": "C", "text": "Conduct a Nucleic Acid Test", "correct": false}, {"label": "D", "text": "Perform a differentiation immunoassay", "correct": true}], "correct_answer": "D. Perform a differentiation immunoassay", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old man presents to the clinic with symptoms of fever, fatigue, and swollen lymph nodes. He reports multiple high-risk sexual encounters. What is the most appropriate initial test to diagnose HIV infection?", "options": [{"label": "A", "text": "CD4 count", "correct": false}, {"label": "B", "text": "Western Blot", "correct": false}, {"label": "C", "text": "Nucleic acid test (NAT)", "correct": false}, {"label": "D", "text": "ELISA", "correct": true}], "correct_answer": "D. ELISA", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/jtMBPvdErWI0l9SrXs7A1744274513.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations to diagnose HIV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4th generation <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">Enzyme</span> immunoassay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This detects both the <strong>HIV antibodies</strong> (HIV 1 &amp; <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> 2) and the <strong>HIV p24 <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> </strong></li>\n<li>It is used for the<strong> initial screening </strong>of the disease</li>\n<li><strong>p24 <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> </strong>can be <strong>detected 16 days</strong> after primary infection</li>\n<li><strong>It is highly sensitive</strong> with a sensitivity of &gt; 99.5%, but not very specific and false positive reports can be seen in,\n\t\t\t\t<ul>\n<li>Pregnancy</li>\n<li>Transplantation</li>\n<li>Recent <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infection</li>\n<li>HIV vaccine administration</li>\n<li>Influenza vaccination</li>\n<li>Blood transfusion</li>\n<li>Autoimmune disorders</li>\n<li>Liver disease</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3rd generation <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">Enzyme</span> immunoassay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This primarily focuses on <strong>HIV <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> detection</strong></li>\n<li>Antibodies can be <strong>detected by 3 - 6 weeks</strong> following infection <strong>(around 22 days)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nucleic acid tests (NAT)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This detects the presence of<strong> <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> RNA</strong> in the blood.</li>\n<li>It helps in the<strong> early diagnosis</strong> and shows positive reports within 12 days of infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Western <span class=\"customMeta\" data-dictid=\"2bc990c16116927771830255971ff6\">blot</span> test</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Western <span class=\"customMeta\" data-dictid=\"2bc990c16116927771830255971ff6\">blot</span> is mainly used to <strong>confirm positive results</strong> from initial screening tests (ELISA)</li>\n<li>This is the<strong> most specific test.</strong></li>\n<li>This will show positive reports only after 30 days of acquiring the infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other tests used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CD4 count</strong> is used to monitor immune function and disease <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> in individuals diagnosed with HIV<strong> (Option A) </strong></li>\n<li><strong>OraQuick</strong><strong>: </strong>It is a rapid test that can be done at home. If it is positive, a confirmatory lab test should be performed.</li>\n<li><strong>LFT</strong> to monitor liver function as the drugs used in this condition can affect the liver.</li>\n<li><strong>RT-PCR assay</strong>: detects <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> RNA.</li>\n<li>Monitoring <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> levels and blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> to assess the risk of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> complications.</li>\n<li><strong>HIV DNA testing.</strong></li>\n<li><strong>PPD Testing</strong>: to evaluate for <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Investigations to diagnose HIV\" data-author=\"NA\" data-hash=\"8401\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"500\" src=\"https://image.prepladder.com/notes/jtMBPvdErWI0l9SrXs7A1744274513.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 43-year-old man arrives at the emergency department with significant weight loss over the past three months, persistent fever, night sweats, severe fatigue, recent oral thrush, and persistent diarrhoea for the last month. He has a history of HIV, which was diagnosed five years ago. Which CD4 count indicates progression to AIDS according to CDC guidelines?", "options": [{"label": "A", "text": "300/μL", "correct": false}, {"label": "B", "text": "250/μL", "correct": false}, {"label": "C", "text": "220/μL", "correct": false}, {"label": "D", "text": "180/μL", "correct": true}], "correct_answer": "D. 180/μL", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical stages of HIV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It usually happens <strong>after 3 to 6 weeks</strong> of primary infection</li>\n<li>Patients may present with varying symptoms and can also show neurologic and <span class=\"customMeta\" data-dictid=\"193e0fc1471692777186c661338b8e\">dermatological</span> involvement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is also called <strong>asymptomatic <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection</strong> or clinical latency.</li>\n<li>Patients can be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> during this stage but can still transmit the virus.</li>\n<li>If left untreated, the patient can <strong>progress to AIDS in around 10 years or even faster.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AIDS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This is a <strong>severe stage</strong> where life-threatening complications can occur</li>\n<li>Diagnosis is made if CD4 count is &lt; 200/μL in individuals above 6 years of age with a history of HIV</li>\n<li>These people have a <strong>high <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> load and can easily transmit</strong> the virus.</li>\n<li>Without treatment for HIV, the progress is bad.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CDC <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> based on CD4 count</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age: &gt; 6 years </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age: 1 - 5 years </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age: &lt; 1 year</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 500/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥1,000/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥1,500/μL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>200-499/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>500 - 999/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>750–1,499/μL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 200/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 500/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 750/μL</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 53-year-old man visits the clinic with recurring respiratory infections and oral candidiasis. Lab tests show a CD4 count of 150 cells/mm³, raising suspicion for HIV. Which structure allows the HIV virus to attach to CD4 cells initially?", "options": [{"label": "A", "text": "CCR5", "correct": false}, {"label": "B", "text": "gp41", "correct": false}, {"label": "C", "text": "p17", "correct": false}, {"label": "D", "text": "gp120", "correct": true}], "correct_answer": "D. gp120", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/COMZ93RbGwnuK8FCEovD1744274145.png", "https://image.prepladder.com/notes/YPyp5RZCSenqMiBVTTjI1744274245.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 31-year-old woman diagnosed with HIV is in her third trimester of pregnancy. Which of the following statements is not true regarding vertical transmission of HIV?", "options": [{"label": "A", "text": "ART greatly lowers the risk of vertical transmission.", "correct": false}, {"label": "B", "text": "Transmission can occur through breast milk.", "correct": false}, {"label": "C", "text": "Prolonged membrane rupture increases transmission risk.", "correct": false}, {"label": "D", "text": "Viral transmission does not occur in the first trimester.", "correct": true}], "correct_answer": "D. Viral transmission does not occur in the first trimester.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Routes of Transmission of <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sexual contact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Receptive and insertive anal intercourse</li>\n<li>Receptive and insertive penile-vaginal intercourse</li>\n<li>Oral intercourse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parenteral route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood transfusion</li>\n<li>Needle-sharing (IV drugs)</li>\n<li>Occupational exposure (e.g., needle stick injuries)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertical transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mother to child (the <strong>best test for identifying vertical transmission</strong> is <strong>HIV <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> DNA</strong>).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of HIV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HIV 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This is the <strong>most common</strong> and widespread type of HIV</li>\n<li>Comparatively, this type <strong>progresses more rapidly</strong> to AIDS (10 years)</li>\n<li>HIV-1 group M commonly causes the AIDS pandemic, and its <strong>subtype C is common in India.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HIV 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This type is less common and mainly <strong>found in Africa</strong></li>\n<li>Progression to AIDS is usually in 15 - 20 years</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old asthmatic patient presents with worsening respiratory symptoms and is diagnosed with Allergic Bronchopulmonary Aspergillosis (ABPA). Which of the following is the most appropriate initial treatment strategy?", "options": [{"label": "A", "text": "High-dose corticosteroids alone", "correct": false}, {"label": "B", "text": "Itraconazole with low-dose corticosteroids", "correct": true}, {"label": "C", "text": "Fluconazole with corticosteroids", "correct": false}, {"label": "D", "text": "Posaconazole", "correct": false}], "correct_answer": "B. Itraconazole with low-dose corticosteroids", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman with asthma has worsening respiratory symptoms. Lab tests show a positive skin-prick test for Aspergillus fumigatus . Which findings are least likely associated with Allergic Bronchopulmonary Aspergillosis (ABPA)?", "options": [{"label": "A", "text": "Elevated total serum IgE", "correct": false}, {"label": "B", "text": "Central bronchiectasis on HRCT", "correct": false}, {"label": "C", "text": "Presence of hyper-attenuated mucus on imaging", "correct": false}, {"label": "D", "text": "Nodular infiltrates on chest X-ray", "correct": true}], "correct_answer": "D. Nodular infiltrates on chest X-ray", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 15 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A clinician notes relative bradycardia in a patient with fever and respiratory symptoms. Which of the following infections is most commonly associated with relative bradycardia?", "options": [{"label": "A", "text": "Brucellosis", "correct": true}, {"label": "B", "text": "Influenza", "correct": false}, {"label": "C", "text": "Streptococcal Pharyngitis", "correct": false}, {"label": "D", "text": "Tuberculosis", "correct": false}], "correct_answer": "A. Brucellosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male presents with a history of fever, malaise, and abdominal discomfort. His temperature has been rising stepwise over the past five days. Physical examination reveals bradycardia and a faint rash on the abdomen. Blood cultures are positive for Salmonella typhi . Based on the diagnosis, what is the most likely fever pattern?", "options": [{"label": "A", "text": "Intermittent fever", "correct": false}, {"label": "B", "text": "Remittent fever", "correct": false}, {"label": "C", "text": "Pel-Ebstein fever", "correct": false}, {"label": "D", "text": "Sustained fever", "correct": true}], "correct_answer": "D. Sustained fever", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/5Ew7tF8ywSZDarJtqr8R1744285208.png", "https://image.prepladder.com/notes/5rUf7R4tkjMDXpfvhcMS1745564214.png", "https://image.prepladder.com/notes/846unk5qgeWZFm9A3Rab1745564238.png", "https://image.prepladder.com/notes/BxjmOnmM0k2tbe67BphC1744376006.png", "https://image.prepladder.com/notes/tDrtHXNo7S7w7ALipVT41744285290.png", "https://image.prepladder.com/notes/yWBoXnWy3eWtI4I3LytG1744285399.png", "https://image.prepladder.com/notes/90pwuXzHf2allpNhdaNI1744285479.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:665px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fever Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fever Graph</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sustained Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous elevated temperature.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typhoid fever, tuberculosis, bacterial pneumonia, neoplasms, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue diseases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Sustained Fever\" data-author=\"A7N8X\" data-hash=\"11256\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Febbre.gif\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/5rUf7R4tkjMDXpfvhcMS1745564214.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intermittent Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever spikes followed by normal temperature. <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malaria, brucellosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Intermittent Fever\" data-author=\"A7N8X\" data-hash=\"11257\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Febbre.gif\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/846unk5qgeWZFm9A3Rab1745564238.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Remittent Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever fluctuates above normal without returning to baseline. <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> diseases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Remittent Fever\" data-author=\"A7N8X\" data-hash=\"9403\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Febbre.gif\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/BxjmOnmM0k2tbe67BphC1744376006.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hectic Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High temperatures with wide fluctuations.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe infections like bacteremia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pel-Ebstein Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weeks of high fevers followed by normal periods. <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hodgkin's disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Double Quotidian Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two fever spikes within 24 hours.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adult Still's disease, malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Double Quotidian Fever\" data-author=\"Jack Edelbrock, 2018\" data-hash=\"8497\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Fever_Patterns_v1.2.svg\" data-tags=\"April2025\" height=\"99\" src=\"https://image.prepladder.com/notes/tDrtHXNo7S7w7ALipVT41744285290.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tertian Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever occurs every third day.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Tertian Fever\" data-author=\"Jack Edelbrock, 2018\" data-hash=\"8498\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Fever_Patterns_v1.2.svg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/yWBoXnWy3eWtI4I3LytG1744285399.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quartan Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever occurs every fourth day.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Quartan Fever\" data-author=\"Jack Edelbrock, 2018\" data-hash=\"8500\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Fever_Patterns_v1.2.svg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/90pwuXzHf2allpNhdaNI1744285479.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Periodic Fever Syndromes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular intervals of fever episodes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cyclic neutropenia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fever Pattern Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><em>P. vivax</em>/<em>P. ovale</em>: <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> days;</li>\n<li><em>P. malariae</em>: every third day;</li>\n<li><em>P. falciparum</em>: no specific pattern</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous or \"saddle-back\" fever with breaks on days 4-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yellow Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recrudescence after initial resolution with back pain, jaundice</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Louse-borne Relapsing Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crisis after 4-10 days, profuse sweating, possible relapses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Typhoid Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stepladder rise over 4-5 days with <span class=\"customMeta\" data-dictid=\"851667fa1916927771918db28ab877\">malaise</span> and headaches</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about malarial fever is incorrect?", "options": [{"label": "A", "text": "Quotidian fever is associated with P. falciparum infection .", "correct": false}, {"label": "B", "text": "Tertian fever occurs every 48 hours.", "correct": false}, {"label": "C", "text": "Quartan fever is linked to P. malariae.", "correct": false}, {"label": "D", "text": "Quotidian fever is associated with P. ovale.", "correct": true}], "correct_answer": "D. Quotidian fever is associated with P. ovale.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Type of Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Quotidian Fever</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Fever occurs once every day, and it will touch the baseline.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>P. falciparum, P. knowlesi</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tertian Fever </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Fever is occurring every 48 hours.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>P. vivax, P. ovale</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Quartan Fever </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Fever will occur after every 72 hours.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>P. malariae</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents to the emergency department with a fever of 38.5°C (101.3°F) that has persisted for three weeks. He reports significant weight loss, night sweats, and fatigue. His medical history is unremarkable. On physical examination, he has splenomegaly and mild lymphadenopathy. Which investigation would be the most appropriate next step in this patient's management?", "options": [{"label": "A", "text": "Chest X-ray", "correct": false}, {"label": "B", "text": "Blood culture", "correct": false}, {"label": "C", "text": "CT scan of the abdomen and pelvis", "correct": true}, {"label": "D", "text": "HIV test", "correct": false}], "correct_answer": "C. CT scan of the abdomen and pelvis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:639px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Other Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Infections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Tuberculosis (military or <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> / extra-pulmonary)</li>\n<li>Endocarditis (culture negative)</li>\n<li>Deep-seated infections (abscesses, prostatitis, etc.)</li>\n<li>Typhoidal and non-typhoidal Salmonella</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Emerging Infections:</strong> HIV, Leishmaniasis, Melioidosis</li>\n<li><strong>Travelers: </strong>Malaria, Visceral leishmaniasis, Histoplasmosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Neoplasms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Malignant lymphomas</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Renal-cell carcinoma, <span class=\"customMeta\" data-dictid=\"6165f47a8c1692777188c0dfc0d75d\">hepatocellular</span> cancer</li>\n<li>Ovarian cancer, atrial myxoma</li>\n<li>Castleman disease, brain tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Auto-inflammatory and <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">Autoimmune</span> Disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Giant-cell arteritis, <span class=\"customMeta\" data-dictid=\"0e5d74e10b1692777196c6affd7d4f\">Polymyalgia</span> rheumatica <strong>(elderly)</strong></li>\n<li>Adult-onset Still's disease <strong>(younger)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease, certain types of uveitis, Behçet's syndrome</li>\n<li>Rheumatoid arthritis, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus, dermatomyositis, polymyositis</li>\n<li>PAN, small vessel vasculitis, FMF</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Miscellaneous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Granulomatous: Kikuchi disease, Sarcoidosis, <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">Granulomatous</span> hepatitis</li>\n<li>Vascular: atrial myxoma, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> emboli, hematomas</li>\n<li>Endocrine: thyrotoxicosis, thyroiditis, Pheochromocytoma</li>\n<li>Hematologic: HUS, TTP</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Cirrhosis, Pancreatitis, <span class=\"customMeta\" data-dictid=\"98767344c416927772029bda6246f7\">Factitious</span> fever</li>\n<li>Drug fever (3-7% of <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> episodes in hospitalized patients; 1/3 due to antibiotics - beta-lactams)</li>\n<li>DRESS, Hyperthermic drug syndromes (NMS, <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">Serotonin</span> syndrome)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not considered an autoinflammatory syndrome?", "options": [{"label": "A", "text": "Familial Mediterranean fever", "correct": false}, {"label": "B", "text": "Adult-onset Still's disease", "correct": false}, {"label": "C", "text": "Rheumatoid arthritis", "correct": true}, {"label": "D", "text": "Cryopyrin-associated periodic syndromes", "correct": false}], "correct_answer": "C. Rheumatoid arthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Systemic Rheumatic and <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">Autoimmune</span> Diseases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Ankylosing spondylitis</li>\n<li>Behçet's disease</li>\n<li>Mixed connective-tissue disease</li>\n<li>Rheumatoid arthritis</li>\n<li>Sjögren's syndrome</li>\n<li>SLE</li>\n<li>Vogt-Koyanagi-Harada syndrome(VKH Syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Vasculitis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Allergic vasculitis</li>\n<li>Eosinophilic <span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\">granulomatosis</span> with polyangiitis</li>\n<li>Giant cell vasculitis/polymyalgia rheumatica</li>\n<li>Granulomatosis with polyangiitis</li>\n<li>Kawasaki disease</li>\n<li>Polyarteritis nodosa</li>\n<li>Takayasu arteritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Granulomatous Diseases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Idiopathic <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> hepatitis, sarcoidosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Autoinflammatory Syndromes <strong>(Option A, B, and D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Adult-onset Still's disease</li>\n<li>CAPS (cryopyrin-associated <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">periodic</span> syndromes)</li>\n<li>Familial Mediterranean fever</li>\n<li>Hyper-IgD syndrome (HIDS, also known as <span class=\"customMeta\" data-dictid=\"9bfcbd8e7916927771925fb3367a47\">mevalonate</span> <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> deficiency)</li>\n<li>PAPA syndrome (pyogenic <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> arthritis, <span class=\"customMeta\" data-dictid=\"089ef1b1bf169277719626559c2930\">pyoderma</span> gangrenosum, and acne)</li>\n<li>PFAPA syndrome (periodic fever, <span class=\"customMeta\" data-dictid=\"c267cc6e5716927771818c84304bbe\">aphthous</span> stomatitis, pharyngitis, adenitis)</li>\n<li>SAPHO (synovitis, acne, pustulosis, hyperostosis, osteomyelitis)</li>\n<li>TRAPS (tumor <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> factor receptor-associated <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">periodic</span> syndrome)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presents with a fever of 39°C that has persisted for the past five days. She reports severe muscle pain, nausea, and retroorbital pain. On examination, she has mild dehydration and a positive tourniquet test. Which of the following investigations would be most appropriate to confirm the diagnosis?", "options": [{"label": "A", "text": "Complete blood count", "correct": false}, {"label": "B", "text": "NS-1 Antigen test", "correct": true}, {"label": "C", "text": "Blood culture", "correct": false}, {"label": "D", "text": "Liver function tests", "correct": false}], "correct_answer": "B. NS-1 Antigen test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:587px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Test Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>ELISA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>IgM <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> virus (MAC-ELISA)</li>\n<li><strong>Positive by Day 4 of infection</strong></li>\n<li>Indicates recent infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>NAAT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Detects <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> RNA</li>\n<li>Useful for early diagnosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>NS-1 Antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>NS-1 (IgG)</li>\n<li>Positive on Day 1 of infection</li>\n<li>Should be performed within 7 days of symptom onset</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old male presents with a one-week history of fever, headache, retro-orbital pain, and myalgia. Skin examination reveals multiple purpura and petechiae on the left shoulder, trunk, and legs. Similar cases have been reported linked to increased incidence of mosquito breeding. What is the most common neurological complication associated with this condition?", "options": [{"label": "A", "text": "Encephalopathy", "correct": true}, {"label": "B", "text": "Guillain-Barré Syndrome", "correct": false}, {"label": "C", "text": "Stroke", "correct": false}, {"label": "D", "text": "Encephalitis", "correct": false}], "correct_answer": "A. Encephalopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dengue encephalopathy</strong> is <strong>most commonly encountered neurological complication</strong> of <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> virus <strong>(Option A)</strong>\n<ul>\n<li>linked primarily to <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> hemorrhagic fever and <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> shock syndrome</li>\n<li>EEG may show abnormalities such as burst <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> and seizures</li>\n<li>CSF profiles typically remain normal.</li>\n<li>Neuroimaging can be normal or reveal <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> cerebral edema.</li>\n</ul>\n</li>\n<li><strong>Encephalitis (Option D ruled out)</strong></li>\n<li><strong>GBS (Option B ruled out)</strong></li>\n<li><strong>Stroke (Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiomyopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dengue virus-induced dilated <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> should always be considered if a <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> fever patient has <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> shock and signs and symptoms of congestive heart failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver involvement in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> is a crucial feature</li>\n<li>The effect ranges from an <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> rise in liver enzymes to the development of ALF</li>\n<li>The <strong>most common <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> manifestation</strong> reported was hepatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumonia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Staphylococcus <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> is an important accompanying problem seen in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> patient</li>\n<li>co-infection between <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> and <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> can result in <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of pneumonia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orchitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orchitis usually occurs together with epididymitis</li>\n<li>Commonly seen in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> between 14 and 35 years of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Hemorrhagic Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All of the following:</p>\n<ul>\n<li>Acute onset of fever</li>\n<li>2-7 days duration</li>\n<li>Hemorrhagic manifestations\n\t\t\t\t<ul>\n<li>Positive <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> test/Petechiae</li>\n<li>Ecchymosis</li>\n<li>Purpura/Bleeding from mucosa, GIT, <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">Injection</span> sites, etc</li>\n</ul>\n</li>\n<li>Platelet count ≤ 100,000 cells/cu.mm.</li>\n<li>Plasma leakage\n\t\t\t\t<ul>\n<li>Rising hematocrit\n\t\t\t\t\t<ul>\n<li>Hemoconcentration &gt;20%</li>\n</ul>\n</li>\n<li>Pleural effusion, ascites/Hypoproteinemia)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Shock Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DHF criteria plus Signs of Shock</li>\n<li>Tachycardia/Cool extremities/Weak pulse/Lethargy/Restlessness</li>\n<li>Pulse pressure &lt;20 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> with increased <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">Diastolic pressure</span> (e.g. 100/80)</li>\n<li>Hypotension (Systolic &lt;80 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for age &lt;5 years/80-90 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for older child and adults)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents with a fever of 39°C for the past three days. She reports muscle aches and mild retro-orbital pain but denies any gastrointestinal symptoms. On examination, she is alert, has a dry mouth, and a rash on her trunk, and her vital signs are stable. She has passed urine twice in the last six hours. Which of the following treatments is most appropriate for her management?", "options": [{"label": "A", "text": "Start intravenous fluids", "correct": false}, {"label": "B", "text": "Administer ORS and paracetamol", "correct": true}, {"label": "C", "text": "Prescribe aspirin for fever", "correct": false}, {"label": "D", "text": "Admit to the hospital for observation", "correct": false}], "correct_answer": "B. Administer ORS and paracetamol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Group A (Outpatient)</strong></p>\n<ul>\n<li>No warning signs:\n\t\t\t\t<ul>\n<li>Abdominal pain or tenderness</li>\n<li>Persistent vomiting</li>\n<li>Clinical fluid accumulation</li>\n<li>Mucosal bleed</li>\n<li>Lethargy or restlessness</li>\n<li>Liver <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> &gt; 2 cm</li>\n<li>Hematocrit count Rise &gt;20% admission value</li>\n<li>Rapid decrease in <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count</li>\n</ul>\n</li>\n<li>And who are able to:\n\t\t\t\t<ul>\n<li>Tolerate adequate volumes of oral fluids</li>\n<li>To pass <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> at least once every 6 hours</li>\n</ul>\n</li>\n</ul>\n<p><strong>Treatment</strong></p>\n<ul>\n<li>Plenty of fluids- ORS, <span class=\"customMeta\" data-dictid=\"ab713160f416927771845c2837bebe\">coconut</span> water (avoid <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> plain water)</li>\n<li>Paracetamol(500-650 mg per dose) for high fever\n\t\t\t\t<ul>\n<li>Dosing should not be less than six hours</li>\n</ul>\n</li>\n<li>Tepid <span class=\"customMeta\" data-dictid=\"1f8d123d5a16927771996d6f75145f\">sponge</span> if the patient still has high fever</li>\n<li>Don't take: aspirin, ibuprofen, <span class=\"customMeta\" data-dictid=\"5877dd8a5b1692777186ba75f558a9\">diclofenac</span> or mefenamic acid<strong> (Option C ruled out)</strong></li>\n<li>Report to hospital immediately if\n\t\t\t\t<ul>\n<li>Bleeding</li>\n<li>Vomiting</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> pain</li>\n<li>Drowsiness</li>\n<li>Breathing difficulty</li>\n<li>Not passing <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> &gt; 6 hours</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Group B (Inpatient)</strong></p>\n<ul>\n<li>Warning signs present or</li>\n<li><strong>Coexisting:</strong>\n<ul>\n<li>Pregnancy, infancy, old age</li>\n<li>Obesity, diabetes mellitus, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> diseases or</li>\n</ul>\n</li>\n<li><strong>Social:</strong>\n<ul>\n<li>Living alone or living far from a health facility without reliable means of transport</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Treatment for &lt;span class=\" custommeta\"=\"\" data-dictid=\"75dc439beb16927771857bde5104df\"/>Dengue GROUP (B)\" data-author=\"NA\" data-hash=\"8501\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"625\" src=\"https://image.prepladder.com/notes/1qshjXRP86UcXAEdMBkg1744285658.png\" width=\"600\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Note: Group C (ICU)</strong></p>\n<ul>\n<li>For Hemodynamically unstable Dengue</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the hospital with fever, muscle aches, vomiting, and respiratory distress after consuming contaminated palm sap in a region known for bat activity. Laboratory tests reveal elevated white blood cell counts in his cerebrospinal fluid. Based on the clinical presentation and diagnostic findings, which of the following statements regarding Nipah virus infection is correct?", "options": [{"label": "A", "text": "The virus is primarily transmitted from human to human through respiratory droplets.", "correct": false}, {"label": "B", "text": "Supportive care is the mainstay of treatment, as there are no approved antiviral therapies specifically for Nipah virus.", "correct": true}, {"label": "C", "text": "The incubation period for Nipah virus infection is usually less than 4 days.", "correct": false}, {"label": "D", "text": "Ribavirin is the first-line antiviral treatment with established efficacy in humans.", "correct": false}], "correct_answer": "B. Supportive care is the mainstay of treatment, as there are no approved antiviral therapies specifically for Nipah virus.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PCR for <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> detection</li>\n<li>ELISA for <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> and <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> antibodies</li>\n<li>CSF analysis for elevated <span class=\"customMeta\" data-dictid=\"09be7d1f11169277720210bf5b0280\">WBC</span> or protein levels</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging Studies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MRI or CT scans to assess neurological involvement (not specific for NiV)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:574px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ribavirin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed results; <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> remains controversial <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>m102.4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monoclonal antibody, promising in animal studies, used compassionately in humans</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Favipiravir</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Under investigation, requires further validation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Remdesivir</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Under investigation, requires further validation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents with fever, conjunctivitis, and a maculopapular rash after returning from a trip to Central America. Her clinical presentation is suggestive of Zika virus infection. Which of the following statements about Zika virus (ZIKV) is true?", "options": [{"label": "A", "text": "Transmitted only through infected bodily fluids.", "correct": false}, {"label": "B", "text": "Incubation period is 1 to 3 days.", "correct": false}, {"label": "C", "text": "Complications include microcephaly and Guillain–Barré syndrome.", "correct": true}, {"label": "D", "text": "Reliable diagnosis via serology in the first week.", "correct": false}], "correct_answer": "C. Complications include microcephaly and Guillain–Barré syndrome.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/xRT4RWcAXuMJY7lKbZy91744285796.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:532px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>3–12 days <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptomatic presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever, arthralgia, conjunctivitis, <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Possible complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Guillain–Barré syndrome</strong></li>\n<li>Congenital microcephaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> issues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cerebral calcification</li>\n<li>Deafness</li>\n<li>Vision problems</li>\n<li>Joint contractures (arthrogryposis)</li>\n<li>Hydrops fetalis</li>\n<li>Growth retardation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infection target</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neural progenitor cells</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Test Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Routine blood tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible leucopenia, thrombocytopenia, or elevated transaminases (often normal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PCR test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects ZIKV in blood (first week) or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (up to 14 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Retrospective diagnosis; cross-reactivity with other flaviviruses <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plaque-reduction neutralisation testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects virus-specific neutralising antibodies to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> primary infections.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:567px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prevention Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Recommendations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mosquito bite prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary method to avoid infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sexual health precautions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infected individuals: safe sex for 6 months</p>\n<p>Delay pregnancy for 6 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asymptomatic travelers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Safe sex and avoid pregnancy for 2 months after returning</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaccination status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No vaccine currently available</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old male presents with progressive bilateral lower limb weakness over the past 10 days. On examination, he has flaccid paralysis and absent deep tendon reflexes in the affected limbs. Cerebrospinal fluid (CSF) analysis reveals a normal white cell count with elevated protein levels. Nerve conduction studies confirm a demyelinating pattern. Based on the Brighton criteria, which level of diagnostic certainty for Guillain-Barré syndrome (GBS) does this patient fulfill?", "options": [{"label": "A", "text": "Level 1", "correct": true}, {"label": "B", "text": "Level 2", "correct": false}, {"label": "C", "text": "Level 3", "correct": false}, {"label": "D", "text": "Level 4", "correct": false}], "correct_answer": "A. Level 1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No alternative diagnosis for weakness</li>\n<li>Diminished/absent deep <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> reflexes in weak limbs</li>\n<li>Monophasic course: onset to nadir within 12 hours to 28 days</li>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"d28003a82c1692777202475273e346\">flaccid</span> limb weakness</li>\n<li>CSF cell count &lt; 50 cells/microlitre</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> protein concentration</li>\n<li>Nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> study (NCS) consistent with <span class=\"customMeta\" data-dictid=\"aa23182e651692777188296980e246\">GBS</span> subtype</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>All Level 1 criteria met, with possible variations (e.g., present reflexes in some cases). <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most Level 1 criteria <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> but lacking one or more key features. <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Minimal criteria were met; these may include <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> or incomplete presentations. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old HIV-positive patient presents with fever, dry cough, and progressive shortness of breath. His CD4+ count is 150 cells/mm³. Chest X-ray shows bilateral interstitial infiltrates. Which of the following is the most likely mechanism of infection in this patient?", "options": [{"label": "A", "text": "Primary infection acquired from a contaminated water source", "correct": false}, {"label": "B", "text": "Airborne transmission from an infected individual", "correct": true}, {"label": "C", "text": "Ingestion of fungal spores from environmental reservoirs", "correct": false}, {"label": "D", "text": "Reactivation of a previously dormant infection acquired during childhood", "correct": false}], "correct_answer": "B. Airborne transmission from an infected individual", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with HIV presents with low-grade fever, nonproductive cough, and progressive shortness of breath over the past month. His HRCT shows bilateral ground-glass opacities. Which of the following statements correctly differentiates PCP in HIV-infected patients from non-HIV individuals?", "options": [{"label": "A", "text": "PCP in HIV-infected patients usually present with acute onset and severe oxygenation impairment.", "correct": false}, {"label": "B", "text": "Non-HIV patients with PCP experience a gradual onset with mild respiratory distress.", "correct": false}, {"label": "C", "text": "HIV-infected individuals typically have a chronic presentation with milder respiratory distress initially.", "correct": true}, {"label": "D", "text": "Mortality in HIV-infected PCP cases is higher (30-60%) compared to non-HIV individuals.", "correct": false}], "correct_answer": "C. HIV-infected individuals typically have a chronic presentation with milder respiratory distress initially.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HIV-Infected Patients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-HIV Patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual (2 weeks to 2 months) <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden (within a week) <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptom Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Milder <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> initially</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxygen Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less severe <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More severe</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:403px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mortality Rate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-HIV Patients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30%–60% <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HIV-Infected Patients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10%–20%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old immunocompromised patient presents with a persistent cough, dyspnea, and fever. A chest X-ray shows bilateral infiltrates. Sputum examination is inconclusive, and a bronchoalveolar lavage (BAL) is performed. Which of the following diagnostic methods is most likely to provide the highest sensitivity for confirming the presence of Pneumocystis jirovecii ?", "options": [{"label": "A", "text": "Induced sputum microscopy", "correct": false}, {"label": "B", "text": "Chest X-ray", "correct": false}, {"label": "C", "text": "Polymerase Chain Reaction (PCR)", "correct": true}, {"label": "D", "text": "β-D-glucan assay", "correct": false}], "correct_answer": "C. Polymerase Chain Reaction (PCR)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BFUNBHIIKjsNQT2MsNH31744286159.png", "https://image.prepladder.com/notes/pzJZYB2sbEbZF4BJxtjC1744286196.png", "https://image.prepladder.com/notes/Si3f9odi71niNQLCFF331744286230.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:501px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral infiltrates, <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More sensitive; shows <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> lesions.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male patient with a history of HIV presents with worsening dyspnea and a dry cough. A chest X-ray reveals bilateral infiltrates, and a diagnosis of Pneumocystis jirovecii pneumonia (PCP) is made. Which of the following is the first-line treatment for this condition?", "options": [{"label": "A", "text": "Pentamidine", "correct": false}, {"label": "B", "text": "Trimethoprim/Sulfamethoxazole (TMP/SMX)", "correct": true}, {"label": "C", "text": "Atovaquone", "correct": false}, {"label": "D", "text": "Clindamycin with Primaquine", "correct": false}], "correct_answer": "B. Trimethoprim/Sulfamethoxazole (TMP/SMX)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pentamidine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV: 4 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For patients intolerant to TMP/SMX <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atovaquone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral: 750 mg twice daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effective for mild to moderate PCP, fewer side effects <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clindamycin + Primaquine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For patients failing TMP/SMX or pentamidine <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dapsone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alone or with TMP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> and treatment in select cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caspofungin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination with low-dose TMP/SMX</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For severe cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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What is the most likely diagnosis?", "options": [{"label": "A", "text": "Tuberculosis (TB)", "correct": true}, {"label": "B", "text": "Heart failure", "correct": false}, {"label": "C", "text": "Hepatic failure", "correct": false}, {"label": "D", "text": "Renal failure", "correct": false}], "correct_answer": "A. Tuberculosis (TB)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\"&gt;Tuberculosis&lt;/span&gt; (TB)\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tuberculosis (TB)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exudative pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> with high protein and <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Light's criteria: Pleural fluid protein &gt; 0.5 times <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> protein, <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt; 0.6 times <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> LDH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excludes heart failure, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure, and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure due to their association with transudative effusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TB is a common cause of <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> effusion, fitting the pleural fluid analysis described</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As seen below, a 49-year-old man presents with flu-like symptoms and a palmoplantar rash. On examination, he has epitrochlear lymphadenopathy. Which of the following is the likely diagnosis?", "options": [{"label": "A", "text": "Primary syphilis", "correct": false}, {"label": "B", "text": "Secondary syphilis", "correct": true}, {"label": "C", "text": "Pyoderma gangrenosum", "correct": false}, {"label": "D", "text": "Steven Johnson syndrome", "correct": false}], "correct_answer": "B. Secondary syphilis", "question_images": ["https://image.prepladder.com/content/DkCGzoBH1QuF6X0Rbgzd1748163602.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV-positive patient presents with the following finding. What is the diagnosis &amp;amp; WHO clinical stage of HIV?", "options": [{"label": "A", "text": "Oral candidiasis &amp;amp; WHO stage 2", "correct": false}, {"label": "B", "text": "Oral hairy leukoplakia &amp;amp; WHO Stage 3", "correct": false}, {"label": "C", "text": "Oral candidiasis &amp;amp; WHO stage 3", "correct": true}, {"label": "D", "text": "Oral hairy leukoplakia &amp;amp; WHO stage 2", "correct": false}], "correct_answer": "C. Oral candidiasis &amp; WHO stage 3", "question_images": ["https://image.prepladder.com/content/q7nRh5LnnTPVpVuz3xDA1747041803.png"], "explanation_images": ["https://image.prepladder.com/content/8R4s4D1itjrZVDXLU9o41747041856.png", "https://image.prepladder.com/content/EmYspCfYY8X6q0Wh0ZjK1747041856.png", "https://image.prepladder.com/content/sKZ22GQ6etVmHyUJXdAQ1747041856.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications of HIV/AIDS</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gastrointestinal tract</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Candidiasis </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Oral_candidiasis#/media/File:Human_tongue_infected_with_oral_candidiasis.jpg\" data-tags=\"\" height=\"344\" src=\"https://image.prepladder.com/content/8R4s4D1itjrZVDXLU9o41747041856.png\" width=\"291\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral, Esophageal and Tracheal candidiasis</li>\n<li>Presents with odynophagia</li>\n<li>Treatment: <strong>IV <span class=\"customMeta\" data-dictid=\"e3d616618b16927772022df400a411\">fluconazole</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Black <span class=\"customMeta\" data-dictid=\"a4789768d21692777188e77f1969cd\">hairy</span> tongue </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Zay Yar Aung, Muhammad Samar Iqbal, Abobakr Fahdawi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Black-hairy-tongue-at-first-presentation_fig1_380128100\" data-tags=\"\" height=\"387\" src=\"https://image.prepladder.com/content/EmYspCfYY8X6q0Wh0ZjK1747041856.png\" width=\"291\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Due to the Ebstein-Barr virus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic diarrhoea </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Due to Cryptosporidium or Isospora Belli</li>\n<li>Investigation: Microscopy reveals\n\t\t\t\t<ul>\n<li>Cyst &lt; 10 μm - Cryptosporidium</li>\n<li>Larger <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> - Isospora belli</li>\n</ul>\n</li>\n<li>Treatment\n\t\t\t\t<ul>\n<li>Cryptosporidium: <strong>Nitazoxanide </strong></li>\n<li>Isospora: <strong>Cotrimoxazole </strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Neoplastic diseases </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kaposi sarcoma</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CC BY 3.0\" data-hash=\"\" data-license=\"OpenStax College - Anatomy &amp; Physiology\" data-source=\"https://en.wikipedia.org/wiki/Kaposi%27s_sarcoma#/media/File:Kaposis_Sarcoma_Lesions.jpg\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/sKZ22GQ6etVmHyUJXdAQ1747041856.png\" width=\"292\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Due to <strong>HHV-8</strong></li>\n<li>Vascular tumours on the skin, <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> or organs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Hodgkin's <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immunoblastic lymphoma</li>\n<li>Burkitt’s lymphoma</li>\n<li>Primary CNS lymphoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Respiratory system</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pneumocystis <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Due to <strong>pneumocystis jirovecii </strong></li>\n<li>Presents with non-productive cough, fever and weight loss</li>\n<li>Investigation\n\t\t\t\t<ul>\n<li>CXR: Bilateral <span class=\"customMeta\" data-dictid=\"b78b1bdf6c1692777195170be3d18f\">perihilar</span> opacities</li>\n<li>Beta-1,3-glucan test positive</li>\n<li>Broncho-alveolar Lavage (BAL): Giemsa <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> or <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> shows oval-shaped fungi.</li>\n</ul>\n</li>\n<li>Treatment: <strong>Trimethoprim-sulfamethoxazole </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Others</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HIV associated Nephropathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CVS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myocardial infarction, cardiomyopathy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is false about Mycoplasma pneumoniae?", "options": [{"label": "A", "text": "Responds well to Amoxiclav", "correct": true}, {"label": "B", "text": "Antibodies are useful in diagnosis", "correct": false}, {"label": "C", "text": "Chest X-ray shows bilateral infiltrates", "correct": false}, {"label": "D", "text": "Can be cultured in a cell-free medium", "correct": false}], "correct_answer": "A. Responds well to Amoxiclav", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Atypical <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> (Walking Pneumonia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atypical <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> is a milder <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of pneumonia, often caused by <span class=\"customMeta\" data-dictid=\"28c0a387c916927771930b5215e045\">Mycoplasma</span> pneumoniae, certain viruses, or moulds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cough, fever, chest pain, headache, and chills, resembling a bad cold.</li>\n<li>As it is generally mild, not requiring <span class=\"customMeta\" data-dictid=\"63b27629261692777182cc4d582eca\">bed rest</span> or hospitalization, allowing people to continue daily activities called<strong>\"walking pneumonia.\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiologic Agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Atypical <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> is caused by organisms that don't grow on standard cultures or appear on <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">Gram</span> stain</strong>, such as:\n\t\t\t\t<ul>\n<li><strong>Mycoplasma pneumonia</strong> (associated with closed living conditions like at school and military barracks)</li>\n<li>Chlamydia pneumoniae</li>\n<li>Legionella species (from <span class=\"customMeta\" data-dictid=\"00e90b2b491692777199a0547a1945\">stagnant</span> water sources or from air conditioners)</li>\n<li>Respiratory viruses: Influenza, adenoviruses, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> syncytial virus (RSV), human metapneumoviruses, and coronaviruses (e.g., SARS-CoV-2)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cases of <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> are increasing, particularly among young adults.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>These pathogens cannot be cultured in the usual ways, making diagnosis more complex.</li>\n<li><strong>Mycoplasma pneumoniae</strong> is a unique <span class=\"customMeta\" data-dictid=\"ff3e9793d01692777182b598b4a090\">bacterium</span> that lacks a <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> and requires a <strong>specialized cell-free medium for culture</strong> <strong>(Option D)</strong> as it cannot be grown on conventional culture media.</li>\n<li><strong>Detection of specific antibodies</strong> <strong>(Option B)</strong> (IgM and IgG) against <strong>Mycoplasma pneumoniae,</strong> can be helpful in confirming the diagnosis.</li>\n<li>PCR and other molecular methods are often necessary for confirmation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray</strong> findings in <span class=\"customMeta\" data-dictid=\"28c0a387c916927771930b5215e045\">Mycoplasma</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> can vary, but <strong>bilateral infiltrates (Option C) </strong>are commonly seen. Infiltrates may appear as patchy or <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> opacities in both lungs. However, chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> findings alone cannot definitively diagnose <span class=\"customMeta\" data-dictid=\"28c0a387c916927771930b5215e045\">Mycoplasma</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> and should be correlated with clinical symptoms and other <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tests.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The absence of a <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> makes these organisms<strong> resistant</strong> to certain antibiotics that target <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> synthesis, such as <strong>penicillins</strong> and <strong>cephalosporins</strong> and require treatment with macrolides like azithromycin, and fluoroquinolones, or tetracyclines like doxycycline.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following is a graphic representation of a patient admitted in the medicine ward with a fever. What could be the possible diagnosis?", "options": [{"label": "A", "text": "Cerebral malaria", "correct": false}, {"label": "B", "text": "Brucellosis", "correct": false}, {"label": "C", "text": "Leptospirosis", "correct": true}, {"label": "D", "text": "Typhoid", "correct": false}], "correct_answer": "C. Leptospirosis", "question_images": ["https://image.prepladder.com/notes/j4wvAa0IPyjQzninu3F11746618881.png"], "explanation_images": ["https://image.prepladder.com/notes/oefUMCR67Snpy3YS2Vb41746520980.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Leptospirosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Agent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Leptospira interrogans (zoonotic bacteria)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reservoir</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rodents</strong> (Ratus norvegicus, <span class=\"customMeta\" data-dictid=\"18fd5724dc169277719319473a650b\">Mus</span> musculus) and domestic animals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Source</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct contact or <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> with <strong>excreta, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> of infected animals.</strong></li>\n<li>Exposure to flooded rice paddies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At risk individuals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Males 20-45 years (most common)</li>\n<li>Urine-contaminated mud(Soil) or water\n\t\t\t\t<ul>\n<li>Sports: rafting, fishing and swimming</li>\n<li>Rice field workers, sewer workers, animal handlers</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mode of transmission</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct contact: <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> through skin abrasion</li>\n<li>Indirect contact: Contact of broken skin with soil, water, vegetation</li>\n<li>Droplet infection: Inhalation while <span class=\"customMeta\" data-dictid=\"5930026faa1692777192fce0743bff\">milking</span> cows.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incubation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>4-20 days</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical features: High fever, severe headache, muscle pain, conjunctival suffusion, and jaundice</li>\n<li><strong>Dark Field examination: </strong>Thin and <span class=\"customMeta\" data-dictid=\"27cf09e9d316927771928763e99e0d\">motile</span> <strong>spirochete</strong>.</li>\n<li>IgM <strong>ELISA</strong>: High sensitivity</li>\n<li>Labs: Elevated liver enzymes, increased <strong>bilirubin</strong>, <strong>thrombocytopenia</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DOC: <strong>Penicillin</strong> 6 million units daily.</li>\n<li>Alternate drugs:\n\t\t\t\t<ul>\n<li>Doxycycline</li>\n<li>Amoxicillin</li>\n<li>Ampicillin</li>\n<li>Ceftriaxone</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prevention</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Avoid contaminated water and use protective clothing</li>\n<li>Livestock vaccination, proper waste disposal</li>\n<li>Rodent control measures: Zinc phosphide</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old medical student with fever had developed epistaxis which had resolved on its own and on evaluation his platelet counts are 14,000/µL and BP is 110/70 mmHg and there is a 28% rise in haematocrit. Then he has been afebrile for the last 24 hours now, what should be the next steps of management of this patient? Give 4 units of platelets Give plenty of oral fluids Give IV fluids Keep under observation Discharge the patient", "options": [{"label": "A", "text": "1 and 2", "correct": false}, {"label": "B", "text": "1,2 and 4", "correct": false}, {"label": "C", "text": "2,3 and 4", "correct": true}, {"label": "D", "text": "2 and 5", "correct": false}], "correct_answer": "C. 2,3 and 4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YLi0a8IeruJAzX8pbMzl1745842841.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the correct ‘organism-drug to which it is intrinsically resistant’ pair:", "options": [{"label": "A", "text": "Aspergillus niger - Voriconazole", "correct": false}, {"label": "B", "text": "Aspergillus fumigatus - Micafungin", "correct": false}, {"label": "C", "text": "Candida albicans - Amphotericin B", "correct": false}, {"label": "D", "text": "Candida Krusei - Fluconazole", "correct": true}], "correct_answer": "D. Candida Krusei - Fluconazole", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"f54d5c5cf11692777183318f259e5f\"&gt;Candida&lt;/span&gt; Krusei - Fluconazole</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples of Clinically Used Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">Acquired</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Species with <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">Intrinsic</span> or High Rates of Resistance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Azoles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluconazole, Voriconazole, Posaconazole</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibition of <span class=\"customMeta\" data-dictid=\"b797df98be1692777187039e0c9684\">ergosterol</span> biosynthesis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"8a94fdab29169277718739c681d8a4\">efflux pump</span> activity, ERG11 mutations, CYP51 <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> mutations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Candida glabrata, <strong>Candida krusei</strong>, <span class=\"customMeta\" data-dictid=\"f54d5c5cf11692777183318f259e5f\">Candida</span> auris, <strong>Aspergillus fumigatus (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Echinocandins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caspofungin, Micafungin, Anidulafungin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibition of β-1,3-glucan synthase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mutations in hot-spot regions of FKS genes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryptococcus spp., <span class=\"customMeta\" data-dictid=\"b02253d2a41692777203176ab1baac\">Fusarium</span> spp.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Polyenes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amphotericin B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ergosterol sequestration</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> ergosterol, <span class=\"customMeta\" data-dictid=\"2a080283331692777187f1a881e3d1\">ERG</span> mutations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Candida auris, <span class=\"customMeta\" data-dictid=\"e3baadccd91692777182c9724090b3\">Aspergillus</span> terreus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The blood investigation of a patient is given below. What is the probable diagnosis? HBsAg- Nonreactive HBeAg- Nonreactive IgG anti-HbcAg – Reactive IgM anti-HbcAg – Nonreactive", "options": [{"label": "A", "text": "Acute hepatitis B", "correct": false}, {"label": "B", "text": "Chronic hepatitis B", "correct": false}, {"label": "C", "text": "Remote infection of hepatitis B", "correct": true}, {"label": "D", "text": "Core window period", "correct": false}], "correct_answer": "C. Remote infection of hepatitis B", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Z0U5FPK4KP9yfiSVZ9D41745342170.png", "https://image.prepladder.com/notes/oVFRfAkn7C6ulwjVbycH1747125650.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Phase/Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>HBsAg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>HBeAg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Anti-HBc </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute HBV </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IgM</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Window Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic HBV/ Infective carrier </strong>(High infectivity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic HBV/Healthy carrier </strong>(Low infectivity)<strong> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p> </p>\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IgG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Remote infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IgG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recovery </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p> </p>\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunized</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nil</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newly diagnosed HIV patient presented with fever, cough and haemoptysis. His sputum sample showed acid-fast bacilli. What is the appropriate management for this patient?", "options": [{"label": "A", "text": "Start ART if CD4&amp;lt;200", "correct": false}, {"label": "B", "text": "Start ART and then ATT after 2 weeks", "correct": false}, {"label": "C", "text": "Start ATT and then ART after 2 weeks", "correct": true}, {"label": "D", "text": "Start ATT and ART simultaneously", "correct": false}], "correct_answer": "C. Start ATT and then ART after 2 weeks", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 19-year-old male, chronic smoker, presented with fever, a painful lump over his left cheek just below the ear, and difficulty in swallowing or talking. The patient also complained of mild testicular pain. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cervical tuberculosis", "correct": false}, {"label": "B", "text": "Diphtheria", "correct": false}, {"label": "C", "text": "Mumps", "correct": true}, {"label": "D", "text": "Lymphoma", "correct": false}], "correct_answer": "C. Mumps", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6wrVd2KZv8VrAmEfs0QH1747902363.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mumps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mumps virus (Paramyxoviridae family)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5-9 years mostly</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory droplets</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Period of communicability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>7 days before to 7 days after the onset of symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-grade<strong> fever,</strong> Headache, <strong>Parotitis (Often Bilateral), <span class=\"customMeta\" data-dictid=\"cc5721398816927771943c33d367a6\">orchitis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most Common <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> in child : Aseptic Meningitis</li>\n<li>Most Common <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> in<strong> Adult : Orchitis</strong> ( does not lead to <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> )</li>\n<li>Oophoritis, pancreatitis, myocarditis, arthritis, <span class=\"customMeta\" data-dictid=\"df0e1364a11692777200ed67550c12\">thyroiditis</span> &amp; conjunctivitis.</li>\n<li>Mumps during early pregnancy <strong>increases <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> wastage but not malformations.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurological Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Meningitis (Most Common) -</strong> 10-30% of cases.</li>\n<li>Encephalitis, <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> myelitis, and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> are less common.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Self-limiting</strong></li>\n<li>Management focuses on symptom relief - pain reduction, hydration, and antipyretics.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the association of Rhino-cerebral Mucor mycosis?", "options": [{"label": "A", "text": "Diabetic ketoacidosis", "correct": true}, {"label": "B", "text": "Pregnancy", "correct": false}, {"label": "C", "text": "Antibiotics", "correct": false}, {"label": "D", "text": "Inhaled steroids", "correct": false}], "correct_answer": "A. Diabetic ketoacidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe fungal infection affecting <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages, sinuses, and brain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primarily caused by <em>Rhizopus oryzae</em>, associated with uncontrolled DM and <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> (DKA).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Begins in <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> turbinates; progresses rapidly due to <span class=\"customMeta\" data-dictid=\"c5ef9f5e371692777181b43f888174\">angioinvasive</span> nature, causing tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> pain, swelling, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge, necrotic eschar.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging studies and histopathological examination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate <span class=\"customMeta\" data-dictid=\"c929a2b71516927771812a8b7b7ec3\">antifungal</span> therapy (e.g., amphotericin B) and aggressive <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> debridement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with cough, cold, fever and malaise associated with weight loss and ascites. A radiograph of the chest is shown below. Ascitic fluid analysis showed elevated adenosine deaminase. Which of the following is the next step in management?", "options": [{"label": "A", "text": "Biopsy", "correct": false}, {"label": "B", "text": "Start ATT after laparotomy stricture removal", "correct": false}, {"label": "C", "text": "Start anti-tubercular therapy", "correct": true}, {"label": "D", "text": "Symptomatic management", "correct": false}], "correct_answer": "C. Start anti-tubercular therapy", "question_images": ["https://image.prepladder.com/notes/ODoJ4iYdBfiHtndxhQa91745309953.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tuberculous Peritonitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Results from the direct spread of <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> from ruptured <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes or <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> organs (e.g., <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> TB in women), or <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal: Nonspecific <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, ascites.</li>\n<li>Systemic: Fever.</li>\n<li>Complication: Coexistence with <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> complicates diagnosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paracentesis: Reveals <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> fluid with high protein content and lymphocytic <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> (neutrophils may predominate at times).</li>\n<li>Direct Smear/Culture: Low yield; culturing large volumes of <span class=\"customMeta\" data-dictid=\"2a9ff5941c1692777182f4c00d6f69\">ascitic fluid</span> may improve results.</li>\n<li>Peritoneal Biopsy: Typically needed for diagnosis, best obtained via laparoscopy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical intervention may be required for diagnosis and management in many cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man is brought to the hospital with high-grade fever and altered consciousness. On examination, he had neck rigidity and pain when bending the neck. A lumbar puncture was performed, which showed a WBC count of 145 cells/µL, majorly lymphocytes, elevated opening pressure with protein of 120 mg/dL, and glucose level of 35 mg/dL. How will you manage this patient?", "options": [{"label": "A", "text": "Piperacillin + Tazobactam", "correct": false}, {"label": "B", "text": "Vancomycin + Ceftriaxone", "correct": false}, {"label": "C", "text": "Amphotericin B + Flucytosine", "correct": true}, {"label": "D", "text": "Ceftriaxone + Ampicillin", "correct": false}], "correct_answer": "C. Amphotericin B + Flucytosine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/LWJfLlS6JeiilQaUcYYN1745309403.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cryptococcus neoformans (most common)</li>\n<li>Candida</li>\n<li>Histoplasma</li>\n<li>Blastomyces</li>\n<li>Coccidioides</li>\n<li>Sporothrix</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunocompromised patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li>Altered mental status, lethargy</li>\n<li>Fever</li>\n<li>Neck stiffness</li>\n<li>Nausea and vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lumbar Puncture:</strong> Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and high protein levels. White cell count can be normal or higher than 20 microL and have a <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> predominance.</li>\n<li>India ink <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> shows <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells.</li>\n<li>CSF ELISA for CRAG (Cryptococcal Antigen).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n<p><strong>(Options A, B &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>LAMB</strong> (Liposomal Amphotericin-B) and <strong>5-Fluorocytosine</strong> (Flucytosine) for 2 weeks</li>\n<li><strong>Fluconazole </strong>is given subsequently for 8-10 weeks.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT a potential complication in a 40-year-old man who presents with a 15-day history of fever and a 1-day history of altered sensorium and is diagnosed with Plasmodium falciparum through a rapid diagnostic test?", "options": [{"label": "A", "text": "Blood glucose &amp;lt;40 mg/dL", "correct": false}, {"label": "B", "text": "Arterial pH &amp;gt;7.2", "correct": true}, {"label": "C", "text": "Serum creatinine -5.2", "correct": false}, {"label": "D", "text": "Unarousable coma", "correct": false}], "correct_answer": "B. Arterial pH &gt;7.2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient, who is a known case of HIV with a CD4 count of 200 cells/cu.mm, presents with 5 days of cough and high-grade fever without chills and rigors. There is no history of diarrhoea, vomiting, or nuchal rigidity. The chest x-ray is normal. What treatment will you give?", "options": [{"label": "A", "text": "Amoxicillin-clavulanic acid + Azithromycin", "correct": false}, {"label": "B", "text": "Amphotericin B", "correct": false}, {"label": "C", "text": "Co-trimoxazole only", "correct": true}, {"label": "D", "text": "Antitubercular treatment", "correct": false}], "correct_answer": "C. Co-trimoxazole only", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives at the hospital with symptoms of fever and chills. A fever profile test is conducted, which rules out malaria and dengue as the cause. However, the rK39 test comes back positive. What is the preferred treatment for this condition?", "options": [{"label": "A", "text": "Amphotericin B", "correct": true}, {"label": "B", "text": "Griseofulvin", "correct": false}, {"label": "C", "text": "Dapsone", "correct": false}, {"label": "D", "text": "Hydroxychloroquine", "correct": false}], "correct_answer": "A. Amphotericin B", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old male presents with a one-week history of fever, headache, retro-orbital pain, and myalgia. Skin examination reveals multiple purpura and petechiae on the left shoulder, trunk, and legs. Similar cases have been reported linked to increased incidence of mosquito breeding. What is the most common neurological complication associated with this condition?", "options": [{"label": "A", "text": "Encephalopathy", "correct": true}, {"label": "B", "text": "Guillain-Barré Syndrome", "correct": false}, {"label": "C", "text": "Stroke", "correct": false}, {"label": "D", "text": "Encephalitis", "correct": false}], "correct_answer": "A. Encephalopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dengue encephalopathy</strong> is <strong>most commonly encountered neurological complication</strong> of <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> virus\n\t\t\t\t<ul>\n<li>linked primarily to <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> hemorrhagic fever and <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> shock syndrome</li>\n<li>EEG may show abnormalities such as burst <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> and seizures</li>\n<li>CSF profiles typically remain normal.</li>\n<li>Neuroimaging can be normal or reveal <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> cerebral edema.</li>\n</ul>\n</li>\n<li><strong>Encephalitis</strong></li>\n<li><strong>GBS</strong></li>\n<li><strong>Stroke</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiomyopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dengue virus-induced dilated <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> should always be considered if a <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> fever patient has <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> shock and signs and symptoms of congestive heart failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver involvement in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> is a crucial feature</li>\n<li>The effect ranges from an <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> rise in liver enzymes to the development of ALF</li>\n<li>The <strong>most common <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> manifestation</strong> reported was hepatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumonia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Staphylococcus <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> is an important accompanying problem seen in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> patient</li>\n<li>co-infection between <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> and <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> can result in <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of pneumonia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orchitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orchitis usually occurs together with epididymitis</li>\n<li>Commonly seen in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> between 14 and 35 years of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Hemorrhagic Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All of the following:</p>\n<ul>\n<li>Acute onset of fever</li>\n<li>2-7 days duration</li>\n<li>Hemorrhagic manifestations\n\t\t\t\t<ul>\n<li>Positive <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> test/Petechiae</li>\n<li>Ecchymosis</li>\n<li>Purpura/Bleeding from mucosa, GIT, <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">Injection</span> sites, etc</li>\n</ul>\n</li>\n<li>Platelet count ≤ 100,000 cells/cu.mm.</li>\n<li>Plasma leakage\n\t\t\t\t<ul>\n<li>Rising hematocrit\n\t\t\t\t\t<ul>\n<li>Hemoconcentration &gt;20%</li>\n</ul>\n</li>\n<li>Pleural effusion, ascites/Hypoproteinemia)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Shock Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DHF criteria plus Signs of Shock</li>\n<li>Tachycardia/Cool extremities/Weak pulse/Lethargy/Restlessness</li>\n<li>Pulse pressure &lt;20 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> with increased <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">Diastolic pressure</span> (e.g. 100/80)</li>\n<li>Hypotension (Systolic &lt;80 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for age &lt;5 years/80-90 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for older child and adults)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the investigation of choice for detecting enteric fever in the first week?", "options": [{"label": "A", "text": "Blood culture", "correct": true}, {"label": "B", "text": "Urine culture", "correct": false}, {"label": "C", "text": "Stool culture", "correct": false}, {"label": "D", "text": "Antibody detection", "correct": false}], "correct_answer": "A. Blood culture", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:609px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Duration of Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Specimen Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>% Positivity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1st week</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood culture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2nd week</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood culture</p>\n<p>Faeces culture</p>\n<p>Widal test</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>75%</p>\n<p>50%</p>\n<p>Low Titre</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3rd week</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Widal test</p>\n<p>Blood culture</p>\n<p>Faeces culture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>80-100%</p>\n<p>60%</p>\n<p>80%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4th week</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urine Culture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>25-40%</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Typhoid</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Salmonella enterica serotypes Typhi and Paratyphi A, B, and C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fecal-oral route via contaminated food/water, known as the \"4 Fs\" (flies, fingers, feces, and fomites)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6-30 days (typically 10-14 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gradually increasing fever (38-40°C)</li>\n<li>Fatigue and malaise</li>\n<li>Headache</li>\n<li>Abdominal pain</li>\n<li>Anorexia</li>\n<li>Variable <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> habits (constipation/diarrhea)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood culture (gold standard)</li>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> culture (most sensitive)</li>\n<li>Widal test (antibody test, less reliable)</li>\n<li>PCR and molecular testing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Azithromycin (areas with high <span class=\"customMeta\" data-dictid=\"1f83ae1e461692777184d9acc4db71\">ciprofloxacin</span> resistance)</li>\n<li>Ciprofloxacin (areas with low resistance)</li>\n<li>Ceftriaxone (severe cases)</li>\n<li>Supportive care (fluids, antipyretics)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intestinal <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> (1.3% of cases)</li>\n<li>Gastrointestinal bleeding</li>\n<li>Delirium (25% of cases)</li>\n<li>Hepatitis</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"628dbda70016927771848651ec4130\">carrier state</span> (1-4% of cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hand hygiene</li>\n<li>Safe food and water practices</li>\n<li>Vaccination (ViPS, Ty21a, or TCV vaccines)</li>\n<li>Improved <span class=\"customMeta\" data-dictid=\"18aafee1a71692777198cdc688e8aa\">sanitation</span> infrastructure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the microorganisms listed below will exhibit intrinsic resistance to meropenem and aminoglycosides, but have sensitivity to cotrimoxazole?", "options": [{"label": "A", "text": "Burkholderia cepacia", "correct": false}, {"label": "B", "text": "Acinetobacter", "correct": false}, {"label": "C", "text": "Pseudomonas", "correct": false}, {"label": "D", "text": "Stenotrophomonas", "correct": true}], "correct_answer": "D. Stenotrophomonas", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Stenotroph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What immunological abnormality is observed due to the absence of CD40 in B cells?", "options": [{"label": "A", "text": "Total lack of NK cells", "correct": false}, {"label": "B", "text": "Lack of CD8-mediated cytotoxicity", "correct": false}, {"label": "C", "text": "Decreased IgG and increase in IgM", "correct": true}, {"label": "D", "text": "Inability of neutrophils to act against infections", "correct": false}], "correct_answer": "C. Decreased IgG and increase in IgM", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Decreased &lt;span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\"&gt;IgG&lt;/span&gt; and increase in IgM\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with HIV, the incorrect statement regarding prophylaxis for various organisms is: (PCP-Pneumocystis pneumonia, MAC-Mycobacterium avium complex)", "options": [{"label": "A", "text": "Prophylaxis for PCP is indicated when CD4 count is &amp;lt;200 cells/µL", "correct": false}, {"label": "B", "text": "Stop prophylaxis for Coccidioides if CD4 count is &amp;gt;250 cells/µL for 6 months", "correct": false}, {"label": "C", "text": "Prophylaxis for MAC is indicated when CD4 count is &amp;lt;50 cells /µL", "correct": false}, {"label": "D", "text": "Prophylaxis for cryptococcus is indicated when the CD4 count is &amp;gt;150 cells/µL", "correct": true}], "correct_answer": "D. Prophylaxis for cryptococcus is indicated when the CD4 count is &gt;150 cells/µL", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathogen </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumocystis jirovecii </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD4 + &lt; 200/μL</strong></p>\n<p><strong>(Option A)</strong></p>\n<p>May stop if CD4+ &gt;200/μL for &gt;/=3 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <strong>TMP-SMX</strong></p>\n<p>Trimethoprim-sulfamethoxazole</p>\n<p><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"7583e5425a1692777185ab1b0d846b\">Dapsone</span> + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">Pyrimethamine</span> + Leucovorin</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Mycobacterium Avium Complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD4+ &lt; 50/μL</strong> and no prior h/o MAC</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">Azithromycin</span> or <span class=\"customMeta\" data-dictid=\"00c4a4fe9b1692777184136ffde6c9\">Clarithromycin</span> (Monotherapy)</p>\n<p><strong>Alternative: </strong>Rifabutin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD4+ &lt; 50/μL</strong> and Prior h/o MAC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <span class=\"customMeta\" data-dictid=\"00c4a4fe9b1692777184136ffde6c9\">Clarithromycin</span> + Ethambutol</p>\n<p><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">Azithromycin</span> + Ethambutol</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Toxoplasma gondii </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TOXO <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> +ve</p>\n<p>CD4 + &lt; 100/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <strong>TMP-SMX</strong></p>\n<p>Trimethoprim-sulfamethoxazole</p>\n\t\t\t \n\n\t\t\t<p><strong>Alternative</strong>:Dapsone + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">Pyrimethamine</span> + Leucovorin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>H/O <span class=\"customMeta\" data-dictid=\"0bcd1473f3169277720036fb73236d\">Toxoplasmic</span> encephalitis</p>\n<p>CD4 + &lt; 200/μL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: <span class=\"customMeta\" data-dictid=\"8d61c0e3d516927771995457e14512\">Sulfadiazine</span> + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">Pyrimethamine</span> + Leucovorin</p>\n<p><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"1d8d8a391016927771843f2f1c40b9\">Clindamycin</span> + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">Pyrimethamine</span> + Leucovorin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PPD&gt;5 mm</p>\n<p>IGRA +ve</p>\n<p>Contact with active TB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong> : <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> + <span class=\"customMeta\" data-dictid=\"cae8cdbe581692777196bd4dec479d\">Pyridoxine</span> - x 9 months</p>\n<p><strong>Alternative</strong>: <span class=\"customMeta\" data-dictid=\"31725380cf16927771975bd3dcd1ee\">Rifabutin</span> or Rifampin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CMV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD4+ &lt; 100/μL</p>\n<p>Prior infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DOC</strong>: Valacyclovir</p>\n<p><strong>Alternative</strong>: Foscarnet</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryptococcus </strong></p>\n<p><strong>Coccidioides </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive serology</p>\n<p><strong>CD4+ &lt; 150/μL (vs Option D)</strong></p>\n<p>Endemic zone</p>\n\t\t\t \n\n\t\t\t<p><strong>May stop if CD4+ ≥250/μL for &gt;6 months</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluconazole</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histoplasmosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD4+ &lt; 150/μL</p>\n<p>Endemic zone</p>\n\t\t\t \n\n\t\t\t<p>May stop if CD4+ &gt;150/μL and cART for ≥6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Itraconazole</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salmonella </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent infections</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ciprofloxacin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bartonella</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD4+ &lt; 200/μL</p>\n<p>Prior infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Doxycycline or Azithromycin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old HIV-positive man presents with neck rigidity and papilledema. His CSF sample showed a capsulated organism positive for India ink staining. Which of the following statements is true?", "options": [{"label": "A", "text": "Intracranial pressure remains normal", "correct": false}, {"label": "B", "text": "Delay antiretroviral therapy by 4-6 weeks after the initiation of antifungal treatment", "correct": true}, {"label": "C", "text": "Initiate treatment with oral fluconazole", "correct": false}, {"label": "D", "text": "Brain imaging shows changes in &amp;gt; 80 % of patients", "correct": false}], "correct_answer": "B. Delay antiretroviral therapy by 4-6 weeks after the initiation of antifungal treatment", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old farmer from Tamil Nadu presented with fever, myalgia, headache and cough. On physical examination, a lesion is seen on the chest. Lung auscultation shows extensive bilateral rales. Blood investigation showed positive IgM for scrub typhus. What would be the appropriate treatment?", "options": [{"label": "A", "text": "Doxycycline", "correct": false}, {"label": "B", "text": "Doxycycline with Ceftriaxone", "correct": false}, {"label": "C", "text": "Ceftriaxone with Azithromycin", "correct": false}, {"label": "D", "text": "Doxycycline with azithromycin", "correct": true}], "correct_answer": "D. Doxycycline with azithromycin", "question_images": ["https://image.prepladder.com/content/Hw6QLzZ46EBvcnuysYdM1744972120.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orientia tsutsugamushi, an <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> bacterium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><strong>Transmission </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bites of infected <span class=\"customMeta\" data-dictid=\"7a9967010c16927771914174ab4e92\">larval</span> stage mites (chiggers).</li>\n<li>These are often found in rural areas, forests, and grasslands.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><br/>\n\t\t\t </p>\n<p style=\"text-align: center;\"><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Headache</li>\n<li>Muscle pain</li>\n<li>Eschar: Blackish <span class=\"customMeta\" data-dictid=\"2def5e60c9169277719811414b8b46\">scab</span> at the site of the <span class=\"customMeta\" data-dictid=\"ad912dcfa1169277718471dbde3b7b\">chigger</span> bite</li>\n<li>Rash</li>\n<li>Lymphadenopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serology: <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">Detection</span> of antibodies in blood</li>\n<li>PCR: Molecular <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of the bacterium</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t </p>\n<p style=\"text-align: center;\"><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recent update:</strong></p>\n<ul>\n<li>According to a recent update, <strong>combination therapy with IV <span class=\"customMeta\" data-dictid=\"d0f202322516927771863db87b76e7\">doxycycline</span> and <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">Azithromycin</span> is more effective than monotherapy.</strong></li>\n</ul>\n<p><strong>Doxycycline</strong>: <strong>(Option A)</strong></p>\n<ul>\n<li>First-line treatment for scrub typhus.</li>\n<li>Administered at 100 mg IV or orally, twice daily for 7 to 14 days.</li>\n<li>Concerns about potential <span class=\"customMeta\" data-dictid=\"d0f202322516927771863db87b76e7\">doxycycline</span> resistance in some cases.</li>\n</ul>\n<p><strong>Azithromycin</strong>:</p>\n<ul>\n<li>Alternative to Doxycycline, especially if resistance is suspected.</li>\n<li>Shorter treatment duration</li>\n<li>Effective <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> into key immune cells (polymorphonuclear leukocytes and macrophages) enhances efficacy.</li>\n</ul>\n<p><strong>Rifampicin</strong>:</p>\n<ul>\n<li>A second-line option, not first-line.</li>\n<li>Risk of inducing resistant <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> so should be used cautiously after ruling out active tuberculosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old HIV patient presented with a painful lesion, as shown in the image. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Basal cell carcinoma", "correct": false}, {"label": "B", "text": "Kaposi sarcoma", "correct": true}, {"label": "C", "text": "Malignant melanoma", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": false}], "correct_answer": "B. Kaposi sarcoma", "question_images": ["https://image.prepladder.com/notes/PjPjZS9P3uSBqYVLaaNp1745917378.png"], "explanation_images": [], "explanation": "<p>Correct Answer B - K\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old HIV-positive male came with complaints of persistent cough and weight loss. He has skin lesions that appear as umbilicated papules and nodules predominantly on the face, trunk, and upper extremities. Chest x-ray showed multiple bilateral nodular infiltrates. His sputum CBNAAT for tuberculosis was negative and he has a low CD4 count. What is the probable diagnosis?", "options": [{"label": "A", "text": "HIV with disseminated histoplasmosis", "correct": true}, {"label": "B", "text": "HIV with disseminated cryptococcosis", "correct": false}, {"label": "C", "text": "HIV with molluscum contagiosum", "correct": false}, {"label": "D", "text": "HIV with tuberculosis", "correct": false}], "correct_answer": "A. HIV with disseminated histoplasmosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\"&gt;HIV&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\"&gt;disseminated&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV-positive man presents with a high-grade fever. Examination reveals a positive Kernig's sign. CSF shows reduced glucose, increased protein, and increased leukocytes. A diagnosis of cryptococcal meningitis is made. What is the appropriate management for this patient?", "options": [{"label": "A", "text": "Vancomycin", "correct": false}, {"label": "B", "text": "High dose fluconazole with flucytosine", "correct": false}, {"label": "C", "text": "Voriconazole", "correct": false}, {"label": "D", "text": "Liposomal amphotericin B", "correct": true}], "correct_answer": "D. Liposomal amphotericin B", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pBGxg8aAn0A8UJiKMVfp1746189641.png"], "explanation": "<p>Correct Answer D- Liposomal amphotericin B</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>The leading <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> cause of <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> in AIDS patients is primarily due to <em>Cryptococcus neoformans</em> (C. neoformans); <em>C. gattii</em> accounts for up to 12%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Presentation</strong></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms include fever, nausea, vomiting, altered mental status, headache, and meningeal signs.</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of seizures and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits.</li>\n<li><strong>Kernig’s Sign- </strong>Positive when <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> extension of the knee elicits pain; indicative of meningeal irritation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CSF Profile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It may be normal or show modest elevations in WBC and protein levels.</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels may be observed.</li>\n<li>Elevated CSF opening pressure is typical.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Identification of organisms via India ink examination of CSF.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Huang, Jinbao &amp; Li, Hongyan &amp; Lan, Changqing &amp; Weng, Heng\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/India-ink-examination-of-a-CSF-specimen-demonstrating-the-typical-transparent-thick_fig2_367498636\" data-tags=\"\" height=\"317\" src=\"https://image.prepladder.com/content/pBGxg8aAn0A8UJiKMVfp1746189641.png\" width=\"452\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li>Detection of <span class=\"customMeta\" data-dictid=\"6bd3522c4516927771855962983e97\">cryptococcal</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> in CSF or blood.</li>\n<li>Blood cultures for <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> are often positive.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> may be necessary for diagnosing CNS <span class=\"customMeta\" data-dictid=\"3963c4741d1692777185554f5ff7c6\">cryptococcoma</span> and to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> it from immune <span class=\"customMeta\" data-dictid=\"13783dcacb1692777197d7062e0d6e\">reconstitution</span> syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Induction therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>IV amphotericin B (0.7 mg/kg daily) or liposomal amphotericin (4–6 mg/kg daily) plus <span class=\"customMeta\" data-dictid=\"bb3e410d281692777202dc2b43aaf7\">flucytosine</span> (25 mg/kg qid) for at least 2 weeks.</li>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function to avoid <span class=\"customMeta\" data-dictid=\"bb3e410d281692777202dc2b43aaf7\">flucytosine</span> toxicity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Maintenance Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Amphotericin should be continued until CSF culture is negative, followed by <span class=\"customMeta\" data-dictid=\"e3d616618b16927772022df400a411\">fluconazole</span> (400 mg/d PO for 8 weeks, then 200 mg/d) until CD4+ T-cell count &gt;200 cells/μL for 6 months.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old patient with a smoking history presents with high-grade fever, cough, confusion, and diarrhea. Chest X-ray shows bilateral infiltrates in bilateral lower lung fields. On sputum gram stain, no organisms were detected. Laboratory results reveal Na: 126mEq/L, AST:62, ALT:56, RBS:112 mg/dl, serum bilirubin of 0.8mg%, and a positive HIV test. Which of the following organisms is responsible?", "options": [{"label": "A", "text": "Streptococcus", "correct": false}, {"label": "B", "text": "Legionella", "correct": true}, {"label": "C", "text": "Pneumocystis jiroveci", "correct": false}, {"label": "D", "text": "Klebsiella", "correct": false}], "correct_answer": "B. Legionella", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- Legionella</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Legionnaires' Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>General Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incubation period: 2-10 days</li>\n<li>Non-specific flu-like symptoms initially</li>\n<li>Often more severe than typical pneumonia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory</strong></p>\n<ul>\n<li>Dry cough</li>\n<li>Shortness of breath</li>\n<li>Chest pain</li>\n</ul>\n<p><strong>Systemic</strong></p>\n<ul>\n<li>High fever (102-105°F)</li>\n<li>Headache</li>\n<li>Myalgias</li>\n<li>Fatigue</li>\n</ul>\n<p><strong>Gastrointestinal</strong></p>\n<ul>\n<li>Diarrhea</li>\n<li>Nausea/vomiting</li>\n<li>Abdominal pain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Blood Analysis- Hyponatremia, Elevated Liver Enzymes</strong></li>\n<li><strong>Urinary Antigen-</strong> Most common test, rapid results, detects L. pneumophila serogroup-1</li>\n<li><strong>Culture- </strong>Gold standard, requires special media, takes 3-5 days</li>\n<li>PCR</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Findings</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chest X-ray: <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> infiltrates/consolidation, <strong>predominantly lower lobes</strong></li>\n<li>CT: <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">Ground-glass</span> opacities, consolidation, pleural effusions possible</li>\n<li>Can be <span class=\"customMeta\" data-dictid=\"cf5b7ec2b51692777193feb17a4888\">multilobar</span> in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild-Moderate Disease:</p>\n<ul>\n<li>Azithromycin 500mg PO daily</li>\n<li>Levofloxacin 750mg PO daily</li>\n<li>Clarithromycin 500mg PO BID</li>\n</ul>\n<p>Severe Disease:</p>\n<ul>\n<li>Levofloxacin 750mg IV daily</li>\n<li>Azithromycin 500mg IV daily</li>\n<li>Consider combination therapy for severe cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Community-Acquired <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> (CAP)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Atypical Pneumonia</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Outpatients</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hospitalized Patients</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Includes M.pneumoniae C.pneumoniae, and <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common causes:</p>\n<ul>\n<li>S.pneumoniae, M.pneumoniae</li>\n<li>H. influenzae, C.pneumoniae, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> viruses(influenza, RSV).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-ICU</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICU Patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar pathogens to outpatients, plus <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pathogens include</p>\n<p>S.pneumoniae, S. aureus (including MRSA), <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species, <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> bacilli, and H. influenzae.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presented with unexplained fever and prolonged respiratory distress despite appropriate treatment. A diagnosis of cryptic tuberculosis was made. Which of the following is the correct statement related to this condition?", "options": [{"label": "A", "text": "Positive skin tuberculin test and negative chest X-ray", "correct": false}, {"label": "B", "text": "Positive skin tuberculin test and positive chest X-ray", "correct": false}, {"label": "C", "text": "Negative skin tuberculin test and negative chest X-ray", "correct": true}, {"label": "D", "text": "Negative skin tuberculin test and positive chest X-ray", "correct": false}], "correct_answer": "C. Negative skin tuberculin test and negative chest X-ray", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- Negative skin &lt;span class=\"customMeta\" data-dictid=\"0fe92012341692777201bab3db39b1\"&gt;tuberculin&lt;/span&gt; test and negative chest X\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Different Modes of <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> Diagnosis:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mode of Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sputum microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Examination of <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> samples under a <span class=\"customMeta\" data-dictid=\"195d6a11ca16927771927a92617498\">microscope</span> to detect the presence of <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Quick and inexpensive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low sensitivity, especially in cases of <span class=\"customMeta\" data-dictid=\"1fdb5ce91d16927771942d7a784ff5\">paucibacillary</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culture and drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Growth of TB bacteria in a laboratory setting to determine drug resistance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Highly sensitive and specific</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slow, can take weeks to obtain results</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nucleic acid <span class=\"customMeta\" data-dictid=\"13e14b31b21692777181520d7c651c\">amplification</span> tests (NAATs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polymerase chain reaction (PCR) or other molecular tests to detect TB DNA/RNA in <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> or other clinical specimens</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid results, high sensitivity and specificity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Expensive, may require specialized equipment and training</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging of the chest to detect <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> changes in the lungs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-invasive, can detect active TB and TB sequelae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lack of specificity, cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between TB and other lung diseases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tuberculin skin test (TST)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Injection of <span class=\"customMeta\" data-dictid=\"12fb06df001692777196ffe29e8bba\">PPD</span> under the skin, followed by measurement of <span class=\"customMeta\" data-dictid=\"7a14c26a7816927771904fb670c6da\">induration</span> at the <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> site after 48-72 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low cost, widely available</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limited ability to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> and active TB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Interferon-gamma release assays (IGRAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood tests that detect TB-specific immune responses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> than TST, not affected by <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> vaccination</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher cost, can be affected by <span class=\"customMeta\" data-dictid=\"498d3df3a416927771894f595a597a\">immunosuppression</span> or other medical conditions</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common presentation of inhalational anthrax?", "options": [{"label": "A", "text": "Atypical pneumonia", "correct": false}, {"label": "B", "text": "Haemorrhagic mediastinitis", "correct": true}, {"label": "C", "text": "Lung abscess", "correct": false}, {"label": "D", "text": "Broncho-pulmonary pneumonia", "correct": false}], "correct_answer": "B. Haemorrhagic mediastinitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Hemorrhag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 6-year-old patient who presents with a mild fever persisting for 7 days , enlarged cervical lymph nodes, and a palpable spleen tip, and subsequently develops a widespread rash after administration of ampicillin?", "options": [{"label": "A", "text": "Infectious mononucleosis", "correct": true}, {"label": "B", "text": "Scarlet fever", "correct": false}, {"label": "C", "text": "Kawasaki", "correct": false}, {"label": "D", "text": "Hodgkin's lymphoma", "correct": false}], "correct_answer": "A. Infectious mononucleosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Infectious mononu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A new vaccine which was launched in 2018 in Thailand with the name CYD-TDV . In which of the following condition it is used?", "options": [{"label": "A", "text": "Dengue", "correct": true}, {"label": "B", "text": "Malaria", "correct": false}, {"label": "C", "text": "Yellow fever", "correct": false}, {"label": "D", "text": "Japanese encephalitis", "correct": false}], "correct_answer": "A. Dengue", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Dengu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which diagnostic test is preferred for detecting HIV in a newborn delivered by an HIV-positive mother?", "options": [{"label": "A", "text": "HIV DNA PCR", "correct": true}, {"label": "B", "text": "Cord blood ELISA", "correct": false}, {"label": "C", "text": "Western blot", "correct": false}, {"label": "D", "text": "Third generation ELISA", "correct": false}], "correct_answer": "A. HIV DNA PCR", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\"&gt;HIV&lt;/span&gt; DNA PCR\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the approximate time interval between HIV infection &amp;amp; manifestation of AIDS in an untreated patient?", "options": [{"label": "A", "text": "7.5-years", "correct": false}, {"label": "B", "text": "10 years", "correct": true}, {"label": "C", "text": "12 years", "correct": false}, {"label": "D", "text": "5 years", "correct": false}], "correct_answer": "B. 10 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are AIDS defining illnesses except:", "options": [{"label": "A", "text": "Encephalopathy attributed to HIV", "correct": false}, {"label": "B", "text": "Invasive cervical cancer", "correct": false}, {"label": "C", "text": "Mycobacterium tuberculosis of any site", "correct": false}, {"label": "D", "text": "Oral candidiasis", "correct": true}], "correct_answer": "D. Oral candidiasis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient presents in an emergency with complaints of severe headache, body aches, irregular fever during the day and night, nausea and vomiting, and loss of taste. He was successfully treated for malaria two months ago , when he had similar symptoms in the past. On examination, he has hepatosplenomegaly and is jaundiced. He feels dizzy and weak during the examination and is in severe distress. His platelet count is also decreased, and his LFTs are also deranged . What is the most common cause of recurrent malaria in this patient?", "options": [{"label": "A", "text": "P. falciparum", "correct": false}, {"label": "B", "text": "P. vivax", "correct": true}, {"label": "C", "text": "Heterozygous sickle cell anaemia", "correct": false}, {"label": "D", "text": "Babesia", "correct": false}], "correct_answer": "B. P. vivax", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - P. viv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with abdominal pain and progressive weight loss for 2 months . He has been suffering from migratory arthropathy for three years. There is no history of any chronic medical conditions. He is taking corticosteroids to help with the arthropathy. Endoscopic investigation shows dark staining of the duodenal mucosa . Histological examination of the biopsy reveals PAS-positive macrophages, leading to a diagnosis of a rare multisystem disease. Which of the following statements is t rue regarding this patient's disorder? Caused by a protozoa Tropheryma whipplei PAS-positive macrophages in the lamina propria of the small intestine Culture-negative endocarditis is a common cardiac presentation Treated with IV Ceftriaxone", "options": [{"label": "A", "text": "1, 2 and 4 are true", "correct": false}, {"label": "B", "text": "2, 3 and 4 are true", "correct": true}, {"label": "C", "text": "1, 2 and 3 are true", "correct": false}, {"label": "D", "text": "1 and 2 are true", "correct": false}], "correct_answer": "B. 2, 3 and 4 are true", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 2, 3 and 4 are tru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the diagnosis ?", "options": [{"label": "A", "text": "Malaria", "correct": true}, {"label": "B", "text": "Hereditary spherocytosis", "correct": false}, {"label": "C", "text": "G6PD Deficiency", "correct": false}, {"label": "D", "text": "Thalassemia", "correct": false}], "correct_answer": "A. Malaria", "question_images": ["https://image.prepladder.com/content/FWGTCnTKpyzyx6vZe8TX1688028940.png"], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV positive patient presented with a whitish plaque in the mouth and esophagus as shown in the image below. Most likely diagnosis is:", "options": [{"label": "A", "text": "Oral leukoplokia", "correct": false}, {"label": "B", "text": "Hairy cell leukemia", "correct": false}, {"label": "C", "text": "Oral candidiasis", "correct": true}, {"label": "D", "text": "Oral cancer", "correct": false}], "correct_answer": "C. Oral candidiasis", "question_images": ["https://image.prepladder.com/content/BGIHPxjd28LxU9XhN6k81714555689.png"], "explanation_images": [], "explanation": "<p>Correct Option C - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common cause of infection post-solid organ transplantation?", "options": [{"label": "A", "text": "Cytomegalovirus", "correct": true}, {"label": "B", "text": "Varicella zoster virus", "correct": false}, {"label": "C", "text": "Epstein – Barr virus", "correct": false}, {"label": "D", "text": "Herpes simplex virus", "correct": false}], "correct_answer": "A. Cytomegalovirus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"ee831318721692777185479e65655e\"&gt;Cytomegalovirus&lt;/span&gt; (CMV)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the drug of choice for Legionnaire’s disease?", "options": [{"label": "A", "text": "Vancomycin", "correct": false}, {"label": "B", "text": "Azithromycin", "correct": true}, {"label": "C", "text": "Streptomycin", "correct": false}, {"label": "D", "text": "Erythromycin", "correct": false}], "correct_answer": "B. Azithromycin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Azith\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 50 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 8 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Apart from the abdominal cavity, which body part is included in e-FAST?", "options": [{"label": "A", "text": "Pelvic Cavity", "correct": false}, {"label": "B", "text": "Peripheral vessels", "correct": false}, {"label": "C", "text": "Thoracic cavity", "correct": true}, {"label": "D", "text": "Dural and subdural spaces", "correct": false}], "correct_answer": "C. Thoracic cavity", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to GCS, a verbal score of 1 indicates:", "options": [{"label": "A", "text": "No Verbal response", "correct": true}, {"label": "B", "text": "Inappropriate words", "correct": false}, {"label": "C", "text": "Incomprehensible sounds", "correct": false}, {"label": "D", "text": "Oriented response", "correct": false}], "correct_answer": "A. No Verbal response", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Simplified Glasgow <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> Scale (GCS) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5 <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common site of peripheral aneurysm?", "options": [{"label": "A", "text": "Brachial artery", "correct": false}, {"label": "B", "text": "Popliteal artery", "correct": true}, {"label": "C", "text": "Radial artery", "correct": false}, {"label": "D", "text": "Femoral artery", "correct": false}], "correct_answer": "B. Popliteal artery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is absent in cases of massive blood transfusion?", "options": [{"label": "A", "text": "DIC", "correct": false}, {"label": "B", "text": "Febrile transfusion reaction", "correct": false}, {"label": "C", "text": "Hypercalcemia", "correct": true}, {"label": "D", "text": "Thrombocytopenia", "correct": false}], "correct_answer": "C. Hypercalcemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications of massive blood transfusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transfusion of cold blood (stored at 4°C).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Body temperature drops, leading to impaired <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> mechanisms (coagulopathy), and worsening bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coagulopathy</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilution of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors and platelets due to transfusion; consumption of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors by ongoing haemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired blood clotting, prolonged <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> time, thrombocytopenia, and increased risk of continued bleeding.</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DIC</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to the release of <span class=\"customMeta\" data-dictid=\"ff2094828c1692777196941a65e6eb\">procoagulant</span> substances</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leads to haemorrhage due to depleted <span class=\"customMeta\" data-dictid=\"7414bd02f216927771889b3e159ef4\">hemostatic</span> components, tissue hypoxia, and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> due to microthrombi, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Citrate Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large volumes of transfused blood contain citrate, which binds to calcium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypocalcemia leads to muscle cramps, seizures, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypocalcemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Packed red blood cells (PRBCs) and other blood products are preserved with <strong>citrate</strong>, an anticoagulant.</li>\n<li>Citrate binds to <strong>ionised calcium</strong> (Ca²⁺) in the recipient's blood, reducing the free <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> level - <strong>hypocalcemia</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presents as muscle spasms, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, and decreased myocardial contractility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium leaks from stored red blood cells into <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels (hyperkalemia) can cause <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, potentially leading to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypokalemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium may shift intracellularly once transfused red blood cells are metabolically revived.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia causes muscle weakness, paralysis, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> into bicarbonate.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased pH (alkalosis) can lead to muscle twitching, irritability, and impaired oxygen release from haemoglobin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inadequate tissue <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> leads to <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid accumulation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lowered blood pH (acidosis) leads to confusion, fatigue, rapid breathing, and worsened <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury (TRALI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibodies in transfused blood <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> the recipient's immune response, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fluid buildup in the lungs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema, presenting as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> with <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> within 6 hours of transfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Associated Circulatory <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (TACO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volume of transfused blood exceeds the patient’s capacity to manage, leading to fluid overload.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary oedema, shortness of breath, hypertension, and signs of heart failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeated transfusions lead to excessive accumulation of iron.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iron deposits in organs (e.g., liver, heart, pancreas), lead to organ damage and failure over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolytic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ABO or Rh incompatibility.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid destruction of red blood cells (hemolysis), causes fever, chills, hemoglobinuria, and potentially <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure or shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Allergic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reaction to proteins in transfused blood products.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms range from mild itching, rash, or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> to severe <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">anaphylaxis</span> (airway constriction, low blood pressure, shock).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial Contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood products are contaminated during collection or storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sepsis, characterized by fever, chills, low blood pressure, and possibly <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Febrile <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reaction</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a non-hemolytic condition that is not completely understood but is believed to be caused by <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> white blood cells in the blood unit or cytokines that accumulate during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, rigour, chills</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about ranula is FALSE?", "options": [{"label": "A", "text": "Mucus extravasation cyst", "correct": false}, {"label": "B", "text": "Arises from submandibular salivary gland", "correct": true}, {"label": "C", "text": "Bluish, translucent cystic swelling on the floor of the mouth", "correct": false}, {"label": "D", "text": "Marsupialization or excision is the treatment", "correct": false}], "correct_answer": "B. Arises from submandibular salivary gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/akYmkU4Zg2U6E2ZO9wmY1747024988.png", "https://image.prepladder.com/content/GNogQfMmb7mub03r2GvM1747024988.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Ranula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n<p><strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Ranulas are a type of <strong>extravasation mucocele</strong>, caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the main <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> or obstructed <span class=\"customMeta\" data-dictid=\"4e0948603216927771801829c2c085\">acini</span> of the <strong>sublingual gland</strong>.</li>\n<li>They appear as <strong>bluish, translucent, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> on the floor of the mouth</strong> and resemble the belly of a frog.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ph0t0happy\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ranula_human_09.jpg\" data-tags=\"\" height=\"513\" src=\"https://image.prepladder.com/content/akYmkU4Zg2U6E2ZO9wmY1747024988.png\" width=\"573\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Commonly found in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> floor of the mouth.</li>\n<li>When it extends through the <span class=\"customMeta\" data-dictid=\"d0922475bc1692777193d420470423\">mylohyoid</span> muscle, it presents as a <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> known as a<strong> \"plunging ranula.\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Typically soft, fluctuant, and painless unless infected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Confirmed through Magnetic Resonance Imaging (MRI)</li>\n<li>Ultrasound</li>\n<li>Aspiration of thick, sticky <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> differentiates it from a lymphangioma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Excision of the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> is preferred. </strong></li>\n<li>Incision, drainage, and marsupialisation have low success rates. Although <strong>marsupialisation</strong> is often adequate, it has a higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate compared to <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> excision.</li>\n<li>OK-432 injection</li>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"534\" src=\"https://image.prepladder.com/content/GNogQfMmb7mub03r2GvM1747024988.png\" width=\"534\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who is taking steroids for psoriasis and is experiencing a low-grade fever only at night, weight loss, and an ulcer on her neck with undermined edges, as depicted in the provided image?", "options": [{"label": "A", "text": "Psoriasis flare-up", "correct": false}, {"label": "B", "text": "Tubercular lymphadenitis", "correct": true}, {"label": "C", "text": "Lymphosarcoma", "correct": false}, {"label": "D", "text": "Syphilis", "correct": false}], "correct_answer": "B. Tubercular lymphadenitis", "question_images": ["https://image.prepladder.com/notes/1TH1dju86skmeaqbBBxB1747998760.png"], "explanation_images": ["https://image.prepladder.com/content/fEc4u0perN8HZQL6yWkS1747025426.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> TB (Tuberculous Lymphadenitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Most common</strong> <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB presentation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Groups</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HIV-positive individuals, Immunosuppressive individuals, children, and non-Caucasian women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Previously M. bovis; now mainly M. tuberculosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Painless </strong>swelling in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, usually <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> or <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> (historically called scrofula).</li>\n<li><strong>Early disease: Discrete nodes</strong></li>\n<li>Advanced disease: Matted, nontender mass, possible <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> draining <span class=\"customMeta\" data-dictid=\"99368d5fef1692777183ea405bed67\">caseous</span> material.</li>\n<li>Pulmonary disease in &lt;50% of cases.</li>\n<li>Systemic symptoms are uncommon except in HIV-positive patients.</li>\n<li>Non-specific reaction → Matting → Cold <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> → Collar stud <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> → Sinus formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (80% yield) or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> biopsy.</strong></li>\n<li>Granulomatous lesions may or may not contain AFBs.</li>\n<li>Cultures are positive in 70–80% of cases.</li>\n<li>HIV-positive patients: Poorly organised or absent granulomas; higher bacterial loads increase <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> yield.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infectious diseases</li>\n<li>Lymphomas</li>\n<li>Metastatic carcinomas</li>\n<li>Rare disorders: Kikuchi’s disease, Kimura’s disease, Castleman’s disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman comes to the OPD with a history of a lump in the left breast. On clinical examination, the size of the lump in the left breast is 9x10 cm with the following appearance and no axillary lymphadenopathy. The histopathology of the biopsy from the lump shows increased stromal cellularity and typical leaflike architecture. What is your likely diagnosis?", "options": [{"label": "A", "text": "Phyllodes tumour", "correct": true}, {"label": "B", "text": "Giant fibroadenoma", "correct": false}, {"label": "C", "text": "Inflammatory carcinoma", "correct": false}, {"label": "D", "text": "Ductal carcinoma", "correct": false}], "correct_answer": "A. Phyllodes tumour", "question_images": ["https://image.prepladder.com/content/d79JUMsTq9YVRORpAoQE1747116110.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis from the given abdominal x-ray?", "options": [{"label": "A", "text": "Ureterocoele", "correct": false}, {"label": "B", "text": "Pelvic bone fracture", "correct": false}, {"label": "C", "text": "Rectal foreign body", "correct": true}, {"label": "D", "text": "Bladder stone", "correct": false}], "correct_answer": "C. Rectal foreign body", "question_images": ["https://image.prepladder.com/content/MyC6v9qsXI7vAK7gc0TR1748163282.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 18 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 7 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Match the following? a. Trisomy 13 1. Huntington's disease b. Trisomy 18 2. Patau syndrome c. Trinucleotide repeat sequence 3. Sickle disease d. Hb point mutation of glutamate to valine 4. Edward syndrome", "options": [{"label": "A", "text": "a-2, b-4, c-1, d-3", "correct": true}, {"label": "B", "text": "b-1, a-3, d-2, c-4", "correct": false}, {"label": "C", "text": "a-2, b-1, c-4, d-3", "correct": false}, {"label": "D", "text": "a-4, b-1, c-3, d-2", "correct": false}], "correct_answer": "A. a-2, b-4, c-1, d-3", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - a-2, b-4, c-1, d-3</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chromosomal anomaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trisomy 13</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Patau syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Short life expectancy</li>\n<li>Cleft lip and palate</li>\n<li>Polydactyly</li>\n<li>Small head</li>\n<li>Frequent <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trisomy 18</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Edward syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Early demise</li>\n<li>Characteristic skull and facies</li>\n<li>Frequent heart, kidney, and other organ anomalies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trinucleotide repeat sequence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Huntington's disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Motor disturbances</li>\n<li>Behavioural and psychiatric symptoms</li>\n<li>Cognitive decline</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hb point <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> of <span class=\"customMeta\" data-dictid=\"ada5fcf7e416927771886ff24152ff\">glutamate</span> to valine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sickle disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anemia</li>\n<li>Jaundice</li>\n<li>Dactylitis</li>\n<li>Sickle cell crisis</li>\n<li>Fatigue</li>\n<li>Fever</li>\n<li>Chest pain</li>\n<li>Shortness of breath</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How much sodium deficit needs to be corrected in a 40 kg female with a serum sodium level of 120 mEq/L to achieve a desired sodium concentration of 140 mEq/L?", "options": [{"label": "A", "text": "400 mEq", "correct": true}, {"label": "B", "text": "300 mEq", "correct": false}, {"label": "C", "text": "200 mEq", "correct": false}, {"label": "D", "text": "100 mEq", "correct": false}], "correct_answer": "A. 400 mEq", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 400 mEq\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the medication review of an elderly male patient with a history of COPD, hypertension, and diabetes, what criteria should the physician consider?", "options": [{"label": "A", "text": "Duke’s criteria", "correct": false}, {"label": "B", "text": "Light criteria", "correct": false}, {"label": "C", "text": "Beer’s criteria", "correct": true}, {"label": "D", "text": "Jones criteria", "correct": false}], "correct_answer": "C. Beer’s criteria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Beer’\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What vitamin deficiency is responsible for the following symptoms in a patient: tingling sensation in the hands and feet, generalized weakness, easy fatigability, pallor, and ataxia?", "options": [{"label": "A", "text": "Vitamin B1", "correct": false}, {"label": "B", "text": "Vitamin B12", "correct": true}, {"label": "C", "text": "Vitamin B2", "correct": false}, {"label": "D", "text": "Vitamin B3", "correct": false}], "correct_answer": "B. Vitamin B12", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">Vitamin</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Deficiency Disease</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Symptoms</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B1 (Thiamine)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Beriberi</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Peripheral neuropathy, muscle wasting, heart failure</span></span></span></span></p>\n<p><span><span><span><span style=\"color:black\">Wernicke-Korsakoff’s syndrome</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B2 (Riboflavin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Ariboflavinosis</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Glossitis, cheilosis, skin rash, <span class=\"customMeta\" data-dictid=\"9038419f6f169277719188195b72b5\">magenta</span> color tongue, <span class=\"customMeta\" data-dictid=\"5d5241c3cf1692777198a1ba71f8d4\">seborrheic</span> dermatitis</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B3 (Niacin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Pellagra</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, diarrhea, dementia</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B5 (Pantothenic acid)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Paresthesia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Numbness, tingling, burning sensation in hands and feet(burning foot syndrome)</span></span></span></span></p>\n<p><span><span><span><span style=\"color:black\">Dermatitis, enteritis, <span class=\"customMeta\" data-dictid=\"5cac5dbe851692777181a2373219b0\">alopecia</span> , ataxia</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B6 (Pyridoxine)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Microcytic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> ,convulsions, depression</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B7 (Biotin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, enteritis</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, , atrophic glossitis, alopecia, <span class=\"customMeta\" data-dictid=\"14d1b66f821692777194e77a2edc9f\">paresthesia</span> , muscle pain, anorexia, hallucinations</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B9 (Folate)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Megaloblastic anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Megaloblastic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> ,neuropathy, <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects, atrophic glossitis</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B12 (Cobalamin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Pernicious anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Peripheral neuropathy, weakness, fatigue, pallor- dementia, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord degeneration, homocysteinemia</span></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cat scratch disease is caused by?", "options": [{"label": "A", "text": "Bartonella henselae", "correct": true}, {"label": "B", "text": "b.Bartonella quintana", "correct": false}, {"label": "C", "text": "c.Bartonella bacilliformis", "correct": false}, {"label": "D", "text": "d.Borrelia burgdorferi", "correct": false}], "correct_answer": "A. Bartonella henselae", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man brings his father who became unconscious while working in a field in the host sun at 42 degrees Celsius in May. One examination, there were no physical signs of dehydration. His serum electrolyte values were normal. The physician found that the body temperature was 106 F. Which of the following symptoms is least likely to be seen in this patient?", "options": [{"label": "A", "text": "Nausea", "correct": false}, {"label": "B", "text": "Hypotension", "correct": false}, {"label": "C", "text": "Sweating", "correct": true}, {"label": "D", "text": "Headache", "correct": false}], "correct_answer": "C. Sweating", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a tall male with a lack of pubic and axillary hair, underdeveloped genitalia, elevated levels of LH and FSH, and a karyotype of XXY?", "options": [{"label": "A", "text": "a.Vanishing testis syndrome", "correct": false}, {"label": "B", "text": "b.Klinefelter’s syndrome", "correct": true}, {"label": "C", "text": "c.Noonan syndrome", "correct": false}, {"label": "D", "text": "d.Adrenal hyperplasia", "correct": false}], "correct_answer": "B. b.Klinefelter’s syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 17 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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Laboratory tests show elevated serum creatinine and 4+ proteinuria. A renal biopsy is conducted to determine the cause. What is the most common histopathological finding in diabetic nephropathy as shown below?", "options": [{"label": "A", "text": "Armani-Ebstein change", "correct": false}, {"label": "B", "text": "Focal Segmental Glomerulosclerosis", "correct": false}, {"label": "C", "text": "Nodular glomerulosclerosis", "correct": false}, {"label": "D", "text": "Diffuse glomerulosclerosis", "correct": true}], "correct_answer": "D. Diffuse glomerulosclerosis", "question_images": ["https://image.prepladder.com/notes/DETbiezHz4z3PtlUJxke1744293293.png"], "explanation_images": ["https://image.prepladder.com/notes/DETbiezHz4z3PtlUJxke1744293293.png", "https://image.prepladder.com/notes/f5bNx4JBNuPO4YbYXVZE1744293436.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathological findings of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse glomerulosclerosis</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thickening of the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and expansion of the mesangium</strong> (due to accumulation of <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> matrix) are the <strong>initial findings</strong> of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> nephropathy, which leads to <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> glomerulosclerosis.</li>\n<li>Seen in advanced diabetes and is a more common finding.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Diabetic glomerulosclerosis\" data-author=\"No machine-readable author provided. KGH assumed\" data-hash=\"8592\" data-license=\"CC-BY-SA-3.0-migrated\" data-source=\"https://commons.wikimedia.org/wiki/File:Diabetic_glomerulosclerosis_%282%29_HE.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/notes/DETbiezHz4z3PtlUJxke1744293293.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nodular Glomerulosclerosis</strong><br/>\n<strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is due to the formation of <strong>eosinophilic PAS+ nodules</strong> in the glomerulus.</li>\n<li>It is also called <strong>Kimmelstiel-Wilson nodules, </strong>a <strong>characteristic finding</strong> of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> nephropathy, which is evident in the later stages of the disease.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Nodular Glomerulosclerosis\" data-author=\"Doc.mari\" data-hash=\"8594\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Diabetic_nephropathy.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/notes/f5bNx4JBNuPO4YbYXVZE1744293436.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Armani-Ebstein change </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is characterised by the presence of <strong>lipid-laden <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> epithelial cells</strong> in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules.</p>\n<figure class=\"caption_element\"><img alt=\"Armani-Ebstein change \" custommeta\"=\"\" data-author=\"Sullivan, Mitchell &amp; Forbes, Josephine. (2019). Glucose and glycogen in the &lt;span class=\" data-dictid=\"a5603ff98316927771865d7ae41f16\"/>diabetic kidney: Heroes or villains?. EBioMedicine. 47. 10.1016/j.ebiom.2019.07.067. \" data-hash=\"8598\" data-license=\"CC BY-NC-ND\" data-source=\"https://www.researchgate.net/figure/Armani-Ebstein-lesions-appear-as-PAS-positive-material-white-arrows-in-the-vacuoles-of_fig2_335097520\" data-tags=\"\" src=\"https://image.prepladder.com/notes/WlDKGhxGSMjdmntqhsYM1744293524.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Damage to <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">Convoluted</span> <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">Tubule</span> (DCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to<strong> <span class=\"customMeta\" data-dictid=\"26a46d0aaa169277720147f4f40f57\">type 4</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis.</strong></li>\n<li>Impaired <strong>excretion of <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> and <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> ions </strong>occurs due to resistance to <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> action at the epithelial sodium channels in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules, leading to <strong>hyperkalemi</strong>a and <strong>metabolic acidosis.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a history of hypertension and diabetes presents with a 3-day history of decreased urine output, nausea, and generalized weakness. He was recently started on angiotensin-converting enzyme (ACE) inhibitors for blood pressure control. On examination, his blood pressure is 100/60 mmHg, heart rate is 96 bpm, and he appears dehydrated with dry mucous membranes. His urine output has decreased to 200 mL over the past 24 hours. Serum creatinine: 2.2 mg/dL (baseline 1.0 mg/dL) Blood urea nitrogen (BUN): 28 mg/dL (baseline 14 mg/dL) Urine sodium: 10 mEq/L Fractional excretion of sodium (FENa): 1.2% Urine osmolality: 500 mOsm/kg Based on this patient's clinical presentation and laboratory findings, which phase of acute kidney injury (AKI) is he most likely experiencing?", "options": [{"label": "A", "text": "Initiation Phase", "correct": false}, {"label": "B", "text": "Maintenance Phase", "correct": true}, {"label": "C", "text": "Recovery Phase", "correct": false}, {"label": "D", "text": "Diuretic Phase", "correct": false}], "correct_answer": "B. Maintenance Phase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following urine sodium concentration values to the likely correct cause of acute kidney injury (AKI): Urine Sodium Concentration (mEq/L) Type of AKI 1. &amp;lt; 20 mEq/L a. Renal AKI 2. &amp;gt; 40 mEq/L b. Pre-renal AKI 3. 20 - 40 mEq/L c. Post-renal AKI", "options": [{"label": "A", "text": "1:a; 2:b; 3:c", "correct": false}, {"label": "B", "text": "1:b; 2:a; 3:c", "correct": true}, {"label": "C", "text": "1:c; 2:b; 3:a", "correct": false}, {"label": "D", "text": "1:b; 2:c; 3:a", "correct": false}], "correct_answer": "B. 1:b; 2:a; 3:c", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pre-Renal AKI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal (Intrinsic) AKI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-Renal AKI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> perfusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage (e.g., ATN, glomerulonephritis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obstruction of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tract</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to kidneys</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Damage to <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> structures (e.g., tubules, glomeruli)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urine <span class=\"customMeta\" data-dictid=\"bbee2f1b011692777182d9b84068ec\">backflow</span> due to obstruction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Sodium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 20 mEq/L (conserving sodium)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 40 mEq/L (impaired sodium reabsorption)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable, often normal(20-40 mEq/L) or slightly low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FENa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 1% (kidneys <span class=\"customMeta\" data-dictid=\"a4d43e9d8416927771856f3d1cb32c\">conserve</span> sodium)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 2% (impaired <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> reabsorption)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Osmolality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 500 mOsm/kg (concentrated urine)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 350 mOsm/kg (dilute urine)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BUN/ <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">Creatinine</span> Ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 20:1 (indicates <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">dehydration</span> or low perfusion)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-20:1 (or normal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or mildly elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fluid replacement (IV fluids for hypovolemia)</li>\n<li>Address the underlying cause(e.g., volume <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> for dehydration, inotropes for heart failure, stopping <span class=\"customMeta\" data-dictid=\"0834e545c9169277719383768d0ff2\">nephrotoxic</span> drugs).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Address the underlying cause(e.g., discontinuing <span class=\"customMeta\" data-dictid=\"0834e545c9169277719383768d0ff2\">nephrotoxic</span> drugs, treating infection or glomerulonephritis).</li>\n<li>Supportive care(e.g., <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">dialysis</span> in severe cases, fluid management, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> correction).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Relieve the obstruction: <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">Catheterization</span> for <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outlet obstruction, surgery or <span class=\"customMeta\" data-dictid=\"6713a50e721692777191903bb2160c\">lithotripsy</span> for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> stones, or <span class=\"customMeta\" data-dictid=\"cb33defbb316927771991b2ef81ec3\">stent</span> placement for ureteral obstructions.</li>\n<li>Address any infection- Antibiotics (e.g., <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection, pyelonephritis).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with hypertension presents with severe left flank pain, nausea, and hematuria, his third episode in a year. A CT scan shows a 2.8 cm stone in the left ureter and several smaller stones in the left kidney. What is the preferred surgical method and prevention strategy? PCNL: Percutaneous nephrolithotomy ESWL: Extracorporeal shock wave lithotripsy", "options": [{"label": "A", "text": "PCNL, high sodium diet", "correct": false}, {"label": "B", "text": "PCNL, low sodium diet", "correct": true}, {"label": "C", "text": "ESWL, low sodium diet", "correct": false}, {"label": "D", "text": "ESWL, high sodium diet", "correct": false}], "correct_answer": "B. PCNL, low sodium diet", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Analgesics</strong> like diclofenac, ketorolac, tramadol</li>\n<li><strong>Fluid therapy:</strong> <span class=\"customMeta\" data-dictid=\"cf23a56e0916927771903ba7e75f72\">IVF</span> (intravenous fluids) are administered to prevent dehydration</li>\n<li><strong>Alpha 1 blocker:</strong> Tamsulosin (relaxes <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and expels the stone).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Extracorporeal shock wave <span class=\"customMeta\" data-dictid=\"6713a50e721692777191903bb2160c\">lithotripsy</span> (ESWL): </strong>Indicated if the size of the calculi<strong> &lt;2 cm</strong>. (<strong>Contraindicated in pregnancy and <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> diathesis)</strong>.<strong> </strong><strong>(Option C, D)</strong></li>\n<li><strong>PCNL (Percutaneous nephrolithotomy): </strong>If the size is <strong>&gt;2 cm</strong>. <strong>(Option B)</strong></li>\n<li><strong>Uretrorenoscopy</strong></li>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"544d770dfc1692777190622242d004\">intrarenal</span> surgery</strong></li>\n<li>Pyelolithotomy and <span class=\"customMeta\" data-dictid=\"5dda24df28169277719383e298df18\">nephrolithotomy</span> (rarely used).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of stone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preventive measures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maintain normal <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> (1200mg/dL)</li>\n<li>Low sodium intake</li>\n<li>Low animal protein intake</li>\n<li><strong>Thiazide (Chlorthalidone)</strong></li>\n<li>DASH (Dietary Approaches to Stop Hypertension) diet</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low sodium diet</li>\n<li><strong>Thiazide (chlorthalidone)</strong></li>\n<li>Alkali supplementation <strong>(potassium <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> or bicarbonate)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uric acid stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Alkalisation of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and maintaining <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> pH 6.5 (by increasing fruits and vegetables in the diet, cutting off animal protein, and, if needed, <span class=\"customMeta\" data-dictid=\"b802ae0373169277718153c4d4fbaf\">alkali</span> supplements)</li>\n<li>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> <strong>(Allopurinol or Febuxostat) </strong>to prevent uricosuria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystine stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Tiopronin (preferred) or penicillamine</strong></li>\n<li>Alkalisation of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> to pH 7.5 <strong>(potassium <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> or bicarbonate)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Struvite stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treat the infection (antibiotics)</li>\n<li>Acetohydroxamic acid</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presents to the emergency department with severe, sharp pain in his left flank radiating to his groin. He reports nausea and has vomited once. Lab investigations show gross hematuria. What is the investigation of choice for confirming the diagnosis in this condition? (DTPA: Diethylenetriamine Pentaacetic Acid)", "options": [{"label": "A", "text": "DTPA renal scan", "correct": false}, {"label": "B", "text": "CT urography", "correct": false}, {"label": "C", "text": "CECT abdomen", "correct": false}, {"label": "D", "text": "NCCT abdomen", "correct": true}], "correct_answer": "D. NCCT abdomen", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/cGZTXG5ZXWJfaCjGeTwe1744295142.png", "https://image.prepladder.com/notes/5RPOqxNtYvw6mAOxZLcl1744295225.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following renal stones with their microscopic appearance, 1. Calcium oxalate dihydrate a. 2. Calcium phosphate b. 3. Struvite stone c. 4. Cystine stone d.", "options": [{"label": "A", "text": "1-d, 2-c, 3-b, 4-a", "correct": false}, {"label": "B", "text": "1-b, 2-a, 3-d, 4-c", "correct": true}, {"label": "C", "text": "1-b, 2-c, 3-d, 4-a", "correct": false}, {"label": "D", "text": "1-d, 2-a, 3-b, 4-c", "correct": false}], "correct_answer": "B. 1-b, 2-a, 3-d, 4-c", "question_images": ["https://image.prepladder.com/notes/5GfVDhHOmmSZz52tr08w1745221105.png", "https://image.prepladder.com/notes/9dDchLw8dXB3P0rVA3y31745221149.png", "https://image.prepladder.com/notes/NJoq0q4zbAfiyVvtoKrQ1745221322.jpeg", "https://image.prepladder.com/notes/vpwkmKkfmUAwRHzyGLqa1745221379.png"], "explanation_images": ["https://image.prepladder.com/notes/pDVKD1Y8xOf8cJPPt8HL1744294512.png", "https://image.prepladder.com/notes/pGKeBSzww7JwPfTxLn461744294156.png", "https://image.prepladder.com/notes/yAuJPNDQwRT0VhMTvcgY1744294226.png", "https://image.prepladder.com/notes/pGtnrd5Ja3ikJM0v4x801744294634.png", "https://image.prepladder.com/notes/NC5aHOPGbzDuujsIeSTa1744294724.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> </strong></p>\n<ul>\n<li>Most common type of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stone.</li>\n<li><strong>Types:</strong> Monohydrate and <span class=\"customMeta\" data-dictid=\"168c514d4016927771861c453b7a5a\">dihydrate</span> forms</li>\n<li><strong>Causes: </strong>Hypercalciuria (most common), hypercalcaemia, hyperoxaluria, hyperuricosuria, hypocitraturia.</li>\n<li><strong>Microscopic appearance</strong>:\n\t\t\t\t<ul>\n<li>Monohydrate crystals:<strong> <span class=\"customMeta\" data-dictid=\"2a7733c0fd1692777186e80fb2ccb5\">Dumbbell</span> or picket fence appearance</strong></li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Calcium &lt;span class=\" custommeta\"=\"\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\"/>oxalate monohydrate\" data-author=\"Doruk Salancı\" data-hash=\"8615\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.m.wikipedia.org/wiki/File:Calcium_oxalate_crystals_(urine)_-_kalsiyum_oksalat_kristalleri_(idrar)_-_01.png\" data-tags=\"\" height=\"151\" src=\"https://image.prepladder.com/notes/yI2YJnkR8IO6KmrzEwM51744294355.png\" width=\"200\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>\n<ul>\n<li>Dihydrate crystals:<strong> Envelope shaped</strong></li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Calcium &lt;span class=\" custommeta\"=\"\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\"/>oxalate <span class=\"customMeta\" data-dictid=\"168c514d4016927771861c453b7a5a\">dihydrate</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stone\" data-author=\"Nair, Sreeja &amp; George, Jacob &amp; Kumar, Sajeev &amp; Gracious, Noble. (2014). Acute <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">Oxalate</span> Nephropathy following Ingestion of Averrhoa bilimbi Juice. Case reports in nephrology. 2014. 240936. 10.1155/2014/240936. \" data-hash=\"8611\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Calcium-oxalate-crystals-in-urine-in-high-power-view_fig4_263743484\" data-tags=\"\" height=\"193\" src=\"https://image.prepladder.com/notes/bTKoPTenh6OOAiTEmUG11744294078.png\" width=\"200\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium phosphate</strong></p>\n<ul>\n<li><strong>Causes:</strong> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> Type I, primary hyperparathyroidism.</li>\n<li><strong>Microscopic appearance:</strong><strong> Rosette-shaped crystals</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Calcium &lt;span class=\" custommeta\"=\"\" data-dictid=\"189b6fc834169277719580eb39bb4c\"/>phosphate <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stone\" data-author=\"Lee, A-Jin &amp; Yoo, Eun‐Hyung &amp; Bae, Young‐Cheol &amp; Jung, Sang &amp; Jeon, Chang-Ho. (2022). Differential identification of urine crystals with morphologic characteristics and solubility test. Journal of Clinical Laboratory Analysis. 36. 10.1002/jcla.24707. \" data-hash=\"8610\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Two-calcium-phosphate-crystals-A-amorphous-calcium-phosphate-with-a-large-plate_fig2_363906476\" data-tags=\"\" height=\"190\" src=\"https://image.prepladder.com/notes/vU2ZKqmOl2rFCtcxXfL61744293984.png\" width=\"200\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uric acid stone</strong></p>\n<ul>\n<li>These crystals are soft, break easily, and can adopt any shape.</li>\n<li>Caused by conditions resulting in <strong>hyperuricosuria (gout).</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Uric acid stone\" data-author=\"Crop by Mikael Häggström of original by Klinkhardt, Julius (1810-1881)\" data-hash=\"8619\" data-license=\"CC-BY-SA-4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Uric_acid_crystal.jpg\" data-tags=\"\" height=\"134\" src=\"https://image.prepladder.com/notes/pDVKD1Y8xOf8cJPPt8HL1744294512.png\" width=\"200\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystine stone</strong></p>\n<ul>\n<li>They are the hardest stones.</li>\n<li><strong>Causes: </strong>Cystinuria, <span class=\"customMeta\" data-dictid=\"bdafa8504416927771856c83e0f6e7\">cystinosis</span> (inborn <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> error, causes death in 1st year of life)</li>\n<li><strong>Microscopic appearance:</strong> <strong>Hexagonal shape </strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Cystine stone\" data-author=\"Lance Wheeler\" data-hash=\"8612\" data-license=\"CC BY-SA 4.0 \" data-source=\"https://commons.wikimedia.org/wiki/File:Cystine_Crystals_in_Canine_Urine_Sediment.jpg\" data-tags=\"\" height=\"151\" src=\"https://image.prepladder.com/notes/pGKeBSzww7JwPfTxLn461744294156.png\" width=\"200\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Struvite stones or Staghorn calculi</strong></p>\n<ul>\n<li>Also known as triple <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stone (MgNH4Po4)</li>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"210e94f8861692777201a0d6de4b0e\">UTI</span> (urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection)</li>\n<li>Causative organism:<strong><em> <span class=\"customMeta\" data-dictid=\"6b6c88fbf01692777196110a6c7118\">Proteus</span> mirabilis.</em></strong><strong> </strong></li>\n<li>Microscopic appearance: <strong>Coffin-lid appearance of crystals.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Struvite stone\" data-author=\"Joel Mills\" data-hash=\"8614\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Struvite_crystals_dog_with_scale_1.JPG\" data-tags=\"\" height=\"165\" src=\"https://image.prepladder.com/notes/yAuJPNDQwRT0VhMTvcgY1744294226.png\" width=\"200\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ciprofloxacin stones </strong></p>\n<ul>\n<li>Stellate shaped</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ciprofloxacin stones\" data-author=\"Khan, Mahboob &amp; Ortega, Luis &amp; Bagwan, Nasreen &amp; Nayer, Ali. (2015). Crystal-induced acute kidney injury due to ciprofloxacin. Journal of nephropathology. 4. 29-31. 10.12860/jnp.2015.06. \" data-hash=\"8620\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Ciprofloxacin-crystals-under-polarized-light_fig5_272077281\" data-tags=\"\" height=\"152\" src=\"https://image.prepladder.com/notes/pGtnrd5Ja3ikJM0v4x801744294634.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amoxicillin stones </strong></p>\n<ul>\n<li>Broom shaped</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Amoxicillin stones \" data-author=\"Couto, Joana &amp; Santos, Luis &amp; Alves, Joana &amp; López, Raquel &amp; Maldonaldo, Cristina. (2017). Amoxicillin Crystalluria: A Rare Side-Effect of a Commonly Prescribed Antibiotic. European Journal of Case Reports in Internal Medicine. 2. 10.12890/2017_000736. \" data-hash=\"8621\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Amoxicillin-crystals-large-aggregated-needle-shaped-shocks-of-wheat-and-broom_fig1_320565913\" data-tags=\"\" height=\"225\" src=\"https://image.prepladder.com/notes/NC5aHOPGbzDuujsIeSTa1744294724.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old female presents at the clinic with sharp, intermittent pain in her lower back and abdomen, along with nausea, vomiting, and hematuria. She has experienced similar episodes thrice in the past two years despite adhering to dietary and lifestyle recommendations. What is the most likely cause of her recurrent symptoms?", "options": [{"label": "A", "text": "Idiopathic hypercalciuria", "correct": true}, {"label": "B", "text": "Primary hyperparathyroidism", "correct": false}, {"label": "C", "text": "Diabetes mellitus", "correct": false}, {"label": "D", "text": "Gout", "correct": false}], "correct_answer": "A. Idiopathic hypercalciuria", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:673px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dietary factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> intake</strong> can lead to stone formation (low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> can lead to <strong>high oxalate</strong> absorption).</li>\n<li>High <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> intake</li>\n<li><strong>High animal protein intake</strong> (leads to <span class=\"customMeta\" data-dictid=\"9975c3cb9b16927771892cfa300d3e\">hypercalciuria</span> and hyperuricosuria)</li>\n<li><strong>Higher sodium and <span class=\"customMeta\" data-dictid=\"8a90a1b8ed16927771997b65c1558b\">sucrose</span> intake</strong> (hypercalciuria)</li>\n<li><strong>Dehydration or inadequate fluid intake</strong> (leads to volume depletion)</li>\n<li>Sugar-sweetened beverages</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-dietary factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in middle age group</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output (due to a hot environment, lack of access to water or a bathroom)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urinary factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypercalciuria</strong></li>\n<li><strong>Hyperuricosuria </strong></li>\n<li><strong>High <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> in urine</strong></li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> </strong>(citrate inhibits stone formation)</li>\n<li>Urinary pH:\n\t\t\t\t<ul>\n<li>Acidic: <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid stone formation</li>\n<li>Alkaline: <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stone formation</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic <span class=\"customMeta\" data-dictid=\"9975c3cb9b16927771892cfa300d3e\">hypercalciuria</span> (recurrent <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones)</strong> <strong>(Option A)</strong></li>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> disease (IBD), especially Crohn’s Disease (calcium <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> stones)</li>\n<li>Gastric <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> surgery</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> (calcium <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> stones) <strong>(Option B)</strong></li>\n<li>Obesity</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection (UTI)</li>\n<li>Diabetes mellitus (Type 2) <strong> (Option C) </strong></li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> or <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> (calcium <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stones)</li>\n<li>Disorders like hypertension, <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> <strong>(Option D)</strong>, <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease, cholelithiasis, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> bone mineral density, and chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease can also increase the risk for stone formation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Family history of stones</strong></li>\n<li><strong>Medullary <span class=\"customMeta\" data-dictid=\"1f8d123d5a16927771996d6f75145f\">sponge</span> kidney: </strong>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> disorder marked by malformations of the <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> collecting ducts in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pyramids, leading to <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> and large <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> cysts, often presenting as <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones.</li>\n<li><strong>Cystinuria: </strong>Reabsorption of filtered cystine, ornithine, arginine, and <span class=\"customMeta\" data-dictid=\"6413333d09169277719125b8a2a652\">lysine</span> caused by mutations in the <strong>SLC3A1</strong> <strong>amino</strong> <strong>acid</strong> <strong>transporter</strong> <strong>gene</strong>, resulting in a high <span class=\"customMeta\" data-dictid=\"c65131cb591692777185e8b4d0055f\">cystine</span> concentration in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and the formation of <span class=\"customMeta\" data-dictid=\"c65131cb591692777185e8b4d0055f\">cystine</span> stones.</li>\n<li><strong>Primary hyperoxaluria:</strong> It is characterised by excessive <span class=\"customMeta\" data-dictid=\"2a7f0b780c1692777187fe83ec76b1\">endogenous</span> <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> production by the liver.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old woman presents to the emergency department with sudden, sharp right flank pain radiating to her groin, along with nausea, vomiting, and hematuria. The physician orders an urgent ultrasound to rule out which of the following emergency conditions?", "options": [{"label": "A", "text": "Ureteric stone", "correct": true}, {"label": "B", "text": "Acute pyelonephritis", "correct": false}, {"label": "C", "text": "Acute appendicitis", "correct": false}, {"label": "D", "text": "Ectopic pregnancy", "correct": false}], "correct_answer": "A. Ureteric stone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with a 15-year history of poorly controlled type 2 diabetes presents for follow-up, reporting fatigue and mild lower extremity oedema. Examination reveals blood pressure of 145/90 mmHg and abdominal mass. Radiological investigation indicates bilateral kidney enlargement. Which of the following is not a cause of bilateral kidney enlargement?", "options": [{"label": "A", "text": "HIV nephropathy", "correct": false}, {"label": "B", "text": "Amyloidosis", "correct": false}, {"label": "C", "text": "Polycystic kidney disease", "correct": false}, {"label": "D", "text": "Renal vein thrombosis", "correct": true}], "correct_answer": "D. Renal vein thrombosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/GJJT8AnpYoX6Lw1kPkeg1744293831.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Enlargement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unilateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Can be either</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diabetic nephropathy</strong> (most common)</li>\n<li>HIV <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> (FSGS)</li>\n<li>Amyloidosis</li>\n<li>Polycystic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</li>\n<li>Leukaemia</li>\n<li>Sickle cell disease</li>\n<li>Acromegaly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Renal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> infarction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hydronephrosis</strong></li>\n<li>Acute pyelonephritis</li>\n<li>Renal lymphoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman with a history of type 2 diabetes presents for a routine follow-up. Her serum creatinine and potassium levels are normal, but she has microalbuminuria and an HbA1c of 8%. Her blood pressure and pulse are within normal limits, and she is currently on metformin for diabetes management. What should be the next step in her management?", "options": [{"label": "A", "text": "Begin a thiazide diuretic", "correct": false}, {"label": "B", "text": "Start insulin therapy", "correct": false}, {"label": "C", "text": "Stop Metformin and start a different OHA", "correct": false}, {"label": "D", "text": "Start an ACE inhibitor", "correct": true}], "correct_answer": "D. Start an ACE inhibitor", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">Hypoglycemic</span> agents (OHAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>SGLT2 inhibitors </strong>lower the risk of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> events and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure; they are also recently approved for HFpEF.</li>\n<li>For HbA1C &lt; 9.5%, OHAs can be used</li>\n<li><strong>Metformin</strong> is <strong>withheld</strong> if <strong>eGFR is &lt; 30 mL/min/1.73 m2 </strong><strong>(Option C)</strong>, and drugs safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure can be used like\n\t\t\t\t<ul>\n<li>Glipizide</li>\n<li>Linagliptin</li>\n<li>Repaglinide</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80% of the calculated dose is started if <strong>HbA1C &gt; 9.5% </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antihypertensives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In the presence of microalbuminuria, ACEi and ARBs have shown evidence to slow the <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> if started in early stages.</li>\n<li>In hypertension, for BP &gt; 130/90, ACEi or ARBs are preferred</li>\n<li>If BP is still not under control, <strong>Calcium channel <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> (CCB)</strong> can be added</li>\n<li><strong>Thiazide diuretic</strong> - in the presence of oedema <strong>(Option A)</strong></li>\n<li>If eGFR &lt;30 ml/min, then the <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> used - <strong>Metolazone.</strong></li>\n<li>ACEi/ARB <span class=\"customMeta\" data-dictid=\"89f5610ffd1692777184b03f1f88cc\">comes</span> with a <span class=\"customMeta\" data-dictid=\"79506a117416927771988bbe7a8302\">side effect</span> of hyperkalemia; hence, regular monitoring of <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> is necessary.</li>\n<li>In the presence of <strong>hyperkalemia</strong>, ACEi/ARB is replaced by CCB</li>\n<li><strong>Alpha <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> (Prazosin) </strong>- <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> in ESRD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>K Binding resins</strong> (Bind to <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and promote its excretion)</p>\n<ul>\n<li>Sodium <span class=\"customMeta\" data-dictid=\"8904ca22bf1692777196567c8fff23\">polystyrene</span> sulfonate</li>\n<li>Patiromer</li>\n<li>Sodium zirconate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Transplant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>If eGFR is &lt; 20 mL/min/1.73</strong><strong>m2</strong><strong>.</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 67-year-old man with a 10-year history of type 2 diabetes and hypertension presents for a routine check-up. His blood pressure is under control, but laboratory tests reveal microalbuminuria. What stage of diabetic nephropathy does this patient likely represent?", "options": [{"label": "A", "text": "Stage 4", "correct": false}, {"label": "B", "text": "Stage 3", "correct": false}, {"label": "C", "text": "Normal", "correct": false}, {"label": "D", "text": "Stage 1", "correct": true}], "correct_answer": "D. Stage 1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stages of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Is the stage of<strong> <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> hyperfiltration</strong> due to <span class=\"customMeta\" data-dictid=\"32562f5afa1692777193c891837db9\">nephron</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> and hyperplasia, leading to <strong>microalbuminuria</strong> (30 - 330 mg/day)</li>\n<li>It is a <strong>reversible condition</strong> of management.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It takes <strong>more than 10 years to progress</strong> from stage 1</li>\n<li>Microalbuminuria is seen in almost all the patients in this stage</li>\n<li>BP is usually normal; 24-hour <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">ambulatory</span> BP can show absent <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> <span class=\"customMeta\" data-dictid=\"15ef9a41601692777186b3c157136e\">dipping</span> and wide pulse pressure.</li>\n<li><strong>Renal biopsy</strong> reveals <strong>Glomerular basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (GBM) thickening</strong> + <strong>mesangial <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> expansion</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occasionally, oedema is present.</li>\n<li>Proteinuria +</li>\n<li><strong>Blood pressure:</strong> <span class=\"customMeta\" data-dictid=\"ecdf1a28291692777190b2a187346a\">Incipient</span> increase and exercise-induced HTN.</li>\n<li><strong>Renal biopsy</strong> reveals <strong>arteriolar hyalinosis, <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">glomerulosclerosis</span> </strong>and <strong>nodular glomerulosclerosis</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated Se.creatinine</li>\n<li><strong>Proteinuria</strong><strong> (nephrotic range).</strong></li>\n<li><strong>Sustained HTN</strong></li>\n<li><strong>Renal biopsy</strong> reveals <strong>fibrosis.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>End stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease</strong></li>\n<li>Progression is after<strong> 25 - 30 year</strong>s of diabetes</li>\n<li><strong>eGFR drops &lt; 15 ml/min</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Stages of &lt;span class=\" custommeta\"=\"\" data-dictid=\"a5603ff98316927771865d7ae41f16\"/>Diabetic nephropathy\" data-author=\"NA\" data-hash=\"8602\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" src=\"https://image.prepladder.com/notes/kA3s6dlpLLG8mmqjT3T01744293717.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male with hypertension and Type 2 diabetes presents with fatigue, mild shortness of breath, decreased urine output, increased lethargy, and mild ankle swelling. His vital signs show BP 140/85 mmHg and HR 88 bpm. He has been diagnosed with Stage 1 acute kidney injury (AKI). What is the expected elevation in serum creatinine levels for this condition?", "options": [{"label": "A", "text": "&amp;gt;3.0 times baseline", "correct": false}, {"label": "B", "text": "2.0–2.9 times baseline", "correct": false}, {"label": "C", "text": "1.5–1.9 times baseline", "correct": true}, {"label": "D", "text": "No elevation in serum creatinine", "correct": false}], "correct_answer": "C. 1.5–1.9 times baseline", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:697px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staging of the severity of AKI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine output</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5–1.9 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> <strong>(Option C)</strong></p>\n<p>(OR)</p>\n<p>≥0.3 mg/dL (≥26.5 μmol/L) increased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.5 mL/kg/hr for 6–12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.0–2.9 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.5 mL/kg/hr for ≥12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥3.0 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> <strong>(Option A)</strong></p>\n<p>(OR)</p>\n<p>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> increase by ≥4.0 mg/dL (≥353.6 μmol/L)</p>\n<p>(OR)</p>\n<p>Initiation of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> replacement therapy</p>\n<p>(OR)</p>\n<p>In patients &lt;18 years of age, there is a decrease in eGFR to &lt;35 mL/min per 1.73 <span class=\"customMeta\" data-dictid=\"ccd114a6101692777192fbb3b688c7\">metre</span> square.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.3 mL/kg/hr for ≥24 hours</p>\n<p>(OR)</p>\n<p>Anuria for ≥12 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old woman with long-standing type 2 diabetes presents with worsening oedema. Laboratory tests show elevated serum creatinine and significant proteinuria. Which of the following mechanisms primarily contributes to the proteinuria in her condition?", "options": [{"label": "A", "text": "Complement-mediated glomerular injury", "correct": false}, {"label": "B", "text": "Immune complex deposition", "correct": false}, {"label": "C", "text": "Glycation leading to mesangial expansion", "correct": true}, {"label": "D", "text": "Autoantibody-mediated podocyte damage", "correct": false}], "correct_answer": "C. Glycation leading to mesangial expansion", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/MoEv41owcYjnBVQrvBlp1744293041.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetic Nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Diabetic Nephropathy-Pathogenesis\" data-author=\"NA\" data-hash=\"8588\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" src=\"https://image.prepladder.com/notes/MoEv41owcYjnBVQrvBlp1744293041.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uncontrolled DM</li>\n<li>Hypertension</li>\n<li>Dyslipidemia</li>\n<li>Smoking</li>\n<li>Family history of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> nephropathy</li>\n<li>Genetic predispositions</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> complications</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt; 5 years in <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> diabetes</li>\n<li>Gradual (&gt; 10 - 20 years) in <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Screening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>By regularly monitoring<strong> AER</strong> and <strong>serum creatinine</strong>.</li>\n<li>Albumin of 30-300 mg/gm is moderate albuminuria.</li>\n<li><strong>False positive albuminuria</strong> can be seen in\n\t\t\t\t<ul>\n<li>Hypertension</li>\n<li>Congestive heart failure</li>\n<li>Pyelonephritis</li>\n</ul>\n</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> is not an early finding, as it only increases after increased <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old woman with a 5-year history of diabetes and recently diagnosed hypertension, who began taking telmisartan one month ago, returns for a follow-up. Investigations reveal hyperkalemia (6.2 mEq/L), serum creatinine of 1.3 mg/dL (baseline 0.9 mg/dL), and metabolic acidosis (pH = 7.1) following a recent upper respiratory infection. What management steps should be considered for her condition? Stop Telmisartan Insulin infusion with dextrose Start Calcium acetate Start Sodium bicarbonate Start ACEi temporarily", "options": [{"label": "A", "text": "1,2,3", "correct": false}, {"label": "B", "text": "2,3,4", "correct": false}, {"label": "C", "text": "3,4,5", "correct": false}, {"label": "D", "text": "1,2,4", "correct": true}], "correct_answer": "D. 1,2,4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:695px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of AKI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid Management</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Strict I/O charting</li>\n<li><strong>IV hydration</strong> (avoid Hypervolemia)</li>\n<li><strong>Input fluids </strong>should be calculated as <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> output + <span class=\"customMeta\" data-dictid=\"dc2db3ca9816927771904d4191a548\">Insensible</span> loss (loss from skin and breathing- 800 ml/day)</li>\n<li>IV is decided based on electrolytes\n\t\t\t\t<ul>\n<li>Hypochloremia - <strong>Normal saline</strong></li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> values - <strong>Ringer lactate</strong></li>\n<li>Rhabdomyolysis - <strong>Sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> + <span class=\"customMeta\" data-dictid=\"ab6984f43316927771937ff19f3807\">Normal saline</span> (Forced <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> diuresis)</strong></li>\n</ul>\n</li>\n<li><strong>Hypervolemia: </strong>200 mg <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> <strong>Furosemide</strong> followed by 10 to 40 mg/hr in a <span class=\"customMeta\" data-dictid=\"433091b3711692777186376c6f526f\">drip</span> +/- <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">Thiazide</span> diuretic</li>\n<li><strong>Fluid restriction</strong> and increased salt <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> in case of <strong>Hyponatremia</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">Bicarbonate</span> - 0.5×weight×(24−actual value): </strong>Half dose <span class=\"customMeta\" data-dictid=\"6e9cbd73891692777198a373ec041f\">stat</span> and Half in divided doses over 24 hours.</li>\n<li><strong>Overcorrection</strong> may lead to <strong>metabolic alkalosis, hypokalemia, hypocalcemia</strong>, and <strong>volume overload. </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduce dietary <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> intake.</li>\n<li><strong>ACEi or ARBs are stopped</strong> as they contribute to hyperkalemia</li>\n<li>In case of moderate (6.1 to 7.0 mEq/L) to severe <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> (&gt;7 mEq/L)\n\t\t\t\t<ul>\n<li><strong>IV <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> gluconate</strong></li>\n<li><strong>IV <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> with dextrose</strong></li>\n<li><strong>Salbutamol nebulization</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperphosphatemia</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduce the dietary <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> intake.</li>\n<li>Phosphate binders are used like\n\t\t\t\t<ul>\n<li><strong>Calcium acetate</strong></li>\n<li><strong>Sevelamer</strong></li>\n<li><strong>Aluminium <span class=\"customMeta\" data-dictid=\"0a57b1bc5916927771895a4f4e60b4\">hydroxide</span> with meals</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe HTN</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>IV <span class=\"customMeta\" data-dictid=\"5729c1fa1a16927771912963eea9a2\">Labetalol</span> and ACEi (in Scleroderma)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dialysis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n<ul>\n<li>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> (pH &lt; 7.1 after correction)</li>\n<li>Hyperkalemia (Not responding to correction)</li>\n<li>eGFR &lt; 10 ml/min</li>\n<li>Volume <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (Not responding to Rx)</li>\n<li>Uremic <span class=\"customMeta\" data-dictid=\"607e653eef1692777195e56becea2c\">pericarditis</span> (Absolute indication)</li>\n<li>Uremic encephalopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disequilibrium</strong> after aggressive <span class=\"customMeta\" data-dictid=\"6ba3fb0ce51692777188eaf7843351\">hemodialysis</span> can be managed by <strong>Mannitol</strong>, as it can lead to <strong>cerebral edema</strong> if untreated.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman with known lupus presents with worsening renal function over the past week. She reports increased fatigue and joint pain. Laboratory results Serum creatinine: 4.2 mg/dL (baseline 0.9 mg/dL) Urinalysis: 4+ protein, 2+ blood Urine protein-to-creatinine ratio (UPCR): 4 g/g (baseline 0.15 g/g) What is the most appropriate test to further evaluate her condition?", "options": [{"label": "A", "text": "CT Abdomen", "correct": false}, {"label": "B", "text": "Serum Electrolytes", "correct": false}, {"label": "C", "text": "ADAM TS 13 Level", "correct": false}, {"label": "D", "text": "Kidney biopsy", "correct": true}], "correct_answer": "D. Kidney biopsy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Workup for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Injury (AKI)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine microscopy</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>“<strong>Muddy brown</strong>” <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> casts: <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> necrosis</li>\n<li><strong>Dysmorphic <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> or <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> casts</strong>: <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> glomerulonephritis</li>\n<li><strong>Eosinophiluria</strong> in <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> nephritis, pyelonephritis, cystitis, atheroembolic disease, or glomerulonephritis.</li>\n<li><strong>Oxalate crystals</strong>: <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">Ethylene</span> <span class=\"customMeta\" data-dictid=\"7451dcad4f1692777188609e12be1d\">glycol</span> toxicity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine osmolarity</strong></p>\n<br/>\n\t\t\t </td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FeNa</strong>: <span class=\"customMeta\" data-dictid=\"7851f9a12616927772034703063277\">Fractional</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of sodium is calculated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>In Diarrhea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>In Ischemic AKI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>FeNa &lt; 1%</strong></li>\n<li>Less <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> sodium</li>\n<li>Urine <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> - 500 mOsm/Kg</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>FeNa &gt; 1%</strong></li>\n<li>High <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> sodium</li>\n<li>Urine <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> - 300 mOsm/Kg</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"8\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KFT</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Elevated Se.Cr, BUN</strong></li>\n<li><strong>Hyponatremia</strong> (Hypervolemic hyponatremia): Due to the increase in body water and body surface.</li>\n<li><strong>Hyperkalemia</strong></li>\n<li><strong>Hypochloremia</strong> (Seen in vomiting)</li>\n<li><strong>Hyperphosphatemia, Hypocalcemia</strong></li>\n<li><strong>Hyperuricemia</strong> (as in Tumor <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ABG </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Metabolic acidosis</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap: <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">Ethylene</span> <span class=\"customMeta\" data-dictid=\"7451dcad4f1692777188609e12be1d\">glycol</span> poisoning</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap: Multiple myeloma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Culture</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To rule out Sepsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coagulogram</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk and complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CPK MM level</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated in <strong>Rhabdomyolysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoimmune panel</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To identify <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">Autoimmune</span> causes of AKI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-phospholipase A2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antibodies</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in membranous nephropathy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ADAMTS 13 Level</strong><strong> (Option C)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps in managing AKI in the context of <strong>TTP</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasound</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To evaluate <strong>Post-renal causes </strong>of AKI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In suspected <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Biopsy</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>When other conditions are ruled out, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> helps in the diagnosis of</p>\n<ul>\n<li>Glomerulonephritis,</li>\n<li>Vasculitis,</li>\n<li>Interstitial nephritis,</li>\n<li>Myeloma kidney,</li>\n<li>Hemolytic <span class=\"customMeta\" data-dictid=\"7b92610b86169277720111ae27d1d8\">Uremic</span> Syndrome (HUS) and Thrombotic Thrombocytopenic <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">Purpura</span> (TTP)</li>\n<li>Allograft dysfunction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old man with newly diagnosed diffuse large B-cell lymphoma presents two days after starting chemotherapy with nausea, vomiting, fatigue, and mild confusion. Lab results reveal elevated potassium, phosphate, uric acid, and low calcium. What is true regarding the prevention of this condition?", "options": [{"label": "A", "text": "Monitor electrolytes every 24 hours", "correct": false}, {"label": "B", "text": "Avoid IV fluids", "correct": false}, {"label": "C", "text": "Calcium supplementation is the primary intervention", "correct": false}, {"label": "D", "text": "Allopurinol should be initiated", "correct": true}], "correct_answer": "D. Allopurinol should be initiated", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention approach of Tumor <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">Lysis</span> syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low-risk Patients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular monitoring of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> electrolytes</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intermediate and High-risk patients-</strong></p>\n<p>High <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid, High LDH, High <span class=\"customMeta\" data-dictid=\"09be7d1f11169277720210bf5b0280\">WBC</span> count, Large tumor size- &gt;10 cm</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Maintain <span class=\"customMeta\" data-dictid=\"a195b609f61692777189953f3adaa6\">hydration</span> </strong>with IV half <span class=\"customMeta\" data-dictid=\"ab6984f43316927771937ff19f3807\">normal saline</span> or <span class=\"customMeta\" data-dictid=\"ab6984f43316927771937ff19f3807\">normal saline</span> at 3000 mL/m²/day.</li>\n<li>Administer <strong>allopurinol at 300 mg/m²/day.</strong></li>\n<li>Monitor potassium, phosphate, calcium, <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid, LDH, and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> <strong>every 8–12 hours</strong><strong> </strong><strong>(Option B).</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Prevention approach of Tumor &lt;span class=\" custommeta\"=\"\" data-dictid=\"803b5ed1c8169277719190b446ac83\"/>Lysis syndrome\" data-author=\"NA\" data-hash=\"8586\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"302\" src=\"https://image.prepladder.com/notes/O5guqzb2kfzVnvULhuak1744292890.png\" width=\"393\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p>*<strong>Rasburicase</strong> is <strong>contraindicated</strong> in patients with<strong> <span class=\"customMeta\" data-dictid=\"96985248371692777188cfb38ca861\">G6PD</span> deficiency.</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old man with a 10-year history of cirrhosis secondary to alcohol use presents to the emergency department with worsening fatigue, abdominal distension, and confusion over the past two weeks. The patient also mentions reduced urine output for the past 48 hrs. His lab tests reveal a serum creatinine of 2.3 mg/dL, and his urine analysis shows a low sodium concentration. What is the appropriate next step in management?", "options": [{"label": "A", "text": "IV fluids", "correct": false}, {"label": "B", "text": "Diuretics", "correct": false}, {"label": "C", "text": "Paracentesis", "correct": false}, {"label": "D", "text": "Albumin infusion", "correct": true}], "correct_answer": "D. Albumin infusion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:641px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatorenal syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Renal <span class=\"customMeta\" data-dictid=\"3f0b42b17016927772014c586d44b7\">vasoconstriction</span> occurs due to altered <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance in advanced liver disease, leading to functional <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> impairment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid (within 1 - 2 weeks)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>￪Serum creatinine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>￬ eGFR</strong> and <strong>￪ <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> creatinine</strong>, but <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function is stable comparatively.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progress</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comparatively better</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic factors</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of large ascites</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> creatinine</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> sodium concentration</li>\n<li>Absence of other identifiable causes of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Withhold diuretics</strong><strong> </strong>as they can worsen <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> perfusion.</li>\n<li><strong>Albumin infusion</strong><strong>: </strong>1 g/kg/day to improve <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> volume and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> perfusion.</li>\n<li>Vasoconstrictors: <strong>Terlipressin </strong>or a combination of midodrine, octreotide, and <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> infusion.</li>\n<li><strong>Definitive treatment: </strong><strong>Liver transplantation. </strong><strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old female with diabetes, hypertension, and CKD presents to the emergency department with chest pain and dyspnea. An ECG indicates possible myocardial infarction. The cardiologist recommends a Contrast-enhanced CT (CECT) coronary angiography. Which test should be performed before the CT scan?", "options": [{"label": "A", "text": "Urine analysis", "correct": false}, {"label": "B", "text": "Serum electrolytes", "correct": false}, {"label": "C", "text": "Liver function tests", "correct": false}, {"label": "D", "text": "Serum creatinine", "correct": true}], "correct_answer": "D. Serum creatinine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contrast-induced nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Onset:</strong> Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> can be observed <strong>1 to 2 days</strong> after contrast administration.</li>\n<li><strong>Peak Elevation:</strong> Typically reached within <strong>3 to 5 days</strong>.</li>\n<li><strong>Resolution:</strong> Usually begins within <strong>1 week</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-risk groups</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Individuals with pre-existing <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease</li>\n<li>Patients with<strong> multiple myeloma</strong></li>\n<li><strong>Diabetic patients, </strong>especially those with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment</li>\n<li><strong>Elderly patients</strong> and those with other <span class=\"customMeta\" data-dictid=\"843b8ecd5416927771842bc110b4e3\">comorbid</span> conditions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hydration:</strong> Ensure adequate <span class=\"customMeta\" data-dictid=\"a195b609f61692777189953f3adaa6\">hydration</span> before and after contrast administration.</li>\n<li><strong>Kidney function evaluation:</strong> Perform <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> tests prior to the procedure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intravenous <span class=\"customMeta\" data-dictid=\"a195b609f61692777189953f3adaa6\">hydration</span> (IV fluids to maintain <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> perfusion)</li>\n<li><strong>N-acetylcysteine </strong>(May offer protective effects on the kidneys)</li>\n<li><strong>IV Sodium bicarbonate</strong> (Urine alkalinisation and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> protection)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old male presents after being trapped under debris for 4 hours, reporting severe leg pain, fatigue, and decreased urine output. Examination shows anxiety, pain, and swelling with bruising in both legs. Serum creatinine is 3.0 mg/dL (baseline 0.9 mg/dL), and BUN is 60 mg/dL. All of the following are associated with exogenous nephrotoxins except,", "options": [{"label": "A", "text": "Chemotherapy-induced nephropathy", "correct": false}, {"label": "B", "text": "Ethylene glycol poisoning", "correct": false}, {"label": "C", "text": "Contrast-induced nephropathy", "correct": false}, {"label": "D", "text": "Mismatched blood transfusion", "correct": true}], "correct_answer": "D. Mismatched blood transfusion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:605px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exogenous Nephrotoxins</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contrast agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Iodinated contrast agents (CT)</li>\n<li>Gadolinium (MRI)</li>\n<li>Sodium <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> solutions (bowel purgatives)</li>\n<li><strong>Contrast-induced nephropathy</strong><strong> (Option C)</strong>\n<ul>\n<li>An increase in <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> levels occurs within 1 to 2 days post-procedure, with peak levels reached by 3 to 5 days and typically resolves within a week.</li>\n<li>Treatment consists of IV fluids, sodium bicarbonate, and <strong>N-acetylcysteine.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vancomycin (Tubular injury)</li>\n<li>Amphotericin B (Hypokalemia, hypomagnesemia)</li>\n<li>Aminoglycosides (Non-oliguric kidney, i.e., <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &gt;400 mL/day)</li>\n<li>Acyclovir (Tubular obstruction)</li>\n<li>Some other drugs, like penicillins, cephalosporins, quinolones, sulfonamides, and rifampin, can also cause AKI.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemotherapeutic agents </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cisplatin (mostly used in lung cancer)</li>\n<li>Carboplatin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxic ingestions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ethylene glycol</strong> <strong> </strong><strong>(Option B)</strong>\n<ul>\n<li>An antifreeze agent found in automobiles can <span class=\"customMeta\" data-dictid=\"eba5ba77ec169277719688fab52fb0\">precipitate</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> crystals in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> tubules, leading to injury or <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output.</li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"5e612ce1381692777181adc76f11e6\">antidote</span> is fomepizole</strong>.</li>\n</ul>\n</li>\n<li><strong>Diethylene glycol, </strong>often found as an <span class=\"customMeta\" data-dictid=\"7b6632f6be16927771803ff363f811\">adulterant</span> in <span class=\"customMeta\" data-dictid=\"b9cdc3b7c21692777195f04d3922c8\">pharmaceutical</span> products like <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> syrups, can lead to <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis, hyperkalemia, and anuria.</li>\n<li><strong>Aristolochic acid is </strong>derived from contaminated <span class=\"customMeta\" data-dictid=\"622e7e7588169277719281aceef2a3\">medicinal</span> herbs and agricultural practices, resulting in <strong>\"Chinese herb nephropathy\"</strong> and <strong>\"Balkan nephropathy.\"</strong></li>\n<li><strong>Melamine </strong>has been <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to contaminated foodstuffs, leading to <span class=\"customMeta\" data-dictid=\"0303f5b246169277719379fa1cc0b5\">nephrolithiasis</span> and <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury (AKI).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:610px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endogenous Nephrotoxins</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Compounds: </strong>Myoglobin (blocks tubule), hemoglobin, <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid, and <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> light chains.</li>\n<li><strong>Associated conditions: </strong>\n<ul>\n<li><strong>Rhabdomyolysis: </strong>Due to crush injury, prolonged immobilization, prolonged seizures, heatstroke, <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> hyperthermia, inhalational <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> (Halothane), and drugs like succinylcholine.</li>\n<li><strong>Mismatched blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> </strong><strong>(Option D)</strong><strong>: </strong>Type 2 hypersensitivity.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Mismatched blood &lt;span class=\" custommeta\"=\"\" data-dictid=\"cbb73554631692777200444a9ea263\"/>transfusion \" data-author=\"NA\" data-hash=\"8570\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"557\" src=\"https://image.prepladder.com/notes/m5PxvnUJAxvm7lrWPa8C1744292214.png\" width=\"423\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Tumour <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> syndrome </strong>occurs in <span class=\"customMeta\" data-dictid=\"ffb779b5ad1692777189091a0aef76\">high-grade</span> lymphomas like<strong> Burkitt lymphoma, ALL (acute lymphoblastic leukemia), and </strong>AML (acute <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> leukemia).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Tumour &lt;span class=\" custommeta\"=\"\" data-dictid=\"803b5ed1c8169277719190b446ac83\"/>lysis syndrome \" data-author=\"NA\" data-hash=\"8572\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"302\" src=\"https://image.prepladder.com/notes/8ATjh2tmgshWSVCLgwUY1744292273.png\" width=\"641\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old breast cancer patient undergoing cisplatin chemotherapy presents with increased fatigue, nausea, decreased appetite, and reduced urine output, along with mild leg swelling. Her serum creatinine is 2.0 mg/dL (baseline 0.8 mg/dL), and BUN is 40 mg/dL. Which of the following novel markers is preferred in this condition?", "options": [{"label": "A", "text": "KIM-1", "correct": true}, {"label": "B", "text": "NGAL", "correct": false}, {"label": "C", "text": "SUPAR", "correct": false}, {"label": "D", "text": "Cystatin-C", "correct": false}], "correct_answer": "A. KIM-1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Novel Biomarkers </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KIM-1 (Kidney injury molecule-1)</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A<strong> <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> <span class=\"customMeta\" data-dictid=\"f0c8d0b3871692777200426e503319\">transmembrane</span> protein</strong> found in<strong> <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> cells</strong> can be detected in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> following ischemic, <span class=\"customMeta\" data-dictid=\"0834e545c9169277719383768d0ff2\">nephrotoxic</span> or chemotherapy-induced <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury (It is highly specific for <strong>cisplatin-induced <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> necrosis</strong>).</p>\n<p>It can be measured in both blood and urine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NGAL (Neutrophil <span class=\"customMeta\" data-dictid=\"3e8d6165cd169277718832ddef3d0d\">Gelatinase</span> Associated Lipocalin) or Lipocalin-2 or Siderocalin</strong></p>\n<p><strong>(Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NGAL is a protein found in human <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">neutrophil</span> granules that binds <strong>iron <span class=\"customMeta\" data-dictid=\"4c04d17d1f1692777198387e3b9615\">siderophore</span> complexes</strong> and provides <strong>tissue-protective effects</strong> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tubule.</li>\n<li>It can be detected in <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> and <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> following <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury.</li>\n<li>It is a good and sensitive marker but is less specific for <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> damage.</li>\n<li>It is very specific for cardio-pulmonary bypass-associated AKI</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SUPAR (Soluble <span class=\"customMeta\" data-dictid=\"793605c8e5169277720157a9770530\">Urokinase</span> <span class=\"customMeta\" data-dictid=\"bab1a0998e1692777195514ec82e5f\">Plasminogen</span> <span class=\"customMeta\" data-dictid=\"a095f733351692777180a29940c98a\">Activator</span> Receptor)</strong></p>\n<p><strong>(Option C) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"6c9fa3a73216927771888299c86e08\">glycoprotein</span> detected<strong> only in plasma</strong> and helps assess <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> health and injury.`</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with chronic heart failure (CHF) and hypertension presents with 2 days of worsening fatigue, decreased urine output, and mild confusion. He appears dehydrated with ankle oedema. His BP is 85/55 mmHg, HR is 102 bpm, and serum creatinine is 2.4 mg/dL (baseline 1.0 mg/dL). Which of the following antihypertensives is considered safe in this condition?", "options": [{"label": "A", "text": "Enalapril", "correct": false}, {"label": "B", "text": "Losartan", "correct": false}, {"label": "C", "text": "Clevidipine", "correct": true}, {"label": "D", "text": "Captopril", "correct": false}], "correct_answer": "C. Clevidipine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/vBNoGobcHiCD4XDDVkTQ1744292099.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents with 3 days of severe watery diarrhea, fatigue, and lightheadedness. Her BP is 90/60 mmHg, HR is 110 bpm, serum creatinine is 1.8 mg/dL (baseline 0.9 mg/dL), and BUN is 30 mg/dL. Immediate fluid resuscitation was initiated. Which of the following conditions is most likely to cause pre-renal azotemia?", "options": [{"label": "A", "text": "Acute glomerulonephritis", "correct": false}, {"label": "B", "text": "Malignant hypertension", "correct": false}, {"label": "C", "text": "Scleroderma", "correct": false}, {"label": "D", "text": "Congestive heart failure", "correct": true}], "correct_answer": "D. Congestive heart failure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glomerular causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tubular and <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sepsis or infection</li>\n<li>Ischaemia</li>\n<li>Nephrotoxins</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HUS (hemolytic-uremic syndrome)</li>\n<li>TTP (thrombotic thrombocytopenic purpura)</li>\n<li>Malignant <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> <strong>(Option B)</strong></li>\n<li>Vasculitis</li>\n<li>Athero-embolization <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> embolus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 32 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 55-year-old female with a history of chronic kidney diseases (CKD) and diabetes mellitus for the past 15 years presents for routine kidney function evaluation. To assess renal function accurately, which of the following is considered the best method to measure her GFR in a clinical setting?", "options": [{"label": "A", "text": "Creatinine clearance", "correct": false}, {"label": "B", "text": "Cockroft Gault equation", "correct": false}, {"label": "C", "text": "Inulin clearance", "correct": false}, {"label": "D", "text": "CKD-EPI equation", "correct": true}], "correct_answer": "D. CKD-EPI equation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GFR</strong> = 141 × min(Scr/κ, 1)α × max(Scr/κ, 1)-1.209 × 0.993Age</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong><em>SCr is <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> in mg/dL, </em></strong></li>\n<li><strong><em>κ is 0.7 for females and 0.9 for males, </em></strong></li>\n<li><strong><em>α is –0.329 for females and –0.411 for males, </em></strong></li>\n<li><strong><em>min indicates the minimum of SCr/κ or 1,</em></strong></li>\n<li><strong><em>and max indicates the maximum of SCr/κ or 1.</em></strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multiply by 1.018 if the patient is a woman</li>\n<li>Multiply by 1.159 for people with African ancestry</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient weighs 80 kg, is 175 cm tall, and has a serum creatinine level of 1.1 mg/dL. Using the Cockcroft-Gault equation, what is this patient's estimated Glomerular filtration rate?", "options": [{"label": "A", "text": "83.2 mL/min", "correct": false}, {"label": "B", "text": "75.7 mL/min", "correct": true}, {"label": "C", "text": "71.5 mL/min", "correct": false}, {"label": "D", "text": "69.2 mL/min", "correct": false}], "correct_answer": "B. 75.7 mL/min", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CrCl = (140 - age in years) × weight in kg / (72 × <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> in mg/dL) × 0.85 (if female, as they have less muscle mass)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 66-year-old male with a history of hypertension and type 2 diabetes mellitus is admitted to the ICU following major cardiac surgery. Post-operatively, his urine output has decreased significantly, raising concerns about acute kidney injury (AKI). Which of the following investigations would be most useful for early detection of AKI in this patient?", "options": [{"label": "A", "text": "Serum BUN", "correct": false}, {"label": "B", "text": "Serum Creatinine", "correct": false}, {"label": "C", "text": "Neutrophil gelatinase-associated lipocalin", "correct": true}, {"label": "D", "text": "Urine granular cast detection", "correct": false}], "correct_answer": "C. Neutrophil gelatinase-associated lipocalin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BIOMARKERS for early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of AKI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NGAL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neutrophil gelatinase-associated lipocalin </strong></p>\n<ul>\n<li>Useful for <strong>early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury (AKI),</strong> particularly following <span class=\"customMeta\" data-dictid=\"0f0e2f0fe91692777183bfa6c6a156\">cardiopulmonary</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> surgery.</li>\n<li>It can be measured in <strong>both <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and plasma,</strong> providing a rapid and sensitive indication of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage before significant changes in traditional markers like <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> are observed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KIM-1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kidney injury molecule - 1</strong></p>\n<ul>\n<li><strong>Type 1 <span class=\"customMeta\" data-dictid=\"f0c8d0b3871692777200426e503319\">transmembrane</span> protein</strong> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">tubule</span> (PCT) of the kidney, upregulated in response to injury.</li>\n<li>Tested in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and plasma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>suPAR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Soluble <span class=\"customMeta\" data-dictid=\"793605c8e5169277720157a9770530\">urokinase</span> plasminogen-activating <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> </strong></p>\n<ul>\n<li>Signalling glycoprotein.</li>\n<li>Tested in <strong>only plasma.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IGFBP7</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulin-like growth factor binding protein 7</strong> and <strong>tissue <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> of metalloproteinase-2 </strong>are being used as <strong>predictive biomarkers</strong> for the high risk of development of moderate to severe AKI in critically ill patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TIMP-2</strong></p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:93px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biomarkers for early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of AKI</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>NGAL</strong><strong> (Neutrophil gelatinase-associated lipocalin) </strong></li>\n<li><strong>KIM-1</strong><strong> (Kidney injury molecule - 1)</strong></li>\n<li><strong>suPAR </strong><strong>(Soluble <span class=\"customMeta\" data-dictid=\"793605c8e5169277720157a9770530\">urokinase</span> plasminogen-activating receptor)</strong></li>\n<li><strong>IGFBP7</strong><strong> (Insulin-like growth factor binding protein 7) </strong></li>\n<li><strong>TIMP-2</strong><strong> (Tissue <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> of metalloproteinase-2) </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 78-year-old female patient with a history of diabetes mellitus presents to the outpatient department for her annual checkup. She reports no new complaints and appears to be in good health. Routine investigations reveal the following results: Glomerular Filtration Rate (GFR): 50 mL/min Urine Albumin Levels: 12 mg/g Based on the kidney disease improving global outcome classification of CKD, what is the risk of kidney failure in this patient?", "options": [{"label": "A", "text": "Low risk", "correct": false}, {"label": "B", "text": "Moderate risk", "correct": true}, {"label": "C", "text": "High risk", "correct": false}, {"label": "D", "text": "Very high risk", "correct": false}], "correct_answer": "B. Moderate risk", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td rowspan=\"10\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>G</strong></p>\n<p><strong>F</strong></p>\n<p><strong>R</strong></p>\n</td>\n<td colspan=\"3\" rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Prognosis of CKD, according to</strong></p>\n<p><strong>KDIGO 2012 <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Persistent <span class=\"customMeta\" data-dictid=\"98ed15279f169277718118ace5f595\">albuminuria</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal to mild increase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate increase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe increase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;30mg/g</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-300 mg/g</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;300mg/g</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or high</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;=90</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mildly decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60-89</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G3a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate decrease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>45-59</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G3b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate to severe decrease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-44</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe decrease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-29</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kidney failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;15</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with worsening fatigue, leg swelling, and occasional shortness of breath. He has a 15-year history of hypertension and type 2 diabetes mellitus. Laboratory tests show elevated serum creatinine and a reduced glomerular filtration rate (GFR). Which of the following diseases is least likely to have caused his condition?", "options": [{"label": "A", "text": "Autosomal dominant polycystic kidney disease", "correct": false}, {"label": "B", "text": "Diabetic nephropathy", "correct": false}, {"label": "C", "text": "Glomerulonephritis", "correct": false}, {"label": "D", "text": "Pyelonephritis", "correct": true}], "correct_answer": "D. Pyelonephritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CHRONIC <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">KIDNEY</span> DISEASE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> diseases </strong>\n<ul>\n<li>Diabetes and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> syndromes</li>\n<li>Autoinflammatory disorders: SLE, Vasculitis</li>\n<li>Infections: HIV, HBV, HCV</li>\n<li>Toxic exposure: <span class=\"customMeta\" data-dictid=\"dcbc4c1178169277718125c5c1cc12\">Antineoplastic</span> agents</li>\n<li>Hypertension</li>\n</ul>\n</li>\n<li><strong>Lifestyle</strong>\n<ul>\n<li>Smoking</li>\n<li>Diet</li>\n<li>Physical activity</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leading causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diabetic nephropathy</strong> (Most common)</li>\n<li>Glomerulonephritis</li>\n<li>Hypertension</li>\n<li>Ischemic heart disease (Cardiorenal syndrome)</li>\n<li>Autosomal dominant <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</li>\n<li>Tubulointerstitial <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manifestation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight loss</li>\n<li>Nausea</li>\n<li>Hiccups (urea irritates <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa)</li>\n<li>Pedal oedema</li>\n<li>Muscle cramping and twitching</li>\n<li>Pruritus and skin pigmentation</li>\n<li>Uremic fetor</li>\n<li>Restless leg syndrome</li>\n<li>Uremic pericarditis</li>\n<li>Hypertension</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 74-year-old male with stage 3 chronic kidney disease presents with fatigue, muscle weakness, and palpitations. His current medications include losartan and spironolactone for hypertension. ECG findings are normal. Serum electrolyte levels are given below. Sodium - 129 mEq/L Potassium - 5.6 mEq/L Bicarbonate - 20 mEq/L Which of the following is the most appropriate initial management of this patient’s electrolyte abnormalities?", "options": [{"label": "A", "text": "Water restriction", "correct": false}, {"label": "B", "text": "Start the patient on hemodialysis", "correct": false}, {"label": "C", "text": "Stop spironolactone and start on patiromer", "correct": true}, {"label": "D", "text": "Administer intravenous calcium gluconate", "correct": false}], "correct_answer": "C. Stop spironolactone and start on patiromer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:655px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> electrolytes in CKD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrolyte Imbalances </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypervolemic hyponatremia: </strong></p>\n<ul>\n<li>High circulating <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> levels.</li>\n<li>Increase in water &gt; sodium retention.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Water restriction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Patiromer</strong> <strong>(Option C)</strong></li>\n<li>Calcium resonium</li>\n<li>Sodium polystyrene</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypokalemia (rare): </strong>Usually due to overuse of diuretics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increase dietary <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> and reduce the dose of diuretics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperphosphatemia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sevelamer </strong></li>\n<li>Calcium <span class=\"customMeta\" data-dictid=\"47765053a81692777180738f50cd4e\">acetate</span> or carbonate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypocalcemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Paricalcitol </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old woman with a history of type 2 diabetes, hypertension, and chronic kidney disease presents for routine follow-up. Her HbA1c is 5.6%, blood pressure is 152/88 mmHg, serum creatinine is 1.8 mg/dL, and urinalysis shows microalbuminuria. She is currently taking Canagliflozin and hydrochlorothiazide. Which medication should be added to her treatment?", "options": [{"label": "A", "text": "Diltiazem", "correct": false}, {"label": "B", "text": "Lisinopril", "correct": true}, {"label": "C", "text": "Regular insulin", "correct": false}, {"label": "D", "text": "Metformin", "correct": false}], "correct_answer": "B. Lisinopril", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> control</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HbA1c &lt; 7%</strong></p>\n<ul>\n<li><strong>Metformin</strong> may be given if eGFR&gt;30ml/min, or else <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> may occur</li>\n<li>SGLT-2 inhibitors (<strong>Canagliflozin, Dapagliflozin)</strong> can prevent <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> nephropathy.</li>\n<li><strong>Insulin </strong>should be given to achieve the HbA1c target.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood pressure control </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Target BP &lt;130/80 mm hg</p>\n<ul>\n<li><strong>ACEi</strong>: Lisinopril, <span class=\"customMeta\" data-dictid=\"59583af20116927771833fb6c4c880\">Captopril</span> <strong>(Option B)</strong></li>\n<li><strong>ARB’s</strong>: Losartan, Telmisartan\n\t\t\t\t<ul>\n<li>ACEi and ARB have nephroprotective activity and thus should be used as the preferred <strong>drug of choice to control BP</strong> <strong>(Option B).</strong></li>\n</ul>\n</li>\n<li><strong>Calcium channel blockers </strong>can be used if ACEi are contraindicated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cholesterol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T<strong>arget LDL&lt;70 mg%</strong></p>\n<ul>\n<li><strong>Statins</strong>: Atorvastatin 40 to 80 mg</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IV iron </strong></li>\n<li><strong>Erythropoietin stimulating agents: </strong>Darbepoetin and epoetin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coagulopathies </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Desmopressin </strong></li>\n<li><strong>Cryoprecipitate </strong></li>\n<li><strong>Conjugated <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> </strong></li>\n<li><strong>Blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin D <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Vitamin D3 supplements </strong></li>\n<li><strong>Phosphate binders </strong>\n<ul>\n<li>Sevelamer</li>\n<li>Calcium <span class=\"customMeta\" data-dictid=\"fdae4d6e3a1692777183b5745d0c02\">carbonate</span> and acetate</li>\n</ul>\n</li>\n<li><strong>Cinacalcet</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal replacement therapy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decision is made at <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> 4 CKD</strong></p>\n<ul>\n<li>Allogeneic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplant</li>\n<li><strong>Hemodialysis:</strong> 4 hours per session, three times a week.</li>\n<li>Peritoneal dialysis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 78-year-old male patient presented to the emergency department in a semi-conscious state with no available medical history. Physical examination revealed a foul-smelling, pungent breath, an arteriovenous (AV) fistula in the left arm, bilateral lower limb oedema, multiple bruises and abrasions on the body, and Kussmaul respirations. A bedside blood glucose measurement showed a level of 200 mg/dL. Based on these findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "B", "text": "Uremic acidosis", "correct": true}, {"label": "C", "text": "Lactic acidosis", "correct": false}, {"label": "D", "text": "Aspirin overdose", "correct": false}], "correct_answer": "B. Uremic acidosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/tJeq9PlLMxTTwWtDH9cS1744300394.png", "https://image.prepladder.com/notes/LBsIhZFD5I7QNIOfBq3a1744300505.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:676px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications of Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid and electrolytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hyperkalemia</strong></li>\n<li><strong>Pitting oedema (</strong>Due to fluid and salt retention)</li>\n<li><strong>Uremic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong>\n<ul>\n<li>It occurs due to the build-up of <span class=\"customMeta\" data-dictid=\"7b92610b86169277720111ae27d1d8\">uremic</span> toxins in the body due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function.</li>\n<li><strong>Features: </strong>Uremic fetor, Kussmaul breathing, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> cognitive ability, confusion/coma.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular system </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Uremic pericarditis</strong></li>\n<li><strong>Cardiac failure</strong> occurs due to salt and water retention, left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy, diastolic dysfunction, frank <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> and myocardial ischemia.</li>\n<li><strong>Vascular calcifications </strong>occur due to hyperphosphatemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Haematological system </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Abnormal <span class=\"customMeta\" data-dictid=\"4cb859ed5d16927771884925c4eef7\">hemostasis</span> </strong>\n<ul>\n<li>Coagulopathies</li>\n<li>Thromboembolism (in cases of hypoalbuminemia)</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Anemia</strong> occurs due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> EPO secretion: <strong>Normocytic normochromic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin changes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nephrogenic fibrosing <span class=\"customMeta\" data-dictid=\"c7e517784c1692777186408d804d5e\">dermopathy</span> </strong>(Progressive <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> induration)</li>\n</ul>\n<ul>\n<li><strong>Calciphylaxis -</strong> build up of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> in small arterioles of skin and fat tissue<strong>. </strong>\n<ul>\n<li>Painful <span class=\"customMeta\" data-dictid=\"53f2eb017116927771918255da4e8b\">livedo</span> reticularis and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> nodules</li>\n<li>Ischemic <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> patches, especially over the legs, thighs, <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and breast</li>\n</ul>\n</li>\n<li><strong>Pruritus and easy bruisability.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Calciphylaxis\" data-author=\"Niels Olson\" data-hash=\"8721\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Calciphylaxis.png\" data-tags=\"\" height=\"271\" src=\"https://image.prepladder.com/notes/tJeq9PlLMxTTwWtDH9cS1744300394.png\" width=\"429\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p style=\"text-align: center;\"><strong>Calciphylaxis </strong></p>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Nephrogenic fibrosing dermopathy\" data-author=\"W. TingM. StoneK. MadisonKevin A. Kurtz\" data-hash=\"8723\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Nephrogenic-fibrosing-dermopathy-with-systemic-Ting-Stone/79f374a8862dcbe074509d1b9356ab3943e93dc8/figure/0\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/notes/LBsIhZFD5I7QNIOfBq3a1744300505.png\" width=\"471\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Nephrogenic fibrosing <span class=\"customMeta\" data-dictid=\"c7e517784c1692777186408d804d5e\">dermopathy</span> </strong></p>\n\t\t\t \n\n\t\t\t<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Osteitis fibrosa cystica (</strong>Due to secondary hyperparathyroidism)</li>\n<li><strong>Osteomalacia</strong> (Due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> levels of <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">Vitamin D</span> and low bone turnover)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nervous system </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hyperuremic <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">encephalopathy</span> </strong></li>\n<li><strong>Peripheral <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> </strong></li>\n<li><strong>Restless leg syndrome </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old male with end-stage renal disease is being evaluated for kidney transplantation. Which of the following investigations is essential to perform on the recipient to list him for transplantation?", "options": [{"label": "A", "text": "Cytomegalovirus serology", "correct": false}, {"label": "B", "text": "Hepatitis B and C serology", "correct": false}, {"label": "C", "text": "USG doppler KUB", "correct": false}, {"label": "D", "text": "CT angiography", "correct": true}], "correct_answer": "D. CT angiography", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements are true regarding HLA matching for renal transplants? Only HLA - A and HLA - DR needs to be matched Life-long immunosuppressive therapy is essential post-transplant ⅚ HLA match required no induction therapy Tacrolimus and Basiliximab are used for induction therapy", "options": [{"label": "A", "text": "1 and 3", "correct": false}, {"label": "B", "text": "2 and 3", "correct": true}, {"label": "C", "text": "1, 2 and 4", "correct": false}, {"label": "D", "text": "3 and 4", "correct": false}], "correct_answer": "B. 2 and 3", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of graft rejection is resistant to therapy and, hence, is the leading cause of graft failure?", "options": [{"label": "A", "text": "Hyperacute Rejection", "correct": false}, {"label": "B", "text": "Acute Rejection", "correct": false}, {"label": "C", "text": "Acute Cellular Rejection", "correct": false}, {"label": "D", "text": "Chronic Rejection", "correct": true}], "correct_answer": "D. Chronic Rejection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a hemodialysis session, the dialysis nurse notices the patient experiencing hypotension. Which of the following strategies might be employed to help manage this condition?", "options": [{"label": "A", "text": "Increase the blood flow rate through the dialyser", "correct": false}, {"label": "B", "text": "Reduce the dialysate sodium concentration gradually", "correct": true}, {"label": "C", "text": "Reduce the concentration of potassium in the dialysate", "correct": false}, {"label": "D", "text": "Decrease the duration of the dialysis session", "correct": false}], "correct_answer": "B. Reduce the dialysate sodium concentration gradually", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/641KoN6FsmECorajr6t31744300754.png", "https://image.prepladder.com/notes/afIlyBbukFj07YhcyM2Y1745643322.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient with end-stage renal disease (ESRD) is evaluated for hemodialysis. The patient presents with fluid overload, hyperkalemia, and significant lethargy. Which of the following is not an indication for initiating hemodialysis in this patient?", "options": [{"label": "A", "text": "Acute pulmonary edema", "correct": false}, {"label": "B", "text": "Hyperkalemia &amp;gt;5 mmol/L", "correct": true}, {"label": "C", "text": "Uremic encephalopathy", "correct": false}, {"label": "D", "text": "[H+] &amp;gt; 85 mmol/L", "correct": false}], "correct_answer": "B. Hyperkalemia &gt;5 mmol/L", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute (AKI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic(CKD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pulmonary edema</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary Edema</li>\n<li>Severe Hypertension</li>\n<li>Edema resistant to diuretics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>&gt;6.5 mmol/L</strong> with<strong> <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> changes (Broad QRS)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Potassium resistant to treatment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uraemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pericarditis</li>\n<li><strong>Encephalopathy</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uremic syndrome (anorexia, nausea, lethargy, etc.), typically when eGFR &lt; 10 mL/min/1.73 m²</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe acidosis</li>\n</ul>\n<p>(<strong>H+ &gt; 79 nmol/L</strong>; pH &lt; 7.1)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> resistant to <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> therapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bleeding <span class=\"customMeta\" data-dictid=\"a6116aa50e1692777186cfd59c5257\">diathesis</span> due to uremia-induced <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> dysfunction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intractable <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> despite <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> and iron supplementation</li>\n<li>Hyperphosphatemia despite <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> binders</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old patient undergoing hemodialysis suddenly develops symptoms of dizziness, significant leg cramps, and chest pain during the treatment session. Which of the following is the most common acute complication occurring in patients undergoing dialysis?", "options": [{"label": "A", "text": "Cardiac arrhythmias", "correct": false}, {"label": "B", "text": "Hypotension", "correct": true}, {"label": "C", "text": "Anaphylactoid reactions", "correct": false}, {"label": "D", "text": "Muscle cramps", "correct": false}], "correct_answer": "B. Hypotension", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ziYKmC3L0o9amOwIeE2p1744301093.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intermittent Hemodialysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continuous Hemodialysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly used for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury (AKI).</li>\n<li>Blood is on one side of the <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">dialysis</span> machine, and <span class=\"customMeta\" data-dictid=\"c8d85b7d2b1692777186b771294a05\">dialysate</span> is on the other side.</li>\n<li>Transfer of substances occurs by <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> and ultrafiltration.</li>\n<li>Common complication: Hypotension.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Intermittent Hemodialysis\" data-author=\"na\" data-hash=\"8735\" data-license=\"na\" data-source=\"na\" data-tags=\"\" height=\"235\" src=\"https://image.prepladder.com/notes/ziYKmC3L0o9amOwIeE2p1744301093.png\" width=\"315\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used in hemodynamically unstable patients.</li>\n<li><strong>Types: </strong>\n<ul>\n<li><strong>Convective Clearance: </strong>Water and dissolved solutes pass through a <span class=\"customMeta\" data-dictid=\"999fcdfb7c1692777198dd05eb1b4c\">semipermeable</span> membrane; <span class=\"customMeta\" data-dictid=\"e6a317ff3c16927771956fee0e76ed\">physiologic</span> <span class=\"customMeta\" data-dictid=\"745d08a9151692777185b2d2527097\">crystalloid</span> solution is added to circulation.</li>\n<li><strong>Diffusive Clearance:</strong> <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">Dialysis</span> with a lower flow rate.</li>\n<li><strong>Hybrid Therapy:</strong> Combines both convective and diffusive clearance<strong>.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications associated with Hemodialysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>During treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Between treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypotension:</strong> <strong>The most common <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> during hemodialysis</strong>, especially in patients with diabetes mellitus.</li>\n<li><strong>Muscle cramps</strong>.</li>\n<li><strong>Anaphylactoid reactions: </strong>These reactions, particularly to the dialyser, are most common during its first use and are often associated with <strong>bio <span class=\"customMeta\" data-dictid=\"10dcdd93561692777190d73418c5a7\">incompatible</span> cellulosic-containing membranes.</strong></li>\n<li><strong>Cardiac arrhythmias: </strong>D/t <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> &amp; acid-base shifts.</li>\n<li><strong>Hemorrhage: </strong>D/t <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> &amp; <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> needle disconnection.</li>\n<li><strong>Air embolism: </strong>D/t faulty lines &amp; equipment malfunction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pulmonary oedema</strong> (D/t fluid overload).</li>\n<li><strong>Systemic sepsis: </strong>Usually involves <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> access devices (catheter or fistula).</li>\n<li><strong>Dialysis <span class=\"customMeta\" data-dictid=\"6020176bfd16927771866a4128521e\">disequilibrium</span> syndrome </strong>typically occurs during or after a patient's first <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">dialysis</span> session. It presents with confusion, restlessness, headache, and muscle twitching. It is caused by a <strong>urea <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between the <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> and blood that raises <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure.</strong></li>\n<li><strong>Amyloidosis (</strong>D/t<strong> </strong><strong>beta 2 microglobulin</strong>)</li>\n<li><strong>Carpal tunnel syndrome (</strong>due to <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> deposition in the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> retinaculum).</li>\n<li><strong>Peripheral neuropathy</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most common opportunistic infection post kidney transplant and the time during which it occurs?", "options": [{"label": "A", "text": "Oral candidiasis - within 1 month of transplantation", "correct": false}, {"label": "B", "text": "Cytomegalovirus - within 1- 6 months of transplantation", "correct": true}, {"label": "C", "text": "Listeria monocytogenes - within 1- 6 months of transplantation", "correct": false}, {"label": "D", "text": "BK virus - after 6 months of transplantation", "correct": false}], "correct_answer": "B. Cytomegalovirus - within 1- 6 months of transplantation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications following <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> transplant</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Graft rejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperacute, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> and chronic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Opportunistic infections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>&lt; 1 Month: </strong>Wound infection, HSV, UTI, Oral candidiasis</li>\n<li><strong>1-6 Months: CMV</strong> (most common), HBV, HCV, <span class=\"customMeta\" data-dictid=\"af71e1cffa16927771950a5fb2c281\">Pneumocystis</span> carinii, Listeria</li>\n<li><strong>&gt;6 Months: BK Virus</strong>, Aspergillus, Nocardia, HBV, HCV, HZV</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypercalcemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This may indicate failure of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> post-transplant.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common post-transplant, often due to <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> medications.</li>\n<li>Gastrointestinal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> can occur from <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic hepatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Particularly from <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B virus, which can progress over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin and lip cancers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common malignancy</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The leading causes of death among <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplant recipients include:</strong></p>\n<ul>\n<li>Cardiovascular events (29%)</li>\n<li>Infections (18%)</li>\n<li>Malignancies (17%)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of hyperacute graft rejection?", "options": [{"label": "A", "text": "Cellular rejection", "correct": false}, {"label": "B", "text": "Granuloma formation", "correct": false}, {"label": "C", "text": "Preformed antibodies", "correct": true}, {"label": "D", "text": "Pre-existing infections", "correct": false}], "correct_answer": "C. Preformed antibodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:741px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">rejection</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperacute <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">rejection</span> </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs due to the presence of <strong>preformed antibodies</strong> <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> antigens on <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> endothelial cells - <strong>Type-2 <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">Hypersensitivity</span> reaction</strong></p>\n<p>It can occur immediately after <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> or during <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> <span class=\"customMeta\" data-dictid=\"fab1b509f91692777197e8f5af6253\">restoration</span> of the graft</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Rejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs due to (<strong>Type-4 <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">Hypersensitivity</span> reaction)</strong></p>\n<p><strong>Types</strong></p>\n<ul>\n<li><strong>Cellular Rejection</strong><strong> (Option A)</strong>\n<ul>\n<li>CD8+ <span class=\"customMeta\" data-dictid=\"6c110fba1a16927771854908b76842\">cytotoxic T lymphocytes</span> (CTLs) directly destroy <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> cells</li>\n<li>CD4+ T cells induce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> that damages the graft.</li>\n</ul>\n</li>\n<li><strong>Antibody-Mediated Rejection</strong>: Antibodies bind to <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> endothelium, activating the complement, leading to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> failure.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>It can occur within days to weeks of transplantation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Rejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs due to T cells reacting against <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> alloantigens, which <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> cytokines that stimulate <strong>fibroblast and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> smooth muscle cell proliferation.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 13 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 35-year-old patient is diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Genetic testing reveals a mutation in the PKD1 gene. Which of the following mechanisms is most likely involved in the formation of renal cysts in this patient?", "options": [{"label": "A", "text": "Decreased production of cyclic AMP (cAMP)", "correct": false}, {"label": "B", "text": "Dysfunction of polycystin proteins on the primary cilium", "correct": true}, {"label": "C", "text": "Overactivation of chloride and aquaporin channels", "correct": false}, {"label": "D", "text": "Decreased proliferation of renal epithelial cells and increased fluid secretion", "correct": false}], "correct_answer": "B. Dysfunction of polycystin proteins on the primary cilium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ADPKD- Introduction and aetiology</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Formation of <strong>epithelial-lined cysts</strong> in kidneys affecting ~5% of tubules. Despite the small number, <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> growth disrupts surrounding tissue, leading to loss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function.</li>\n<li>It is autosomal dominant with full <span class=\"customMeta\" data-dictid=\"cd2e83c3ad1692777195dad2ab75ec\">penetrance</span> but variable expressivity.</li>\n<li>Bilaterally enlarged kidneys with <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> and <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> cysts are seen</li>\n<li>Key defects: <strong>(Option D ruled out)</strong>\n<ul>\n<li>Increased cell <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> and fluid secretion</li>\n<li>Decreased cell differentiation</li>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> matrix</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Heterogeneity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>PKD1 mutations:</strong> ~85% of cases.</li>\n<li><strong>PKD2 mutations:</strong> ~15% (milder clinical presentation).</li>\n<li>Other genes: <strong>GANAB and DNAJB11 </strong>(rare cases, affecting polycystin-1 trafficking).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by mutations in PKD1 (polycystin-1) and PKD2 (polycystin-2).\n\t\t\t\t<ul>\n<li><strong>PKD1: large G-protein coupled receptor.</strong></li>\n<li><strong>PKD2: <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel protein.</strong></li>\n</ul>\n</li>\n<li>Polycystin proteins interact on the <strong>primary cilium</strong>. <strong>(Option C)</strong>\n<ul>\n<li>Dysfunction leads to impaired <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> signalling and <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> formation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular Mechanisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Polycystin-1 and -2 Complex: Forms a receptor-channel complex involved in <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> signalling and G-protein regulation.</li>\n<li>Affects processes like cell cycle, <span class=\"customMeta\" data-dictid=\"5d6a3738a016927771853497ecb24b\">cytoskeleton</span> organization, and cell migration.</li>\n<li>Disruption leads to <strong>abnormal <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> signalling, and increased cAMP, </strong>promoting <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> growth<strong> via <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> and <span class=\"customMeta\" data-dictid=\"3f961706a01692777181011d842df8\">aquaporin</span> channels</strong>. <strong>(Option A and C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cyst Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>\"Second hit\" mutation</strong> in normal PKD1/ PKD2 <span class=\"customMeta\" data-dictid=\"88c5dcbf0a1692777181e199712f81\">allele</span> leads to <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> formation.</li>\n<li>Partial loss of function initiates <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> growth, accelerated by <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> injury or genetic/epigenetic changes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the earliest presentation of Autosomal dominant polycystic kidney disease (ADPKD)?", "options": [{"label": "A", "text": "Reduced GFR", "correct": false}, {"label": "B", "text": "Urinary tract infection", "correct": false}, {"label": "C", "text": "Renal stones", "correct": false}, {"label": "D", "text": "Hypertension", "correct": true}], "correct_answer": "D. Hypertension", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is least likely to be a case of Autosomal Dominant Polycystic Kidney Disease (ADPKD)?", "options": [{"label": "A", "text": "2 cysts in one kidney of a 20-year-old", "correct": false}, {"label": "B", "text": "2 cysts in each kidney of a 36-year-old", "correct": false}, {"label": "C", "text": "4 cysts in each kidney of a 67-year-old", "correct": false}, {"label": "D", "text": "2 cysts in one kidney of a 30-year-old", "correct": true}], "correct_answer": "D. 2 cysts in one kidney of a 30-year-old", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Renal Ultrasonography.\n\t\t\t\t<ul>\n<li>Non-invasive, used for <span class=\"customMeta\" data-dictid=\"de809764741692777196fbafdae4e5\">presymptomatic</span> screening and donor evaluation.</li>\n<li>Limited sensitivity for PKD2 <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> due to late-onset; may miss smaller cysts.</li>\n</ul>\n</li>\n<li>CT Scan\n\t\t\t\t<ul>\n<li>More sensitive than <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> for detecting smaller cysts.</li>\n</ul>\n</li>\n<li>T2-MRI (With/Without Contrast)\n\t\t\t\t<ul>\n<li>Detects cysts as small as 2–3 mm using <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">gadolinium</span> contrast.</li>\n<li>Minimal <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> compared to CT contrast agents.</li>\n<li>Some cysts may remain undetected even with MRI.</li>\n</ul>\n</li>\n<li>Genetic Testing\n\t\t\t\t<ul>\n<li>Used in ambiguous cases or <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> presentations.</li>\n<li>Next-generation sequencing reduces costs and improves sensitivity.</li>\n<li>PKD1 gene testing is complex and expensive due to the presence of pseudogenes.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood Pressure Control\n\t\t\t\t<ul>\n<li><strong>ACE inhibitors or ARBs</strong></li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Antibiotic Treatment for <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> Infections\n\t\t\t\t<ul>\n<li>Preferred Antibiotics: Lipid-soluble (trimethoprim-sulfamethoxazole, quinolones, chloramphenicol)</li>\n<li>Duration: 4–6 weeks</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Kidney Stone Management\n\t\t\t\t<ul>\n<li>Hydration</li>\n<li>Analgesics for pain relief</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Pain management:</li>\n</ul>\n<ul>\n<li>Analgesics</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> Decompression</li>\n<li>Nerve Block</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Dialysis and Transplantation:\n\t\t\t\t<ul>\n<li>Dialysis Options: Peritoneal <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">dialysis</span> or hemodialysis</li>\n<li>Challenges with Peritoneal Dialysis: Limited <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> space, increased risk of <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> and back pain</li>\n<li>Pre-transplant Nephrectomy: May be needed for large kidneys or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections to accommodate the graft</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Medications to Slow Disease Progression:\n\t\t\t\t<ul>\n<li>mTOR Inhibitors: Sirolimus, everolimus</li>\n<li>V2R Antagonists: Tolvaptan</li>\n<li>Somatostatin Analogues: Octreotide-LAR</li>\n<li>Combination Therapy: Enhances efficacy, reduces side effects</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-day-old newborn presents with respiratory distress and low urine output. Prenatal ultrasound had shown enlarged, echogenic kidneys and reduced amniotic fluid levels. The family history reveals that the parents are related, but neither parent has any complaints. Which gene mutation is most likely responsible for this newborn’s condition?", "options": [{"label": "A", "text": "PKHD1", "correct": true}, {"label": "B", "text": "PKHD2", "correct": false}, {"label": "C", "text": "PHD1", "correct": false}, {"label": "D", "text": "PHD2", "correct": false}], "correct_answer": "A. PKHD1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">Recessive</span> <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">Polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease (ARPKD).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>PKHD1</strong> gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 6p21.1–6p12.2</li>\n<li>Produces fibrocystin/polyductin (FPC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pre-neonatal and <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">Neonatal</span> period: <strong>Enlarged <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> kidneys, oligohydramnios, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypoplasia</strong></li>\n</ul>\n<ul>\n<li>Later stages: <strong>Systemic hypertension, progressive <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, and liver involvement</strong></li>\n</ul>\n<ul>\n<li>Liver disease: <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (CHF) and Caroli disease</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> with hepatosplenomegaly, <span class=\"customMeta\" data-dictid=\"d4607865bb1692777201a35341db81\">variceal</span> bleeding, and cholangitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neonatal care: <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">Intensive</span> care and <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> control</li>\n<li>Renal management: Dialysis, <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplantation</li>\n<li>Liver complications: May require liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> or <span class=\"customMeta\" data-dictid=\"e2218202be1692777196fa2a021f5e\">portosystemic</span> shunting for Caroli disease</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a pathophysiology of Thrombotic thrombocytopenic purpura (TTP)?", "options": [{"label": "A", "text": "Reduced activity of ADAMTS14 enzyme", "correct": true}, {"label": "B", "text": "Accumulation of ultra-large von Willebrand factor (VWF) multimers", "correct": false}, {"label": "C", "text": "Platelet aggregation", "correct": false}, {"label": "D", "text": "Antibodies against ADAMTS13 enzyme", "correct": false}], "correct_answer": "A. Reduced activity of ADAMTS14 enzyme", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 Y/O male presents with fatigue, petechiae, and easy bruising. Over the past week, she has noticed increasing confusion and intermittent headaches. On examination, her blood pressure is normal, and she has no signs of active bleeding. Laboratory findings show the following: Haemoglobin: 7.5 g/dL Platelet count: 20,000/mm³ Blood smear: Schistocytes present LDH: Elevated Haptoglobin: Low Creatinine: 1.8 mg/dL Coagulation studies: Normal PT and aPTT What is the most likely diagnosis?", "options": [{"label": "A", "text": "HELLP syndrome", "correct": false}, {"label": "B", "text": "Disseminated Intravascular Coagulation (DIC)", "correct": false}, {"label": "C", "text": "Systemic Lupus Erythematosus (SLE)", "correct": false}, {"label": "D", "text": "Thrombotic Thrombocytopenic Purpura (TTP)", "correct": true}], "correct_answer": "D. Thrombotic Thrombocytopenic Purpura (TTP)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female presents with fatigue, fever, and confusion. She also reports easy bruising and occasional nosebleeds. On examination, she has petechiae on her extremities and mild jaundice. What is the most effective initial treatment in addition to plasma exchange for this condition? Laboratory findings include: Hemoglobin: 7.0 g/dL Platelet count: 12,000/mm³ Blood smear: Schistocytes present LDH: Elevated Haptoglobin: Low Creatinine: 1.5 mg/dL Coagulation profile: Normal PT and aPTT", "options": [{"label": "A", "text": "Prednisolone", "correct": true}, {"label": "B", "text": "Rituximab", "correct": false}, {"label": "C", "text": "Vincristine", "correct": false}, {"label": "D", "text": "Cyclophosphamide", "correct": false}], "correct_answer": "A. Prednisolone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:334px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Platelet Count &lt; 30,000/microlitre</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reticulocyte count &gt; 2.5%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indirect <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> &gt; 2mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MCV &lt; 90fL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>INR &lt; 1.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Creatinine &lt; 2 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Undetectable Haptoglobin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma exchange (PEX) with high-dose <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> therapy.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The mainstay of treatment in TTP</strong></p>\n<ul>\n<li>Corticosteroids operate by decreasing the activity of the <span class=\"customMeta\" data-dictid=\"77c058b3b21692777197f5fd539d12\">reticuloendothelial</span> system as well as decreasing <span class=\"customMeta\" data-dictid=\"06e07ce7821692777182e8ffd9676f\">autoantibody</span> production.</li>\n<li>Both the ultra-large <span class=\"customMeta\" data-dictid=\"0327d20161169277720287847fa436\">VWF</span> multimers and the ADAMTS13 autoantibodies are effectively removed from <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> by <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> exchange therapy.</li>\n<li>The recommended volume of exchange is one <strong>estimated <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume (usually 40 mL/kg of body weight)</strong> with each treatment.</li>\n<li>The <strong>recommended dose for corticosteroids is 1 mg/kg per day of prednisolone.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rituximab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An anti-CD20 <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">monoclonal</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> was found to help treat TTP <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> to PEX. It targets B-lymphocytes and has a <strong>good response rate in <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> and relapsed TTP.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caplacizumab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It has a high potential for TTP. It is a humanized <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">monoclonal</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> fragment (a bivalent, variable-domain-only fragment) that attacks the A1 section of <span class=\"customMeta\" data-dictid=\"0327d20161169277720287847fa436\">VWF</span> and prevents <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> adhesion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Splenectomy, vincristine, <span class=\"customMeta\" data-dictid=\"fa041055ec16927771858fe49c76d3\">cyclosporine</span> and cyclophosphamide.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents to the emergency department with fatigue, pallor and decreased urine output for the past three days. She reports a recent history of diarrhoea that started and has now resolved. Physical examination reveals pallor, mild jaundice, and petechiae on the lower limbs. Laboratory studies show haemoglobin of 7.8 g/dL, platelet count of 35,000/mm³, elevated serum creatinine of 2.5 mg/dL, and LDH of 950 U/L.A peripheral blood smear reveals schistocytes. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hemolytic uremic syndrome (HUS)", "correct": true}, {"label": "B", "text": "Disseminated intravascular coagulation (DIC)", "correct": false}, {"label": "C", "text": "Systemic vasculitis", "correct": false}, {"label": "D", "text": "Thrombotic thrombocytopenic purpura (TTP)", "correct": false}], "correct_answer": "A. Hemolytic uremic syndrome (HUS)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Typical HUS/ D+HUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shiga toxin-producing <span class=\"customMeta\" data-dictid=\"c2ea0d4bf01692777187d486aa6385\">Escherichia</span> <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> (STEC), called typical HUS, is the most common cause of HUS.</li>\n<li><strong>Escherichia <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> 0157:H7 (E <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> 0157:H7) </strong>has been <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to typical HUS.</li>\n<li><strong>Typical HUS comprises 90% to 95% of HUS.</strong></li>\n<li>Commonly arises from consuming contaminated food or drink and through person-to-person contact.</li>\n<li>It has low <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> compared to <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> HUS.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atypical HUS/</strong></p>\n<p><strong>D-HUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The cause of aHUS is the <strong>abnormal <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of the alternative <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> pathway. </strong></li>\n<li>The <span class=\"customMeta\" data-dictid=\"9f49574bce1692777181ca753a683c\">alternative <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> pathway</span> is activated with particular emphasis on regulatory Factor H, stabilises C3, and inactivates C3b.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary HUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HUS secondary to underlying conditions or infections, commonly presenting as aHUS with <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> system activation.</li>\n<li>The most significant component of this category is HUS caused by <strong>Streptococcus pneumoniae.</strong></li>\n<li>Caused by Inherited vitamin B12 <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> disorder, HIV, <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> virus and <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> hypertension.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the first-line treatment for atypical hemolytic uremic syndrome (aHUS)?", "options": [{"label": "A", "text": "Eculizumab", "correct": true}, {"label": "B", "text": "Ravulizumab", "correct": false}, {"label": "C", "text": "Cyclophosphamide", "correct": false}, {"label": "D", "text": "Rituximab", "correct": false}], "correct_answer": "A. Eculizumab", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Typical HUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Management of typical HUS caused by <span class=\"customMeta\" data-dictid=\"1f21b98a111692777199de81e90bef\">STEC</span> is <strong>generally supportive.</strong></li>\n<li>Patients are often volume-depleted, and less volume <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> has been <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to an increased need for <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> replacement therapy.</li>\n<li><strong>Blood transfusions and <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> transfusions </strong>are provided to avoid thrombotic complications.</li>\n<li><strong>Antimotility agents and antibiotics are avoided in typical HUS</strong> caused by STEC, as they correlate with poorer outcomes, likely due to heightened <span class=\"customMeta\" data-dictid=\"f6cedefabe1692777198d050d24a4d\">Shiga toxin</span> exposure.</li>\n<li>If S dysenteriae or S <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> is present, early antibiotics are given to improve the outcomes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atypical HUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The cornerstones of treatment for aHUS are <strong>first-line treatment with <span class=\"customMeta\" data-dictid=\"6a9b33e69916927771861bd0e99af4\">eculizumab</span> and second-line with <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> exchange.</strong></li>\n<li><strong>Eculizumab</strong> is a <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">recombinant</span> <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">monoclonal</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> that targets the C5 component of <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> by preventing its cleavage.</li>\n<li><strong>Ravulizumab</strong> is a new C5 <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> that binds to C5 preventing <span class=\"customMeta\" data-dictid=\"db5610b3121692777184e0965a9fa4\">cleavage</span> and it has similar <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> to <span class=\"customMeta\" data-dictid=\"6a9b33e69916927771861bd0e99af4\">eculizumab</span> but with 4 times as long of a half-life.</li>\n<li><strong>Adverse effects of eculizumab</strong> are infection by <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> organisms such as S pneumoniae and <span class=\"customMeta\" data-dictid=\"e8810d5c6b169277718827849b05a3\">Haemophilus</span> influenzae, and all patients should be given appropriate vaccines and monitored.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary HUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Depends on the treatment of the underlying condition.</li>\n<li><strong>Eculizumab</strong> has some <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> in treating <strong>pregnancy-related secondary HUS.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female came to OP with a fever, weakness of the right side of her body, and bleeding episodes while brushing. Preliminary investigations revealed S.Creatinine: 2 mg/dL (0.6-1.1 mg/dl) Platelet count: 20,000 cells/cu.mm (1,50,000-4,00,000 cells/cu.mm) Bleeding time: 10 mins (2-7 mins) PT: 15 sec (11.5-13.5 seconds) aPTT: 38 sec (21-35 seconds) Peripheral smear revealed the following What is the likely diagnosis?", "options": [{"label": "A", "text": "Immune thrombocytopenic purpura", "correct": false}, {"label": "B", "text": "IgA Vasculitis", "correct": false}, {"label": "C", "text": "Thrombotic thrombocytopenic purpura", "correct": true}, {"label": "D", "text": "Disseminated intravascular coagulation", "correct": false}], "correct_answer": "C. Thrombotic thrombocytopenic purpura", "question_images": ["https://image.prepladder.com/notes/B9uwq9gorD6ZWKPqP4Ym1744291447.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ITP</strong><strong> (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TTP</strong><strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HSP </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DIC </strong><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Child (5-15 y)</li>\n<li>Middle-aged females (20-40y)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Middle-aged females &gt;&gt; males</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Children usually in the first decade</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No specific age predominance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autoimmune causes</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases - mainly SLE.</li>\n<li>Infections: HIV, Hep-C, H.pylori</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Deficiency/autoantibodies to ADAMTS-13</li>\n<li>ADAMTS-13 is responsible for cleaving vWF.</li>\n<li>Deficiency of ADAMTS-13 leads to ↑ <span class=\"customMeta\" data-dictid=\"0327d20161169277720287847fa436\">vWF</span> levels.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>IgA-mediated <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">Vasculitis</span> - blood vessels are affected, and platelets are spared</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sepsis</li>\n<li>Trauma</li>\n<li>Malignancy (AML-M3)</li>\n<li>Obstetric: <span class=\"customMeta\" data-dictid=\"f5df620f42169277718051194dc6e4\">Abruptio</span> placenta, <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid embolism</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever + thrombo- cytopenia</li>\n<li>Self-resolving in children</li>\n<li>May cause <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> manifestations in adults</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever + thrombo- cytopenia</li>\n<li>MAHA</li>\n<li>Stroke</li>\n<li>AKI/CKD</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non thrombo- cytopenic Purpura</li>\n<li>Fever</li>\n<li>AKI (rarely)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> counts with <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> manifestations + <span class=\"customMeta\" data-dictid=\"bf6247405e16927771891b6a068d36\">hypotensive</span> shock</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C3 - Normal (N)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibrinogen - N</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibrinogen - ↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N/ minor ↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>aPTT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N/ minor ↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Primary cilia of the kidney are present in all of the following except", "options": [{"label": "A", "text": "Principal cells of Collecting duct", "correct": false}, {"label": "B", "text": "Intercalated cells of Collecting duct", "correct": true}, {"label": "C", "text": "Proximal convoluted tubule (PCT)", "correct": false}, {"label": "D", "text": "Distal convoluted tubule (DCT)", "correct": false}], "correct_answer": "B. Intercalated cells of Collecting duct", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Introduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specialized microtubule-based projections from the <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> surface of epithelial cells of the kidney.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Functions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mainly responsible for <span class=\"customMeta\" data-dictid=\"28f5a05c8b1692777198471034364a\">signal transduction</span> by</p>\n<ul>\n<li><strong>Chemosensors: </strong>measures <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> traversing the tubule</li>\n<li><strong>Mechanosensors:</strong> measure the volume of <span class=\"customMeta\" data-dictid=\"e0c336554f16927772018d95c26ac1\">ultrafiltrate</span> passing through the kidney.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present in all epithelial cells of the kidney</p>\n<ul>\n<li>Proximal <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">tubule</span> (PCT) <strong>(Option C ruled out)</strong></li>\n<li>Distal <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">tubule</span> (DCT) <strong>(Option D ruled out)</strong></li>\n<li>Principal cells of Collecting <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <strong>(Option A ruled out)</strong></li>\n</ul>\n<p><strong>EXCEPT: <span class=\"customMeta\" data-dictid=\"cfd35769b016927771901681bcc115\">Intercalated</span> cells of Collecting <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> &amp; Loop of Henle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutations in ciliary-associated proteins result in diseases together known as <strong>Ciliopathies</strong>. A few examples in kidneys are,</p>\n<ul>\n<li>Autosomal Dominant Variety of <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">Polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease <strong>(ADPKD)</strong></li>\n<li>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">Recessive</span> <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">Polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease <strong>(ARPKD)</strong></li>\n<li><strong>Medullary <span class=\"customMeta\" data-dictid=\"1f8d123d5a16927771996d6f75145f\">Sponge</span> Kidney</strong> (MSK)</li>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease (MCKD) / <strong>Autosomal Dominant <span class=\"customMeta\" data-dictid=\"11a108da951692777201ccf7220331\">Tubulointerstitial</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease (ADTKD)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Wheel depicting primary ciliopathies\" custommeta\"=\"\" data-author=\"Dewhurst, Rebecca &amp; Molinari, Elisa &amp; Sayer, John. (2023). Spheroids, organoids and kidneys-on-chips: how complex human cellular models have assisted in the study of &lt;span class=\" data-dictid=\"4aa6035df41692777190b41d4a1583\"/>kidney disease and renal ciliopathies. Microfluidics and Nanofluidics. 27. 10.1007/s10404-023-02629-4. \" data-hash=\"8552\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Wheel-depicting-primary-ciliopathies-which-present-with-a-renal-phenotype-Other-common_fig3_368605929\" data-tags=\"\" src=\"https://image.prepladder.com/notes/2zunkKH9Um9R8hBDB8wl1744291660.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presented with recurrent episodes of hematuria associated with loin pain for the past 6 months. He also gives a history of episodes of recurrent UTIs in his early childhood. IVP done showed the following. What is the most likely composition of renal stones in this patient?", "options": [{"label": "A", "text": "Calcium oxalate", "correct": true}, {"label": "B", "text": "Struvite", "correct": false}, {"label": "C", "text": "Uric acid", "correct": false}, {"label": "D", "text": "Cystine", "correct": false}], "correct_answer": "A. Calcium oxalate", "question_images": ["https://image.prepladder.com/notes/KEgmnIUKeHWnX65FZfAy1744291789.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cystic dilatations of <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> portions of collecting duct</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Childhood: usually <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or may have episodes of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> UTI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adult: 50-60 years</strong></p>\n<ul>\n<li>Nephrolithiasis: <strong>Calcium oxalate</strong> stone (most common) <strong>(Option A)</strong></li>\n<li>Recurrent hematuria</li>\n<li>Pyelonephritis: secondary to <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> UTI</li>\n<li>Polyuria:<strong> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in collecting <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> receptors</strong></li>\n<li>anaemia: <span class=\"customMeta\" data-dictid=\"ce12dc160c1692777195473ab2cc21\">Peritubular</span> cell damage → ↓ <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">Erythropoietin</span> levels</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IVP: <span class=\"customMeta\" data-dictid=\"7619c1f37016927771836a9a61bc25\">Bouquet</span> of <span class=\"customMeta\" data-dictid=\"885830d4c216927772022cdb65cbf1\">flowers</span> (or) Paint brush appearance</strong></li>\n<li>USG: Associated <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> <span class=\"customMeta\" data-dictid=\"e0869bcc2d169277719336bc5b8a6d\">nephrocalcinosis</span> may be seen</li>\n<li>CT: NCCT/Helical CT - Best Investigation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treatment of complications</li>\n<li>UTI prophylaxis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient was diagnosed with End Stage Renal Disease (ESRD) at the age of 30y. On evaluation, mutation analysis was positive for the UMOD (Uromodulin) gene. Which among the following is the least likely manifestation of this condition?", "options": [{"label": "A", "text": "Polyuria", "correct": false}, {"label": "B", "text": "Bland urinary sediments", "correct": false}, {"label": "C", "text": "Polycythemia", "correct": true}, {"label": "D", "text": "Gout", "correct": false}], "correct_answer": "C. Polycythemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Group of inherited <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disorder characterised by Tubulo-interstitial <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> and <span class=\"customMeta\" data-dictid=\"862b9b46641692777183ea602de834\">bland</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> sediments.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>UMOD</strong> (Uromodulin)</li>\n<li><strong>MUC-1</strong> (Mucin)</li>\n<li>Other genes: <span class=\"customMeta\" data-dictid=\"fe8bf9d7d7169277719780a365f7a4\">REN</span> (Renin), HNF1β (Hepatocyte nuclear factor)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autosomal dominant pattern</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manifestations/ Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Polyuria: </strong>Tubulointerstitial disorders have a non-oliguric presentation <strong>(Option A)</strong></li>\n<li><strong>anaemia: </strong>Peritubular cell damage → ↓ <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">Erythropoietin</span> levels <strong>(Option C)</strong></li>\n<li><strong>CKD/ESRD:</strong> Due to progressive <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage</li>\n<li><strong>Gout:</strong> usual presentation in adults, mainly in <strong>ADTKD-UMOD</strong> <strong>(Option D)</strong></li>\n<li>Hypovolemia: mainly seen in ADTKD-REN</li>\n<li>Liver damage: mainly seen in ADTKD-HNF1β</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Urine examination: <strong>Bland <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> sediments - most specific finding </strong>(RBC/WBC/Epithelial casts) <strong>(Option B)</strong></li>\n<li><strong>USG: Shrunken kidneys</strong></li>\n<li>Histopathology: <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> atrophy, <span class=\"customMeta\" data-dictid=\"11a108da951692777201ccf7220331\">tubulointerstitial</span> fibrosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anti-gout drugs: <strong>Allopurinol and Febuxostat</strong> are mainly useful in <strong>ADTKD-UMOD.</strong></li>\n<li>Replenishment of body fluids &amp; Supportive care</li>\n<li>Hemodialysis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 8 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 40-year-old woman presents with a 3-month history of excessive thirst and increased urination. She denies any recent illnesses, medications or head trauma. Her laboratory tests reveal normal serum sodium and osmolality, but her urine is dilute with low osmolality. A fluid deprivation test is performed, and her urine osmolarity remains low despite an increase in plasma osmolality. However, administration of desmopressin (DDAVP) results in a significant increase in urine osmolarity. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Central diabetes insipidus", "correct": true}, {"label": "B", "text": "Nephrogenic diabetes insipidus", "correct": false}, {"label": "C", "text": "Psychogenic polydipsia", "correct": false}, {"label": "D", "text": "SIADH", "correct": false}], "correct_answer": "A. Central diabetes insipidus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:783px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central DI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nephrogenic DI</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Polydipsia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gestational DI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deficiency of <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> (Arginine vasopressin) <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kidneys are unable to respond to AVP, even if levels are normal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excessive water intake, suppressing <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> secretion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased activity of <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> degrading <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired</strong>: Head trauma, tumours, granulomas, infections, inflammation, toxins, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> events, hypoxia.</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired</strong>: Drugs (lithium, demeclocycline), <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders (hypercalcaemia, hypokalaemia), obstruction, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> issues, granulomas, tumours, and infiltration.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dipsogenic</strong>: Inappropriate thirst, head trauma, brain diseases.</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"6937cb294a1692777201467ccb0597\">vasopressinase</span> activity.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Psychogenic</strong>: Psychiatric conditions, <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> water drinking.</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the AVP–neurophysin II or WFS1 genes.</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> or aquaporin-2 genes.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iatrogenic</strong>: Belief in the health benefits of excessive water intake.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basal <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> AVP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low or undetectable (&lt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or elevated (&gt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low due to <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> by excessive water intake.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low due to increased degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L) but can temporarily concentrate with fluid deprivation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> increases <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> in severe CDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> has no effect on severe NDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plasma <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> and sodium increase above normal without <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> concentration.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not typically performed during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot absent or small.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright- spot may be faint or absent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot present.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not routinely used for diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Desmopressin (DDAVP) Trial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abolishes <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> and polydipsia; reduces <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No effect on <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, fluid intake, or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eliminates <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> but not polydipsia, leading to hyponatremia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effective in controlling symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma Copeptin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low or undetectable.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may be normal or elevated.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suppressed due to low AVP.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may be low due to <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thiazide diuretics, amiloride, low-sodium diet, <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> inhibitors.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Behavioural therapy, education about overhydration.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lifelong treatment is usually needed for <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> CDI</li>\n<li>Genetic forms may improve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dependent on the underlying cause</li>\n<li>Lithium-induced NDI may persist.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dependent on behavioural <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> and addressing the underlying cause.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually, it resolves after delivery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male presents with persistent polyuria and polydipsia. His plasma osmolarity is 310 mOsm/kg, and his urine osmolarity remains low (150 mOsm/L) despite overnight fluid deprivation. Plasma copeptin levels are measured after hypertonic saline infusion and are found to be low. MRI reveals an absent posterior pituitary bright spot. Which of the following genetic mutations is most likely responsible for his condition?", "options": [{"label": "A", "text": "Mutation in the AVP–neurophysin II gene", "correct": true}, {"label": "B", "text": "Mutation in the V2 receptor gene", "correct": false}, {"label": "C", "text": "Mutation in the WFS1 gene", "correct": false}, {"label": "D", "text": "Mutation in the AQP1 gene", "correct": false}], "correct_answer": "A. Mutation in the AVP–neurophysin II gene", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:783px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central DI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nephrogenic DI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Polydipsia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gestational DI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deficiency of <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kidneys are unable to respond to AVP, even if levels are normal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excessive water <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> suppresses <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> secretion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased activity of <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> degrading <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired</strong>: Head trauma, tumours, granulomas, infections, inflammation, toxins, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> events, hypoxia.</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired</strong>: Drugs (lithium, demeclocycline), <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders (hypercalcaemia, hypokalaemia), obstruction, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> issues, granulomas, tumours, and infiltration.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dipsogenic</strong>: Inappropriate thirst, head trauma, brain diseases.</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"6937cb294a1692777201467ccb0597\">vasopressinase</span> activity.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Psychogenic</strong>: Psychiatric conditions, <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> water drinking.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic</strong>:<strong> Mutations in the AVP–neurophysin II </strong>or WFS1 genes.</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> or aquaporin-2 genes.</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iatrogenic</strong>: Belief in the health benefits of excessive water intake.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basal <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> AVP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low or undetectable (&lt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or elevated (&gt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low due to <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> by excessive water intake.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low due to increased degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L) but can temporarily concentrate with fluid deprivation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urine does not concentrate; <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> increases <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> in severe CDI.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urine does not concentrate; <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> has no effect on severe NDI.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plasma <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> and sodium increase above normal without <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> concentration.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not typically performed during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot absent or small.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot- may be faint or absent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot present.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not routinely used for diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Desmopressin (DDAVP) Trial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abolishes <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> and polydipsia; reduces <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No effect on <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, fluid intake, or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eliminates <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> but not polydipsia, leading to hyponatremia.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effective in controlling symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma Copeptin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low or undetectable.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be normal or elevated.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suppressed due to low AVP.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be low due to <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thiazide diuretics, amiloride, low-sodium diet, <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> inhibitors.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Behavioural therapy, education about overhydration.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lifelong treatment is usually needed for <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> CDI</li>\n<li>Genetic forms may improve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dependent on the underlying cause</li>\n<li>Lithium-induced NDI may persist.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dependent on behavioural <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> and addressing the underlying cause.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually resolves after delivery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man with a long-standing history of bipolar disorder, treated with lithium, presents with polyuria and polydipsia. He complains of waking up multiple times at night to urinate. Laboratory tests reveal elevated serum sodium and osmolality with dilute urine. Which of the following is the most appropriate initial management step for this patient?", "options": [{"label": "A", "text": "Desmopressin (DDAVP) 10 mcg intranasally twice daily", "correct": false}, {"label": "B", "text": "Discontinuation of lithium and initiation of a low-sodium diet", "correct": true}, {"label": "C", "text": "Hydrochlorothiazide 25 mg orally once daily", "correct": false}, {"label": "D", "text": "Fluid restriction to 1 litre per day", "correct": false}], "correct_answer": "B. Discontinuation of lithium and initiation of a low-sodium diet", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following scenarios is LEAST likely to result in the development of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?", "options": [{"label": "A", "text": "A 50-year-old male with bacterial pneumonia requiring intensive care unit admission", "correct": false}, {"label": "B", "text": "A 45 y/o female with subarachnoid haemorrhage and altered mental status", "correct": false}, {"label": "C", "text": "A 70 y/o male with chronic obstructive pulmonary disease (COPD) exacerbation being treated with diuretics", "correct": true}, {"label": "D", "text": "A 35 y/o female on carbamazepine therapy for epilepsy presenting with fatigue and confusion", "correct": false}], "correct_answer": "C. A 70 y/o male with chronic obstructive pulmonary disease (COPD) exacerbation being treated with diuretics", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion</li><li>↳ Definition Excessive ADH release leads to impaired water excretion and hyponatremia with euvolemia or hypervolemia.</li><li>↳ Definition</li><li>↳ Definition</li><li>↳ Definition</li><li>↳ Excessive ADH release leads to impaired water excretion and hyponatremia with euvolemia or hypervolemia.</li><li>↳ Excessive ADH release leads to impaired water excretion and hyponatremia with euvolemia or hypervolemia.</li><li>↳ Aetiology CNS disturbances: Stroke, infection, subarachnoid haemorrhage (Option B ruled out) , etc. Malignancies: Small cell lung cancer (most common) , other cancers. Drugs: Carbamazepine (Option D ruled out) , oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia (Option A ruled out) , respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ Aetiology</li><li>↳ Aetiology</li><li>↳ Aetiology</li><li>↳ CNS disturbances: Stroke, infection, subarachnoid haemorrhage (Option B ruled out) , etc. Malignancies: Small cell lung cancer (most common) , other cancers. Drugs: Carbamazepine (Option D ruled out) , oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia (Option A ruled out) , respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ CNS disturbances: Stroke, infection, subarachnoid haemorrhage (Option B ruled out) , etc. Malignancies: Small cell lung cancer (most common) , other cancers. Drugs: Carbamazepine (Option D ruled out) , oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia (Option A ruled out) , respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ CNS disturbances: Stroke, infection, subarachnoid haemorrhage (Option B ruled out) , etc.</li><li>↳ subarachnoid haemorrhage</li><li>↳ (Option B ruled out)</li><li>↳ Malignancies: Small cell lung cancer (most common) , other cancers.</li><li>↳ Small cell lung cancer (most common)</li><li>↳ Drugs: Carbamazepine (Option D ruled out) , oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc.</li><li>↳ Carbamazepine</li><li>↳ (Option D ruled out)</li><li>↳ Surgery: Pain-induced ADH hypersecretion.</li><li>↳ Pulmonary diseases: Pneumonia (Option A ruled out) , respiratory failure, etc.</li><li>↳ Pneumonia</li><li>↳ (Option A ruled out)</li><li>↳ Hormone deficiency: Hypopituitarism, hypothyroidism.</li><li>↳ HIV: Associated with infections.</li><li>↳ Hereditary SIADH: V2 receptor mutation.</li><li>↳ Pathophysiology ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ Pathophysiology</li><li>↳ Pathophysiology</li><li>↳ Pathophysiology</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia.</li><li>↳ Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ Clinical Presentation Acute hyponatremia : Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms ( nausea, confusion, falls in elderly ).</li><li>↳ Clinical Presentation</li><li>↳ Clinical Presentation</li><li>↳ Clinical Presentation</li><li>↳ Acute hyponatremia : Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms ( nausea, confusion, falls in elderly ).</li><li>↳ Acute hyponatremia : Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms ( nausea, confusion, falls in elderly ).</li><li>↳ Acute hyponatremia : Nausea, vomiting, headache, seizures, coma.</li><li>↳ Acute</li><li>↳ :</li><li>↳ Nausea, vomiting, headache, seizures, coma.</li><li>↳ Chronic hyponatremia: Nonspecific symptoms ( nausea, confusion, falls in elderly ).</li><li>↳ Chronic</li><li>↳ nausea, confusion, falls in elderly</li><li>↳ Diagnosis Schwartz and Bartter criteria: Serum sodium &lt;135 mEq/L Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair renal water excretion.)</li><li>↳ Diagnosis</li><li>↳ Diagnosis</li><li>↳ Diagnosis</li><li>↳ Schwartz and Bartter criteria: Serum sodium &lt;135 mEq/L Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair renal water excretion.)</li><li>↳ Schwartz and Bartter criteria:</li><li>↳ Schwartz and Bartter criteria:</li><li>↳ Serum sodium &lt;135 mEq/L Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair renal water excretion.)</li><li>↳ Serum sodium &lt;135 mEq/L</li><li>↳ Serum osmolality &lt;275 mOsm/kg</li><li>↳ Urine sodium &gt;40 mEq/L</li><li>↳ Urine osmolality &gt;100 mOsm/kg</li><li>↳ The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range)</li><li>↳ The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair renal water excretion.)</li><li>↳ Tests: Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Tests: Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Tests:</li><li>↳ Tests:</li><li>↳ Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Management Fluid restriction : For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Management</li><li>↳ Management</li><li>↳ Management</li><li>↳ Fluid restriction : For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Fluid restriction : For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Fluid restriction : For mild to moderate symptoms.</li><li>↳ Fluid restriction</li><li>↳ Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs).</li><li>↳ Hypertonic saline (3%):</li><li>↳ Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Vasopressin receptor antagonists (Conivaptan, Tolvaptan)</li><li>↳ Vasopressin receptor antagonists (Conivaptan, Tolvaptan)</li><li>↳ Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Complications Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Complications</li><li>↳ Complications</li><li>↳ Complications</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction.</li><li>↳ Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syndrome of Inappropriate <span class=\"customMeta\" data-dictid=\"27bd08bbaa16927771812e98e16787\">Antidiuretic</span> Hormone Secretion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excessive <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> release leads to impaired water <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> and <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> with <span class=\"customMeta\" data-dictid=\"159ab75ed316927771879ce7b3cb84\">euvolemia</span> or hypervolemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CNS disturbances: Stroke, infection, <strong>subarachnoid haemorrhage </strong><strong>(Option B ruled out)</strong>, etc.</li>\n<li>Malignancies: <strong>Small cell lung cancer (most common)</strong>, other cancers.</li>\n<li>Drugs: <strong>Carbamazepine </strong><strong>(Option D ruled out)</strong>, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc.</li>\n<li>Surgery: Pain-induced <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> hypersecretion.</li>\n<li>Pulmonary diseases: <strong>Pneumonia </strong><strong>(Option A ruled out)</strong>, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, etc.</li>\n<li>Hormone deficiency: Hypopituitarism, hypothyroidism.</li>\n<li>HIV: Associated with infections.</li>\n<li>Hereditary SIADH: V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> mutation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ADH function: Regulates <span class=\"customMeta\" data-dictid=\"2108d4f8a21692777202226f391d3b\">water balance</span> by controlling <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolality; <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> causes water retention, leading to hyponatremia.</li>\n<li>Volume regulation: In hypovolemia, <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> release is driven by volume receptors, worsening hyponatremia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute </strong>hyponatremia<strong>: </strong><strong>Nausea, vomiting, headache, seizures, coma.</strong></li>\n<li><strong>Chronic </strong>hyponatremia: <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">Nonspecific</span> symptoms (<strong>nausea, confusion, falls in elderly</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schwartz and Bartter criteria:</strong></p>\n<ul>\n<li>Serum sodium &lt;135 mEq/L</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> &lt;275 mOsm/kg</li>\n<li>Urine sodium &gt;40 mEq/L</li>\n<li>Urine <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> &gt;100 mOsm/kg</li>\n<li>The absence of clinical evidence of volume <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> (like normal skin turgor, <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> within the reference range)</li>\n<li>The absence of <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> due to other causes (like <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, hypothyroidism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure, <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> insufficiency, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease with salt wastage, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> disease, and drugs that impair <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> water excretion.)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests:</strong></p>\n<p>Renal function, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> osmolality, <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tests, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for underlying causes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fluid restriction</strong>: For mild to moderate symptoms.</li>\n<li><strong>Hypertonic <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> (3%):</strong> For severe hyponatremia, with careful <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> rate (&lt;8 mEq/L in 24 hrs).</li>\n<li>Medications:\n\t\t\t\t<ul>\n<li><strong>Vasopressin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists (Conivaptan, Tolvaptan)</strong></li>\n<li><strong>Other: Loop diuretics, salt tablets, demeclocycline, lithium.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osmotic <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> syndrome: Risk from rapid sodium correction.</li>\n<li>Severe hyponatremia: Can lead to seizures, coma, and death in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with a history of small-cell lung carcinoma presents to the emergency department with confusion, nausea and fatigue. On examination, his volume status appears euvolemic, and lab results show a serum sodium level of 118 mEq/L, serum osmolality of 260 mOsm/kg and urine osmolality of 600 mOsm/kg. Which of the following is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Administer hypertonic saline (3% NaCl)", "correct": true}, {"label": "B", "text": "Administer normal saline (0.9% NaCl)", "correct": false}, {"label": "C", "text": "Fluid restriction", "correct": false}, {"label": "D", "text": "Administer vasopressin receptor antagonists (vaptans)", "correct": false}], "correct_answer": "A. Administer hypertonic saline (3% NaCl)", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion</li><li>↳ Definition Excessive ADH release leads to impaired water excretion and hyponatremia with euvolemia or hypervolemia.</li><li>↳ Definition</li><li>↳ Definition</li><li>↳ Definition</li><li>↳ Excessive ADH release leads to impaired water excretion and hyponatremia with euvolemia or hypervolemia.</li><li>↳ Excessive ADH release leads to impaired water excretion and hyponatremia with euvolemia or hypervolemia.</li><li>↳ Aetiology CNS disturbances: Stroke, infection, trauma, etc. Malignancies: Small cell lung cancer (most common) , other cancers. Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia, respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ Aetiology</li><li>↳ Aetiology</li><li>↳ Aetiology</li><li>↳ CNS disturbances: Stroke, infection, trauma, etc. Malignancies: Small cell lung cancer (most common) , other cancers. Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia, respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ CNS disturbances: Stroke, infection, trauma, etc. Malignancies: Small cell lung cancer (most common) , other cancers. Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia, respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ CNS disturbances: Stroke, infection, trauma, etc.</li><li>↳ Malignancies: Small cell lung cancer (most common) , other cancers.</li><li>↳ Small cell lung cancer (most common)</li><li>↳ Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc.</li><li>↳ Surgery: Pain-induced ADH hypersecretion.</li><li>↳ Pulmonary diseases: Pneumonia, respiratory failure, etc.</li><li>↳ Hormone deficiency: Hypopituitarism, hypothyroidism.</li><li>↳ HIV: Associated with infections.</li><li>↳ Hereditary SIADH: V2 receptor mutation.</li><li>↳ Pathophysiology ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ Pathophysiology</li><li>↳ Pathophysiology</li><li>↳ Pathophysiology</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia.</li><li>↳ Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ Clinical Presentation Acute hyponatremia : Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms ( nausea, confusion, falls in elderly ).</li><li>↳ Clinical Presentation</li><li>↳ Clinical Presentation</li><li>↳ Clinical Presentation</li><li>↳ Acute hyponatremia : Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms ( nausea, confusion, falls in elderly ).</li><li>↳ Acute hyponatremia : Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms ( nausea, confusion, falls in elderly ).</li><li>↳ Acute hyponatremia : Nausea, vomiting, headache, seizures, coma.</li><li>↳ Acute</li><li>↳ :</li><li>↳ Nausea, vomiting, headache, seizures, coma.</li><li>↳ Chronic hyponatremia: Nonspecific symptoms ( nausea, confusion, falls in elderly ).</li><li>↳ Chronic</li><li>↳ nausea, confusion, falls in elderly</li><li>↳ Diagnosis Schwartz and Bartter criteria: Serum sodium &lt;135 mEq/L Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair renal water excretion.)</li><li>↳ Diagnosis</li><li>↳ Diagnosis</li><li>↳ Diagnosis</li><li>↳ Schwartz and Bartter criteria: Serum sodium &lt;135 mEq/L Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair renal water excretion.)</li><li>↳ Schwartz and Bartter criteria:</li><li>↳ Schwartz and Bartter criteria:</li><li>↳ Serum sodium &lt;135 mEq/L Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair renal water excretion.)</li><li>↳ Serum sodium &lt;135 mEq/L</li><li>↳ Serum osmolality &lt;275 mOsm/kg</li><li>↳ Urine sodium &gt;40 mEq/L</li><li>↳ Urine osmolality &gt;100 mOsm/kg</li><li>↳ The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range)</li><li>↳ The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair renal water excretion.)</li><li>↳ Tests: Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Tests: Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Tests:</li><li>↳ Tests:</li><li>↳ Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Management Fluid restriction : For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Management</li><li>↳ Management</li><li>↳ Management</li><li>↳ Fluid restriction : For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Fluid restriction : For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Fluid restriction : For mild to moderate symptoms.</li><li>↳ Fluid restriction</li><li>↳ Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs).</li><li>↳ Hypertonic saline (3%):</li><li>↳ Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Vasopressin receptor antagonists (Conivaptan, Tolvaptan)</li><li>↳ Vasopressin receptor antagonists (Conivaptan, Tolvaptan)</li><li>↳ Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Complications Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Complications</li><li>↳ Complications</li><li>↳ Complications</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction.</li><li>↳ Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Normal saline (0.9% NaCl) (Option B): It is not appropriate in SIADH as it can worsen hyponatremia due to the body’s retained water.</li><li>↳ Normal saline (0.9% NaCl) (Option B):</li><li>↳ Fluid restriction (Option C): It is the mainstay treatment for mild to moderate SIADH (minimal symptoms, serum sodium &gt; 125 mEq/l) but is not sufficient in the setting of severe symptomatic hyponatremia.</li><li>↳ Fluid restriction (Option C):</li><li>↳ Vasopressin receptor antagonists (vaptans) (Option D): It may be considered in chronic management or refractory cases but is not suitable for the initial treatment of severe, symptomatic hyponatremia.</li><li>↳ Vasopressin receptor antagonists (vaptans) (Option D):</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syndrome of Inappropriate <span class=\"customMeta\" data-dictid=\"27bd08bbaa16927771812e98e16787\">Antidiuretic</span> Hormone Secretion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excessive <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> release leads to impaired water <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> and <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> with <span class=\"customMeta\" data-dictid=\"159ab75ed316927771879ce7b3cb84\">euvolemia</span> or hypervolemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CNS disturbances: Stroke, infection, trauma, etc.</li>\n<li>Malignancies: <strong>Small cell lung cancer (most common)</strong>, other cancers.</li>\n<li>Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc.</li>\n<li>Surgery: Pain-induced <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> hypersecretion.</li>\n<li>Pulmonary diseases: Pneumonia, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, etc.</li>\n<li>Hormone deficiency: Hypopituitarism, hypothyroidism.</li>\n<li>HIV: Associated with infections.</li>\n<li>Hereditary SIADH: V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> mutation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ADH function: Regulates <span class=\"customMeta\" data-dictid=\"2108d4f8a21692777202226f391d3b\">water balance</span> by controlling <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolality; <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> causes water retention, leading to hyponatremia.</li>\n<li>Volume regulation: In hypovolemia, <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> release is driven by volume receptors, worsening hyponatremia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute </strong>hyponatremia<strong>:</strong><strong> Nausea, vomiting, headache, seizures, coma.</strong></li>\n<li><strong>Chronic </strong>hyponatremia: <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">Nonspecific</span> symptoms (<strong>nausea, confusion, falls in elderly</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schwartz and Bartter criteria:</strong></p>\n<ul>\n<li>Serum sodium &lt;135 mEq/L</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> &lt;275 mOsm/kg</li>\n<li>Urine sodium &gt;40 mEq/L</li>\n<li>Urine <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> &gt;100 mOsm/kg</li>\n<li>The absence of clinical evidence of volume <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> (like normal skin turgor, <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> within the reference range)</li>\n<li>The absence of <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> due to other causes (like <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, hypothyroidism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure, <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> insufficiency, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease with salt wastage, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> disease, and drugs that impair <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> water excretion.)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests:</strong></p>\n<p>Renal function, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> osmolality, <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tests, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for underlying causes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fluid restriction</strong>: For mild to moderate symptoms.</li>\n<li><strong>Hypertonic <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> (3%):</strong> For severe hyponatremia, with careful <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> rate (&lt;8 mEq/L in 24 hrs).</li>\n<li>Medications:\n\t\t\t\t<ul>\n<li><strong>Vasopressin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists (Conivaptan, Tolvaptan)</strong></li>\n<li><strong>Other: Loop diuretics, salt tablets, demeclocycline, lithium.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osmotic <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> syndrome: Risk from rapid sodium correction.</li>\n<li>Severe hyponatremia: Can lead to seizures, coma, and death in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old female presents with fatigue, muscle weakness, and salt cravings. Laboratory tests reveal hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. Genetic testing shows a mutation in the SLC12A3 gene. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Bartter syndrome", "correct": false}, {"label": "B", "text": "Liddle syndrome", "correct": false}, {"label": "C", "text": "Gitelman syndrome", "correct": true}, {"label": "D", "text": "Conn’s syndrome", "correct": false}], "correct_answer": "C. Gitelman syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:655px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gitelman syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gitelman syndrome is an autosomal recessive, <strong>salt-losing <span class=\"customMeta\" data-dictid=\"a37c8a2866169277720112cc9b8442\">tubulopathy</span> </strong>characterized by <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> wasting, hypokalemia, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis, hypocalciuria, hypomagnesemia, and hyperreninemic hyperaldosteronism.</li>\n<li>It is also known as <strong>familial hypokalemia-hypomagnesemia</strong>.</li>\n<li>It is one of the <strong>most common inherited tubulopathies.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>SLC12A3 gene </strong>mutation (thiazide-sensitive NCCT).</li>\n<li><strong>CLCNKB</strong> <strong>gene </strong>mutation (GS-like phenotype).</li>\n<li><strong>TRPM6 gene </strong>mutation (magnesium transport).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of NCCT function → sodium and <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> wasting.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> → <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> and <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> <span class=\"customMeta\" data-dictid=\"4b2f2a6d0a16927771902f60fa9ff7\">ion</span> loss → hypokalemia, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis.</li>\n<li>Reduced TRPM6 expression → hypomagnesemia.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">tubule</span> → hypocalciuria.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fatigue, muscle weakness, cramps.</strong></li>\n<li><strong>Salt cravings</strong>, thirst.</li>\n<li>Low blood pressure, joint pain (chondrocalcinosis).</li>\n<li>Growth retardation, delayed puberty.</li>\n<li>Cardiac arrhythmias (rare).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Electrolytes: Hypokalemia, hypomagnesemia, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis, hypocalciuria.</li>\n<li>Hormones: Elevated renin, aldosterone.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical findings: Chronic hypokalemia, hypomagnesemia, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis, hypocalciuria.</li>\n<li>Genetic testing confirms SLC12A3 mutation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Potassium: High doses of <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> (KCl).</li>\n<li>Magnesium: <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">Magnesium</span> <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> is preferred.</li>\n<li>Additional options: <span class=\"customMeta\" data-dictid=\"d2ccc8e61a1692777195dd4ac863ba\">Potassium-sparing diuretics</span> (amiloride, spironolactone), NSAIDs (e.g., indomethacin), and renin-angiotensin system blockers.</li>\n<li>Encourage NaCl intake.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long-term Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risks: Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, chondrocalcinosis, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, pregnancy complications.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bartter syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gitelman syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liddle syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal/decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal/decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased (Hypertension)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Potassium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n<p>(hypokalemia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n<p>(hypokalemia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n<p>(hypokalemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metabolic alkalosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metabolic alkalosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metabolic alkalosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urinary calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased (hypercalciuria)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n<p>(hypocalciuria)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy presents with polyuria, polydipsia, vomiting, and stunted growth. His family history reveals a sibling with nephrocalcinosis. Lab results show hypokalemia, metabolic alkalosis, elevated renin, and aldosterone levels. Genetic testing reveals a mutation in the NKCC2 gene. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Gitelman syndrome", "correct": false}, {"label": "B", "text": "Liddle syndrome", "correct": false}, {"label": "C", "text": "Bartter syndrome (Type I)", "correct": true}, {"label": "D", "text": "Syndrome of inappropriate antidiuretic hormone secretion (SIADH)", "correct": false}], "correct_answer": "C. Bartter syndrome (Type I)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bartter syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bartter syndrome is an autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder of salt <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> that leads to <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> fluid depletion, low/ normal blood pressure, and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Type I: NKCC2 <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (sodium-potassium-chloride cotransporter)</li>\n<li>Type II: ROMK <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (potassium channel)</li>\n<li>Type III: CLC-Kb <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (chloride channel)</li>\n<li>Type IV: Barttin mutation</li>\n<li>Type V: Calcium-sensing receptor, ClC-Ka/Kb mutations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aminoglycoside-induced Bartter-like syndrome</strong> (hypokalemia, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis, hypomagnesemia, hypocalcemia)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defective sodium, potassium, and <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the thick <strong>ascending limb of the loop of Henle</strong></li>\n<li>Increased sodium delivery to the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> nephron</li>\n<li>Secondary <span class=\"customMeta\" data-dictid=\"982551b8f81692777189e20f09de85\">hyperaldosteronism</span> due to <span class=\"customMeta\" data-dictid=\"15d91786931692777197c8932c8000\">RAAS</span> activation</li>\n<li>Potassium loss, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis, and impaired calcium/magnesium reabsorption</li>\n<li><strong>Nephrocalcinosis </strong>due to <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> wasting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infants: Failure to thrive</li>\n<li>Children/ adolescents:<strong> Polyuria, polydipsia, vomiting, dehydration, stunted growth, <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> deafness</strong></li>\n<li>Antenatal: Polyhydramnios, <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> delivery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypokalemia, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> and <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> levels</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> sodium, potassium, and <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> E2 (PGE2)</li>\n<li><strong>Elevated 24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> </strong>(to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> from Gitelman syndrome)</li>\n<li>Imaging to confirm nephrocalcinosis</li>\n<li>Genetic testing for <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> identification</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Potassium supplements (KCl)</li>\n<li>ACE inhibitors or ARBs to reduce <span class=\"customMeta\" data-dictid=\"15d91786931692777197c8932c8000\">RAAS</span> activation</li>\n<li>NSAIDs (e.g., <strong>indomethacin</strong>) to <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> PGE2</li>\n<li>Magnesium supplementation if <span class=\"customMeta\" data-dictid=\"d196d1af63169277718961a27bf8c4\">hypomagnesemia</span> is present</li>\n<li>Kidney <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> resolves <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> abnormalities with no recurrence</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bartter syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gitelman syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liddle syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal/decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal/decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased (Hypertension)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Potassium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n<p>(hypokalemia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n<p>(hypokalemia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n<p>(hypokalemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metabolic alkalosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metabolic alkalosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metabolic alkalosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urinary calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased (hypercalciuria)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n<p>(hypocalciuria)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following conditions to their underlying mechanisms. Conditions Mechanisms A) Gitelman Syndrome 1. Increased mineralocorticoid activity B) Conn's Syndrome 2. Inhibition of sodium-chloride cotransporter C) Bartter Syndrome 3. Loop of Henle dysfunction D) Diuretic Abuse 4. Induced loss of electrolytes E) Liddle Syndrome 5. Gain of function mutation in epithelial sodium channels", "options": [{"label": "A", "text": "A-2, B-1, C-3, D-4, E-5", "correct": true}, {"label": "B", "text": "A-3, B-1, C-2, D-4, E-5", "correct": false}, {"label": "C", "text": "A-5, B-1, C-3, D-4, E-2", "correct": false}, {"label": "D", "text": "A-2, B-4, C-3, D-1, E-5", "correct": false}], "correct_answer": "A. A-2, B-1, C-3, D-4, E-5", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Redistribution into cells</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presenting Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Insulin promotes <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> uptake.</li>\n<li>Excess insulin, especially during the treatment of potassium-deficient states like <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> ketoacidosis, can lead to hypokalemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased β2-adrenergic <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> activity</strong></p>\n<p><strong>(Epinephrine)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conditions such as alcohol withdrawal, hyperthyroidism, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> myocardial infarction, and severe head injury increase <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> nervous system activity, promoting <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> and hypokalemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β2-adrenergic agonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medications like bronchodilators and tocolytics stimulate <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> uptake, potentially causing hypokalemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>α-adrenergic antagonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These medications can lead to hypokalemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyrotoxic <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">periodic</span> paralysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It involves <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">periodic</span> attacks of muscle weakness due to profound hypokalemia, often accompanied by <span class=\"customMeta\" data-dictid=\"0768daa0be169277718906a2461894\">hypophosphatemia</span> and hypomagnesemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Theophylline and Caffeine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These substances can <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> cAMP-dependent signalling, leading to hypokalemia, usually in cases of <span class=\"customMeta\" data-dictid=\"3f4eecb1c6169277719459c801fb19\">overdose</span> or significant over-ingestion.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 18 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 30 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old male presents to the emergency department with severe weakness and palpitations. He has been on a thiazide diuretic for hypertension. His ECG reveals flattened T waves and the presence of U waves. Serum potassium is 2.3 mEq/L. What is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Oral potassium chloride 20 mEq", "correct": false}, {"label": "B", "text": "IV potassium chloride 10 mEq/hour with cardiac monitoring", "correct": true}, {"label": "C", "text": "IV potassium chloride 20 mEq/hour with cardiac monitoring", "correct": false}, {"label": "D", "text": "IV potassium chloride 25 mEq/hour with cardiac monitoring", "correct": false}], "correct_answer": "B. IV potassium chloride 10 mEq/hour with cardiac monitoring", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old patient with a history of chronic kidney disease presents in the Emergency Department with palpitations and muscle fasciculations. The ECG shows tall T waves and a prolonged QT interval. Serum electrolytes: Na—136 mEq/l; K—6.2 mEq/l. What is the next immediate step in the management of this patient?", "options": [{"label": "A", "text": "IV Insulin", "correct": false}, {"label": "B", "text": "IV Salbutamol", "correct": false}, {"label": "C", "text": "IV Calcium gluconate", "correct": true}, {"label": "D", "text": "Hemodialysis", "correct": false}], "correct_answer": "C. IV Calcium gluconate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not an ECG finding in hypermagnesemia?", "options": [{"label": "A", "text": "Prolonged PR interval", "correct": false}, {"label": "B", "text": "Prolonged QRS interval", "correct": false}, {"label": "C", "text": "Prolonged QT interval", "correct": false}, {"label": "D", "text": "Narrow PR interval", "correct": true}], "correct_answer": "D. Narrow PR interval", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excessive <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> intake\n\t\t\t\t<ul>\n<li>Cathartics, urologic irritants</li>\n<li>Parenteral <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> administration</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Rapid mobilisation from soft tissues\n\t\t\t\t<ul>\n<li>Trauma, shock, sepsis</li>\n<li>Cardiac arrest</li>\n<li>Burns</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> excretion\n\t\t\t\t<ul>\n<li>Renal failure</li>\n<li>Familial hypocalciuric hypercalcemia</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Others:\n\t\t\t\t<ul>\n<li>Adrenal insufficiency</li>\n<li>Hypothyroidism</li>\n<li>Hypothermia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical Findings</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasodilation and <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> blockade</li>\n<li>Hypotension</li>\n<li>Nausea, lethargy, weakness, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, paralysis, and coma</li>\n<li>Hypoactive <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> reflexes</li>\n<li>Gastrointestinal <span class=\"customMeta\" data-dictid=\"c98a53a7471692777189362d166a8f\">hypomotility</span> or ileus</li>\n<li>Facial flushing</li>\n<li>Pupillary dilation</li>\n<li>Paradoxical bradycardia</li>\n<li><strong>Prolonged PR, QRS, and QT intervals (Options A, B, and C)</strong></li>\n<li>Heart block and asystole</li>\n<li>Hypocalcemia and hypercalciuria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Identify and interrupt the sources of magnesium</li>\n<li>Magnesium-free cathartics or enemas for ingested magnesium</li>\n<li>Vigorous IV hydration</li>\n<li>Hemodialysis</li>\n<li>Administer IV <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> (100–200 mg over 1–2 h) for temporary improvement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old male presenting with seizures has a serum magnesium level of 0.5 mmol/L. What is the most likely ECG finding?", "options": [{"label": "A", "text": "Tall tented T-wave", "correct": false}, {"label": "B", "text": "ST straightening", "correct": true}, {"label": "C", "text": "Narrow PR interval", "correct": false}, {"label": "D", "text": "Narrow QT interval", "correct": false}], "correct_answer": "B. ST straightening", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Clinical Features Tetany Cardiac arrhythmias (e.g., torsades de pointes) Central nervous system excitation and seizure Vasoconstriction and hypertension Associated with hyponatremia and hypokalemia ECG abnormalities: prolonged PR or QT intervals (Option C and D ruled out) , T-wave flattening/inversion (Option A ruled out) , ST straightening (Option B) Management Identify and treat the underlying cause. IV magnesium chloride: Administer at a rate of ≤0.5 mmol/kg in the first 24 hours. IM magnesium sulfate: Alternative if IV access is not possible. Oral magnesium salts: Limited effectiveness due to poor absorption and potential diarrhoea. If caused by diuretic use, potassium-sparing agents can help reduce urinary magnesium loss.</li><li>↳ Clinical Features Tetany Cardiac arrhythmias (e.g., torsades de pointes) Central nervous system excitation and seizure Vasoconstriction and hypertension Associated with hyponatremia and hypokalemia ECG abnormalities: prolonged PR or QT intervals (Option C and D ruled out) , T-wave flattening/inversion (Option A ruled out) , ST straightening (Option B)</li><li>↳ Clinical Features</li><li>↳ Clinical Features</li><li>↳ Clinical Features</li><li>↳ Tetany Cardiac arrhythmias (e.g., torsades de pointes) Central nervous system excitation and seizure Vasoconstriction and hypertension Associated with hyponatremia and hypokalemia ECG abnormalities: prolonged PR or QT intervals (Option C and D ruled out) , T-wave flattening/inversion (Option A ruled out) , ST straightening (Option B)</li><li>↳ Tetany Cardiac arrhythmias (e.g., torsades de pointes) Central nervous system excitation and seizure Vasoconstriction and hypertension Associated with hyponatremia and hypokalemia ECG abnormalities: prolonged PR or QT intervals (Option C and D ruled out) , T-wave flattening/inversion (Option A ruled out) , ST straightening (Option B)</li><li>↳ Tetany</li><li>↳ Cardiac arrhythmias (e.g., torsades de pointes)</li><li>↳ Central nervous system excitation and seizure</li><li>↳ Vasoconstriction and hypertension</li><li>↳ Associated with hyponatremia and hypokalemia</li><li>↳ ECG abnormalities: prolonged PR or QT intervals (Option C and D ruled out) , T-wave flattening/inversion (Option A ruled out) , ST straightening (Option B)</li><li>↳ (Option C and D ruled out)</li><li>↳ (Option A ruled out)</li><li>↳ (Option B)</li><li>↳ Management Identify and treat the underlying cause. IV magnesium chloride: Administer at a rate of ≤0.5 mmol/kg in the first 24 hours. IM magnesium sulfate: Alternative if IV access is not possible. Oral magnesium salts: Limited effectiveness due to poor absorption and potential diarrhoea. If caused by diuretic use, potassium-sparing agents can help reduce urinary magnesium loss.</li><li>↳ Management</li><li>↳ Management</li><li>↳ Management</li><li>↳ Identify and treat the underlying cause. IV magnesium chloride: Administer at a rate of ≤0.5 mmol/kg in the first 24 hours. IM magnesium sulfate: Alternative if IV access is not possible. Oral magnesium salts: Limited effectiveness due to poor absorption and potential diarrhoea. If caused by diuretic use, potassium-sparing agents can help reduce urinary magnesium loss.</li><li>↳ Identify and treat the underlying cause. IV magnesium chloride: Administer at a rate of ≤0.5 mmol/kg in the first 24 hours. IM magnesium sulfate: Alternative if IV access is not possible. Oral magnesium salts: Limited effectiveness due to poor absorption and potential diarrhoea. If caused by diuretic use, potassium-sparing agents can help reduce urinary magnesium loss.</li><li>↳ Identify and treat the underlying cause.</li><li>↳ IV magnesium chloride: Administer at a rate of ≤0.5 mmol/kg in the first 24 hours.</li><li>↳ IM magnesium sulfate: Alternative if IV access is not possible.</li><li>↳ Oral magnesium salts: Limited effectiveness due to poor absorption and potential diarrhoea.</li><li>↳ If caused by diuretic use, potassium-sparing agents can help reduce urinary magnesium loss.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tetany</li>\n<li>Cardiac arrhythmias (e.g., torsades <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> pointes)</li>\n<li>Central nervous system <span class=\"customMeta\" data-dictid=\"8265e091151692777187f264d73f3b\">excitation</span> and seizure</li>\n<li>Vasoconstriction and hypertension</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> and hypokalemia</li>\n<li>ECG abnormalities: prolonged PR or QT intervals <strong>(Option C and D ruled out)</strong>, T-wave flattening/inversion <strong>(Option A ruled out)</strong>, ST straightening <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Identify and treat the underlying cause.</li>\n<li>IV <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> chloride: Administer at a rate of ≤0.5 mmol/kg in the first 24 hours.</li>\n<li>IM <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> sulfate: Alternative if IV access is not possible.</li>\n<li>Oral <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> salts: Limited effectiveness due to poor <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> and potential diarrhoea.</li>\n<li>If caused by <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> use, potassium-sparing agents can help reduce <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> loss.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following will not lead to a plasma magnesium level of &amp;lt; 1.5 mEq/L? Bartter’s syndrome Gitelman’s syndrome Gentamicin Acute pancreatitis Diabetes mellitus Foscarnet therapy Proton pump inhibitor therapy Hungry bone syndrome", "options": [{"label": "A", "text": "1,2,3", "correct": false}, {"label": "B", "text": "1,2,3,4,5", "correct": false}, {"label": "C", "text": "3,4,8", "correct": false}, {"label": "D", "text": "None of the above", "correct": true}], "correct_answer": "D. None of the above", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Causes:</li><li>↳ Causes:</li><li>↳ Inadequate Intake Starvation Malnutrition Alcoholism Parenteral alimentation Gastrointestinal Losses Prolonged vomiting/nasogastric aspiration Chronic diarrhoea/laxative abuse Malabsorption Small bowel bypass surgery Fistulae Urinary Losses Diuretic therapy Alcohol Tubulotoxic drugs ( Gentamicin , Cisplatin) Volume expansion Diabetic ketoacidosis Post-obstructive diuresis Recovery from acute tubular necrosis Inherited Tubular Defects Bartter’s syndrome Gitelman’s syndrome Primary renal magnesium wasting Miscellaneous Acute pancreatitis Foscarnet therapy Proton pump inhibitor therapy Hungry bone syndrome Diabetes mellitus</li><li>↳ Inadequate Intake Starvation Malnutrition Alcoholism Parenteral alimentation</li><li>↳ Inadequate Intake</li><li>↳ Inadequate Intake</li><li>↳ Inadequate Intake</li><li>↳ Starvation Malnutrition Alcoholism Parenteral alimentation</li><li>↳ Starvation Malnutrition Alcoholism Parenteral alimentation</li><li>↳ Starvation</li><li>↳ Malnutrition</li><li>↳ Alcoholism</li><li>↳ Parenteral alimentation</li><li>↳ Gastrointestinal Losses Prolonged vomiting/nasogastric aspiration Chronic diarrhoea/laxative abuse Malabsorption Small bowel bypass surgery Fistulae</li><li>↳ Gastrointestinal Losses</li><li>↳ Gastrointestinal Losses</li><li>↳ Gastrointestinal Losses</li><li>↳ Prolonged vomiting/nasogastric aspiration Chronic diarrhoea/laxative abuse Malabsorption Small bowel bypass surgery Fistulae</li><li>↳ Prolonged vomiting/nasogastric aspiration Chronic diarrhoea/laxative abuse Malabsorption Small bowel bypass surgery Fistulae</li><li>↳ Prolonged vomiting/nasogastric aspiration</li><li>↳ Chronic diarrhoea/laxative abuse</li><li>↳ Malabsorption</li><li>↳ Small bowel bypass surgery</li><li>↳ Fistulae</li><li>↳ Urinary Losses Diuretic therapy Alcohol Tubulotoxic drugs ( Gentamicin , Cisplatin) Volume expansion Diabetic ketoacidosis Post-obstructive diuresis Recovery from acute tubular necrosis</li><li>↳ Urinary Losses</li><li>↳ Urinary Losses</li><li>↳ Urinary Losses</li><li>↳ Diuretic therapy Alcohol Tubulotoxic drugs ( Gentamicin , Cisplatin) Volume expansion Diabetic ketoacidosis Post-obstructive diuresis Recovery from acute tubular necrosis</li><li>↳ Diuretic therapy Alcohol Tubulotoxic drugs ( Gentamicin , Cisplatin) Volume expansion Diabetic ketoacidosis Post-obstructive diuresis Recovery from acute tubular necrosis</li><li>↳ Diuretic therapy</li><li>↳ Alcohol</li><li>↳ Tubulotoxic drugs ( Gentamicin , Cisplatin)</li><li>↳ Gentamicin</li><li>↳ Volume expansion</li><li>↳ Diabetic ketoacidosis</li><li>↳ Post-obstructive diuresis</li><li>↳ Recovery from acute tubular necrosis</li><li>↳ Inherited Tubular Defects Bartter’s syndrome Gitelman’s syndrome Primary renal magnesium wasting</li><li>↳ Inherited Tubular Defects</li><li>↳ Inherited Tubular Defects</li><li>↳ Inherited Tubular Defects</li><li>↳ Bartter’s syndrome Gitelman’s syndrome Primary renal magnesium wasting</li><li>↳ Bartter’s syndrome Gitelman’s syndrome Primary renal magnesium wasting</li><li>↳ Bartter’s syndrome</li><li>↳ Bartter’s syndrome</li><li>↳ Gitelman’s syndrome</li><li>↳ Gitelman’s syndrome</li><li>↳ Primary renal magnesium wasting</li><li>↳ Miscellaneous Acute pancreatitis Foscarnet therapy Proton pump inhibitor therapy Hungry bone syndrome Diabetes mellitus</li><li>↳ Miscellaneous</li><li>↳ Miscellaneous</li><li>↳ Miscellaneous</li><li>↳ Acute pancreatitis Foscarnet therapy Proton pump inhibitor therapy Hungry bone syndrome Diabetes mellitus</li><li>↳ Acute pancreatitis Foscarnet therapy Proton pump inhibitor therapy Hungry bone syndrome Diabetes mellitus</li><li>↳ Acute pancreatitis</li><li>↳ Acute pancreatitis</li><li>↳ Foscarnet therapy</li><li>↳ Foscarnet therapy</li><li>↳ Proton pump inhibitor therapy</li><li>↳ Proton pump inhibitor therapy</li><li>↳ Hungry bone syndrome</li><li>↳ Hungry bone syndrome</li><li>↳ Diabetes mellitus</li><li>↳ Diabetes mellitus</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:516px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inadequate Intake</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Starvation</li>\n<li>Malnutrition</li>\n<li>Alcoholism</li>\n<li>Parenteral alimentation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal Losses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolonged vomiting/nasogastric aspiration</li>\n<li>Chronic diarrhoea/laxative abuse</li>\n<li>Malabsorption</li>\n<li>Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> surgery</li>\n<li>Fistulae</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urinary Losses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretic therapy</li>\n<li>Alcohol</li>\n<li>Tubulotoxic drugs (<strong>Gentamicin</strong>, Cisplatin)</li>\n<li>Volume expansion</li>\n<li>Diabetic ketoacidosis</li>\n<li>Post-obstructive diuresis</li>\n<li>Recovery from <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> necrosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inherited <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> Defects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bartter’s syndrome</strong></li>\n<li><strong>Gitelman’s syndrome</strong></li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> wasting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Miscellaneous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute pancreatitis</strong></li>\n<li><strong>Foscarnet therapy</strong></li>\n<li><strong>Proton pump <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> therapy</strong></li>\n<li><strong>Hungry bone syndrome</strong></li>\n<li><strong>Diabetes mellitus</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the normal serum magnesium level?", "options": [{"label": "A", "text": "0.7-1 mmol/L", "correct": true}, {"label": "B", "text": "1.5-2 mmol/L", "correct": false}, {"label": "C", "text": "0.3-1.4 mmol/L", "correct": false}, {"label": "D", "text": "1.5-2 mmol/L", "correct": false}], "correct_answer": "A. 0.7-1 mmol/L", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> magnesium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0.7–1 mmol/L</strong> (1.5–2 meq/L; 1.7–2.4 mg/dL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Functions of magnesium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Crucial for normal <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> activity</li>\n<li>Forms a key complex with <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> for energy metabolism.</li>\n<li>Acts as a <span class=\"customMeta\" data-dictid=\"a416d7580c1692777184952da793d1\">cofactor</span> for enzymes, transporters, and nucleic acids</li>\n<li>Found in bone, supporting skeletal structure.</li>\n<li>Within cells, it is involved in biochemical reactions and energy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Denosumab is a monoclonal antibody used in hypercalcemia. What is its mechanism of action?", "options": [{"label": "A", "text": "Increases bone resorption", "correct": false}, {"label": "B", "text": "Binds to RANK receptor", "correct": false}, {"label": "C", "text": "Binds to RANK ligand", "correct": true}, {"label": "D", "text": "Promotes function of osteoclasts", "correct": false}], "correct_answer": "C. Binds to RANK ligand", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">monoclonal</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> for the treatment of hypercalcemia.</li>\n<li>It is considered the most powerful <span class=\"customMeta\" data-dictid=\"37ee8474081692777181f0c84a480b\">antiresorptive</span> agent available.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanism of Action</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Binds to RANK <span class=\"customMeta\" data-dictid=\"6e1f8c026516927771919d54418520\">ligand</span> (RANKL) <strong>(Option B ruled out)</strong> <strong>(Option C)</strong> → prevents its binding to RANK <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> on <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> precursors and <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> osteoclasts → Inhibits differentiation, activation, and function of osteoclasts <strong>(Option D ruled out)</strong>→reduces <span class=\"customMeta\" data-dictid=\"17d9369c3f1692777183b01f1dc72f\">bone resorption</span> <strong>(Option A ruled out) </strong>and hence reducing bone <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> release into plasma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use in malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repeated doses of 120 mg subcutaneously for <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> of <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (especially in patients unresponsive to bisphosphonates).</p>\n<p>Also used in Osteoporosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female who has been diagnosed with a Parathyroid gland malignancy was brought to ED with acute onset low levels of consciousness and severe pain in the abdomen. Her vitals were HR- 56 bpm, BP- 88/64 mmHg. ECG done showed a shortened QT interval. Serum Ca2+ (calcium)- 13 mg/dL. What is the most appropriate first step in managing this patient?", "options": [{"label": "A", "text": "IV fluids", "correct": true}, {"label": "B", "text": "Furosemide", "correct": false}, {"label": "C", "text": "Steroids", "correct": false}, {"label": "D", "text": "IV Zoledronate", "correct": false}], "correct_answer": "A. IV fluids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1) Adequate hydration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>4-6 L of IV <span class=\"customMeta\" data-dictid=\"ab6984f43316927771937ff19f3807\">Normal saline</span> over the first 24 hours and body water must be replenished.</li>\n<li><strong>First step in management</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2) Loop diuretics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Like <span class=\"customMeta\" data-dictid=\"b1527c07251692777203d317fb2eb0\">Furosemide</span> must be given IV, but only after correcting body fluid status <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3) Bis- phosphonates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>DOC for hypercalcemic crisis - mainstay of treatment </strong><strong>(Option D)</strong></li>\n<li>IV <span class=\"customMeta\" data-dictid=\"27920b5def1692777202f57479a0d4\">Zoledronate</span> 4 mg</li>\n<li>IM <span class=\"customMeta\" data-dictid=\"b6214f893c169277719411a8622fc1\">Pamidronate</span> 60 mg</li>\n<li>The onset of action: 1-3 days (hence not suitable in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> presentations)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4) Steroids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mainly useful in <strong>Malignancy</strong>, <strong>sarcoidosis</strong>, and <strong>Vitamin D <span class=\"customMeta\" data-dictid=\"fa5fbbb509169277719078b91cffd9\">intoxication</span> </strong><strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5) Others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Salmon calcitonin:</strong>\n<ul>\n<li>Given as <strong>nasal spray</strong></li>\n<li>Rapid onset of action</li>\n<li><strong>ADR: Tachyphylaxis</strong></li>\n</ul>\n</li>\n<li><strong>Denosumab: </strong>Monoclonal <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> against <strong>RANK-ligand</strong> and prevents its binding to RANK <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> on osteoclasts</li>\n<li><strong>Gallium nitrate: </strong>alternative to Bisphosphonates, ADR- Nephrotoxic</li>\n<li>Hemodialysis: rarely required</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is the least likely cause of this finding seen in the X-ray shown below?", "options": [{"label": "A", "text": "Parathyroid hyperplasia", "correct": false}, {"label": "B", "text": "Sarcoidosis", "correct": false}, {"label": "C", "text": "Hungry bone syndrome", "correct": true}, {"label": "D", "text": "Vitamin D intoxication", "correct": false}], "correct_answer": "C. Hungry bone syndrome", "question_images": ["https://image.prepladder.com/notes/c0fDfwioJM17yGRRyJHh1744290741.png"], "explanation_images": ["https://image.prepladder.com/notes/c0fDfwioJM17yGRRyJHh1744290741.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Primary hyperparathyroidism:</strong> <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">Parathyroid</span> hyperplasia/ adenoma/ <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> <strong>(Option A)</strong></li>\n<li><strong>Tertiary hyperparathyroidism:</strong> secondary to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> insufficiency</li>\n<li>Hypercalcemia of malignancy: bone tumours, multiple myeloma, breast cancer</li>\n<li><strong>Granulomatous diseases:</strong> Sarcoidosis, tuberculosis, <span class=\"customMeta\" data-dictid=\"a06a8ebae41692777198013abbc10d\">silicosis</span> <strong>(Option B)</strong></li>\n<li>Vitamin D <span class=\"customMeta\" data-dictid=\"fa5fbbb509169277719078b91cffd9\">intoxication</span> <strong>(Option D)</strong></li>\n<li><strong>Milk <span class=\"customMeta\" data-dictid=\"b802ae0373169277718153c4d4fbaf\">alkali</span> syndrome:</strong> <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> intake</li>\n<li>Endocrinal: <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, pheochromocytoma</li>\n<li>Drugs: <strong>Thiazide diuretics</strong>, vitamin A, OCPs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mild <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> (11-11.5 mg/dL): </strong>usually asymptomatic, neuropsychiatric manifestations (lack of concentration, depression, personality changes)</li>\n<li><strong>Moderate <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> (11.5-12.5 mg/dL):</strong> Nephrolithiasis, <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease, increased risk of fractures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"78912d4b7f16927771890c20495303\">hypercalcemia</span> (&gt; 12.5 mg/dL): </strong>known as<strong> Hypercalcemic crisis</strong></p>\n<ul>\n<li>Gastrointestinal: Pancreatitis</li>\n<li>Renal: <strong>Nephrocalcinosis</strong>, AKI/CKD</li>\n<li>Neurological: Stupor, coma</li>\n<li><strong>ECG changes:</strong> <strong>Short QT interval</strong>, Bradycardia, AV block</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to ED with sudden onset breathlessness. Upon examination, you will notice the following signs: What is the most appropriate definitive management for this patient?", "options": [{"label": "A", "text": "IV 10% Calcium gluconate 10 mL", "correct": true}, {"label": "B", "text": "IV Regular insulin infusion at 0.1U/hour", "correct": false}, {"label": "C", "text": "Oral Vitamin D3 1L U daily", "correct": false}, {"label": "D", "text": "IV Sodium bicarbonate (NaHCO3)", "correct": false}], "correct_answer": "A. IV 10% Calcium gluconate 10 mL", "question_images": ["https://image.prepladder.com/notes/6NlLydXYOPERTrz3JBsT1744290670.png"], "explanation_images": ["https://image.prepladder.com/notes/7UrO41d21e2CAdxIpg9Y1744290344.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paraesthesia - usually involving fingers and toes</li>\n<li>Circumoral numbness</li>\n<li>Positive <strong>Chvostek sign</strong>: <span class=\"customMeta\" data-dictid=\"90e9d2db7f1692777201d0a9b101c5\">twitching</span> of <span class=\"customMeta\" data-dictid=\"a042d4d7881692777184ae941a44b9\">circumoral</span> muscles on gentle tapping of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve</li>\n<li>Positive <strong>Trousseau sign</strong>: <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">Carpal</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> is seen upon inflating the BP <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> to <strong>20 mmHg above the patient’s <span class=\"customMeta\" data-dictid=\"29e7d0f8b21692777198c303b6dc41\">SBP</span> for 3 mins.</strong></li>\n<li>Severe: <span class=\"customMeta\" data-dictid=\"ae4dc0619116927771831407152055\">Carpopedal</span> spasm, Laryngospasm, Bronchospasm, QT prolongation on ECG</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute Hypocalcemia/Severe symptoms: <strong>IV 10% <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> Gluconate</strong> 10 mL diluted with 5% Dextrose/ <span class=\"customMeta\" data-dictid=\"ab6984f43316927771937ff19f3807\">Normal saline</span> <strong>(Option A)</strong></li>\n<li>Chronic Hypocalcemia: <strong>Oral <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> <span class=\"customMeta\" data-dictid=\"508e14a7ca16927772002140ece8fb\">tablet</span> 1000-1500 mg/day</strong> (elemental calcium) + <strong>Oral Vitamin D3</strong> 25K-1L U/day <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient’s serum Calcium (Ca2+) value was 8 mg/dL. Which among the following is the least likely explanation for this?", "options": [{"label": "A", "text": "Milk alkali syndrome", "correct": true}, {"label": "B", "text": "Elderly female with osteomalacia", "correct": false}, {"label": "C", "text": "Post Parathyroid gland resection", "correct": false}, {"label": "D", "text": "Baby detected with microdeletion on Chromosome 22q11", "correct": false}], "correct_answer": "A. Milk alkali syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parathyroid agenesis</li>\n<li>Post-Parathyroidectomy (Hungry bone syndrome)</li>\n<li>Post-radiation (Radiotherapy for neck malignancies)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vitamin D <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (nutritional/renal cause)</li>\n<li>Pseudohypoparathyroidism syndrome (G protein mutations)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ca2+ chelators</li>\n<li>Bisphosphonates</li>\n<li>Phenytoin</li>\n<li>Ketoconazole</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Miscellaneous/others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute pancreatitis</li>\n<li>Rhabdomyolysis</li>\n<li>Osteoblastic <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> (Prostate cancer)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following drugs help in the elimination of Potassium (K+) from the body except", "options": [{"label": "A", "text": "Calcium gluconate", "correct": true}, {"label": "B", "text": "Patiromer", "correct": false}, {"label": "C", "text": "Sodium polystyrene sulfonate", "correct": false}, {"label": "D", "text": "Furosemide", "correct": false}], "correct_answer": "A. Calcium gluconate", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/LuuEUEifHhw9f8DhDGRG1744290198.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate <span class=\"customMeta\" data-dictid=\"99de407a1516927771818ac910ab5f\">antagonism</span> of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium gluconate: </strong><strong>(Option A)</strong></p>\n<ul>\n<li>Dose: 10 mL of 10% IV <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> gluconate</li>\n<li>DOC in management of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> severe <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> <strong>(K+ &gt; 6.5 mEq/L)</strong></li>\n<li>DOC in <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">Hyperkalemia</span> with <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Redistribution of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> K+ </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular Insulin:</strong></p>\n<ul>\n<li>10 U of IV Regular insulin</li>\n<li>Usually followed by 50 mL 50% Dextrose</li>\n<li>Most effective drug</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Removal of K+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sodium <span class=\"customMeta\" data-dictid=\"8904ca22bf1692777196567c8fff23\">polystyrene</span> sulfonate:</strong> ADR - Intestinal <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> <strong>(Option C)</strong></li>\n<li><strong>Sodium zirconate (ZS-9):</strong> more safer</li>\n<li><strong>Patiromer:</strong> Oral novel <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"f19c6dd7c01692777183e1e331de64\">binder</span> <strong>(Option B)</strong></li>\n<li><strong>Loop &amp; <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">Thiazide</span> diuretics: </strong>Furosemide, <span class=\"customMeta\" data-dictid=\"8defc2479516927771895cc400c2a1\">Hydrochlorothiazide</span> <strong>(Option D)</strong></li>\n<li><strong>Hemodialysis: </strong>Most effective for K+ elimination, done for <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> hyperkalemia.</li>\n<li><strong>Sodium bicarbonate</strong> (NaHCO3) &amp; <strong>IV Normal saline</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female with a history of congestive heart failure on ACE inhibitors presents to the emergency department with symptoms of weakness and palpitations. On examination, there were signs of elevated JVP and bounding pulse. The ECG findings of the patient suggest tall T waves and wide QRS complex. What is the most appropriate treatment option for this patient?", "options": [{"label": "A", "text": "IV Albuterol", "correct": false}, {"label": "B", "text": "IV Epinephrine", "correct": false}, {"label": "C", "text": "10 units of Regular Insulin", "correct": false}, {"label": "D", "text": "IV Furosemide", "correct": true}], "correct_answer": "D. IV Furosemide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a cause of hyperkalemia?", "options": [{"label": "A", "text": "Succinylcholine medication", "correct": false}, {"label": "B", "text": "Tumor lysis syndrome", "correct": false}, {"label": "C", "text": "Metabolic acidosis", "correct": false}, {"label": "D", "text": "Hyperaldosteronism", "correct": true}], "correct_answer": "D. Hyperaldosteronism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Intake</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> from food is a very uncommon cause of <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> in adult patients with normal <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function but can be an important cause in those with <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intracellular <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Shifts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cellular injury</li>\n<li>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> <strong>(Option C)</strong></li>\n<li>Sepsis</li>\n<li>Dehydration</li>\n<li>Insulin deficiency</li>\n<li>Diabetic Ketoacidosis</li>\n<li>Tumor <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> syndrome <strong>(Option B)</strong></li>\n<li>Hyperkalemic <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">periodic</span> paralysis</li>\n<li>Medications such as Succinylcholine <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impaired <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Excretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute or chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</strong> is a common cause of hyperkalemia.</li>\n<li>Hyperkalemia is usually not seen until the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> rate falls below 30 ml/min.</li>\n<li><strong>Tubular <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> </strong>due to <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> deficiency.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with Acute myeloid leukaemia is admitted for chemotherapy. On the third day of treatment, he complains of muscle weakness and palpitations. Serum uric acid levels are elevated. On examination, there is a sign of hypoperfusion, and his ECG shows peaked T waves. What is the most likely cause of his presentation?", "options": [{"label": "A", "text": "Hypoaldosteronism", "correct": false}, {"label": "B", "text": "Tumor lysis syndrome", "correct": true}, {"label": "C", "text": "Gout", "correct": false}, {"label": "D", "text": "Drug reactions", "correct": false}], "correct_answer": "B. Tumor lysis syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male is brought to the emergency department with vomiting and seizures. What is his most probable serum sodium level?", "options": [{"label": "A", "text": "132", "correct": false}, {"label": "B", "text": "127", "correct": false}, {"label": "C", "text": "120", "correct": true}, {"label": "D", "text": "135", "correct": false}], "correct_answer": "C. 120", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Sodium Level (mmol/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>130–135</p>\n<p><strong>(Option A ruled out)</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>125–129</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nausea, Delirium, Headache</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 124<strong> </strong></p>\n<p><strong>(Option C) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vomiting</strong>, Somnolence, <strong>Seizures</strong>, Coma, <span class=\"customMeta\" data-dictid=\"1b798ee2c21692777183440eb9102c\">Cardiorespiratory</span> arrest</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old female presents to the clinic with complaints of muscle weakness, fatigue, and occasional palpitations for the past few days. She has a history of congestive heart failure and is on furosemide for fluid management. On physical examination, she appears mildly dehydrated. ECG findings are given below. What is the most likely electrolyte abnormality in this patient?", "options": [{"label": "A", "text": "Hyperkalemia", "correct": false}, {"label": "B", "text": "Hyponatremia", "correct": false}, {"label": "C", "text": "Hypokalemia", "correct": true}, {"label": "D", "text": "Hypernatremia", "correct": false}], "correct_answer": "C. Hypokalemia", "question_images": ["https://image.prepladder.com/notes/2ww3s9YYOMj6Q73Cnf8P1744289544.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents to the clinic with muscle weakness, fatigue and occasional palpitations. Laboratory tests reveal serum potassium levels of 2.9 mEq/L. Which of the following syndromes is not a known cause of this condition?", "options": [{"label": "A", "text": "Liddle syndrome", "correct": false}, {"label": "B", "text": "Gitelman syndrome", "correct": false}, {"label": "C", "text": "Fanconi syndrome", "correct": false}, {"label": "D", "text": "Kounis syndrome", "correct": true}], "correct_answer": "D. Kounis syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/PtVmiR97YXNVsG4ckrzb1745643132.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diuretic Use:</strong> <span class=\"customMeta\" data-dictid=\"1848b160c11692777191b60caaf622\">Loop diuretics</span> (furosemide) and <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretics can lead to significant <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> loss.</li>\n<li><strong>Hyperaldosteronism</strong>: Conditions like Conn's syndrome increase <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> secretion, increasing <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> excretion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> Disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gitelman syndrome</strong><strong>(Option B)</strong>: A genetic disorder causing loss of electrolytes, including potassium.</li>\n<li><strong>Liddle syndrome </strong><strong>(Option A)</strong><strong>: </strong>A genetic condition that increases sodium <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> and <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> excretion.</li>\n<li><strong>Cushing’s Syndrome</strong>: <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">Excess</span> <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> can lead to <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> through its <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">mineralocorticoid</span> effects.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal Losses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vomiting</li>\n<li>Diarrhea</li>\n<li>Laxative Abuse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> Intake</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inadequate Dietary Intake</li>\n<li><strong>Intravenous Fluids: </strong>Administration of IV fluids without adequate <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> supplementation can lead to hypokalemia, particularly in hospitalised patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cellular Shift</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Alkalosis</strong>: In <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis, <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> shifts into cells, contributing to hypokalemia.</li>\n<li><strong>Insulin Administration: </strong>Insulin promotes <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> into cells, which can lead to hypokalemia, especially when given in high doses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Miscellaneous Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fanconi Syndrome </strong><strong>(Option C)</strong>: A condition that affects the <span class=\"customMeta\" data-dictid=\"406aede9e21692777194b4cefe9958\">PCT</span> and can lead to the loss of <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> and other electrolytes.</li>\n<li><strong>Magnesium Deficiency</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> includes chloride-responsive <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> from 11-β or 17-α-hydroxylase deficiency</li>\n<li>Renin-secreting tumors</li>\n<li>Ectopic <span class=\"customMeta\" data-dictid=\"28498d654b1692777185eb08ad5560\">corticotropin</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"9bbbb7c9b316927771806ddc890ba2\">adrenocorticotropic</span> hormone syndrome</li>\n<li>Cushing disease or Cushing syndrome</li>\n<li>Hereditary glucocorticoid-responsive aldosteronism</li>\n<li>Hypertensive emergency and <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> hypertension</li>\n<li>Renovascular <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female with a history of chronic kidney disease presents to the emergency department with muscle weakness and palpitations. What is the most likely acid-base disturbance, given the patient's serum potassium and bicarbonate levels? Laboratory results reveal the following: Serum potassium: 6.5 mEq/L Serum bicarbonate: 15 mEq/L", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": true}, {"label": "C", "text": "Respiratory alkalosis", "correct": false}, {"label": "D", "text": "Respiratory acidosis", "correct": false}], "correct_answer": "B. Metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old female is admitted to the hospital with severe dehydration and a serum sodium level of 160 mEq/L. You plan to correct her sodium levels gradually to prevent complications such as cerebral oedema. The goal is to decrease the serum sodium level by no more than how many mEq per hour.", "options": [{"label": "A", "text": "1.5 mEq per hour", "correct": false}, {"label": "B", "text": "0.5 mEq per hour", "correct": true}, {"label": "C", "text": "2 mEq per hour", "correct": false}, {"label": "D", "text": "1 mEq per hour", "correct": false}], "correct_answer": "B. 0.5 mEq per hour", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male presents to the hospital with confusion and dehydration. Blood tests reveal a serum sodium level of 150 mEq/L. Which of the following is not a cause of this condition?", "options": [{"label": "A", "text": "Diabetes insipidus", "correct": false}, {"label": "B", "text": "Excessive lactulose use", "correct": false}, {"label": "C", "text": "Alzheimer’s disease", "correct": false}, {"label": "D", "text": "Hypoaldosteronism", "correct": true}], "correct_answer": "D. Hypoaldosteronism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Water Deficit (Dehydration)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diabetes Insipidus (Central or Nephrogenic) </strong><strong>(Option A)</strong><strong>: </strong>Inadequate <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> or response to <span class=\"customMeta\" data-dictid=\"27bd08bbaa16927771812e98e16787\">antidiuretic</span> hormone (ADH) leads to excessive <span class=\"customMeta\" data-dictid=\"5ca36f9c45169277720309b0504fed\">free water</span> loss in the urine.</li>\n<li><strong>Gastrointestinal Losses:</strong> Severe diarrhoea, especially in conditions like osmotic diarrhoea can cause loss of water leading to hypernatremia.</li>\n<li><strong>Burns</strong>: Large surface area burns can lead to fluid loss and concentration of sodium.</li>\n<li><strong>Impaired <span class=\"customMeta\" data-dictid=\"ae74115deb169277720071d599b428\">Thirst</span> Mechanism </strong><strong>(Option C)</strong>: This can occur in elderly patients with neurological conditions (dementia, Alzheimer’s disease).</li>\n<li><strong>Excessive <span class=\"customMeta\" data-dictid=\"a03905bbbe1692777191c66ee744b7\">lactulose</span> use </strong><strong>(Option B)</strong><strong>:</strong> <span class=\"customMeta\" data-dictid=\"a03905bbbe1692777191c66ee744b7\">Lactulose</span> can cause <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">dehydration</span> and <span class=\"customMeta\" data-dictid=\"113313e2e01692777189a8535b4b04\">hypernatremia</span> through significant fluid losses, especially in patients with diarrhoea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Excess Sodium Gain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypertonic Sodium Solutions:</strong> Administration of <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">hypertonic</span> <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> (e.g., 3% saline) or sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> can cause hypernatremia.</li>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"982551b8f81692777189e20f09de85\">Hyperaldosteronism</span> (Conn’s Syndrome):</strong> <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">Excess</span> <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> causes sodium <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> and <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> excretion, potentially leading to <span class=\"customMeta\" data-dictid=\"113313e2e01692777189a8535b4b04\">hypernatremia</span> in rare cases.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iatrogenic (Hospital-Acquired) Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inappropriate Use of Diuretics:</strong> Certain diuretics can cause <span class=\"customMeta\" data-dictid=\"5ca36f9c45169277720309b0504fed\">free water</span> loss without significant sodium loss.</li>\n<li><strong>Overcorrection of Hyponatremia:</strong> Too rapid <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> with <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">hypertonic</span> <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> can result in hypernatremia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male weighing 60 kg is admitted to the emergency department with symptoms of confusion and seizures. Blood investigations revealed a serum sodium level of 125 mEq/L. You aim to calculate the total sodium deficit that needs to be corrected to bring his serum sodium to a target of 135 mEq/L. What is the total sodium deficit (in mEq) that needs to be corrected in this patient?", "options": [{"label": "A", "text": "180 mEq", "correct": false}, {"label": "B", "text": "240 mEq", "correct": false}, {"label": "C", "text": "360 mEq", "correct": true}, {"label": "D", "text": "216 mEq", "correct": false}], "correct_answer": "C. 360 mEq", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following statements is false about chronic hyponatremia?", "options": [{"label": "A", "text": "Rate of correction should be &amp;lt; 8 mEq/L in the first 24 hours", "correct": false}, {"label": "B", "text": "Osmotic demyelination syndrome typically manifests 24 hours after rapid correction of Na+", "correct": false}, {"label": "C", "text": "Males will require more Na+ correction than females for the same deficit", "correct": false}, {"label": "D", "text": "No treatment is usually required for asymptomatic patients", "correct": true}], "correct_answer": "D. No treatment is usually required for asymptomatic patients", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wntUk6WGEiVi1kVaqrlX1739897956.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fall in Na+ levels gradually (&gt;48 hours)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endocrinal: SIADH, Hypothyroidism</li>\n<li>Organ failure: CKD, Cirrhosis, CHF</li>\n<li>Drugs: Prolonged <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> use</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"175\" src=\"https://image.prepladder.com/content/wntUk6WGEiVi1kVaqrlX1739897956.png\" width=\"294\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Extrusion of osmolytes</strong> (creatine, glutamate, betaine) takes place over time to maintain the <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> of <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> as the brain adapts to hyponatremia.</li>\n<li>Minor outflow of positive ions - Na+/K+ occurs along with water.</li>\n<li><strong>Cerebral oedema is usually absent</strong>/less predominant.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache, nausea, vomiting, dizziness</li>\n<li><strong>Less severe symptoms </strong>are seen.</li>\n<li>CNS manifestations:<strong> </strong>Cognitive and <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> disturbances.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Correction of Na+ must be slow and gradual, as rapid <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> can lead to Osmotic <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> syndrome.</li>\n<li><strong>3% <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">Hypertonic</span> <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> at 6-8 mEq/L in the first 24 hours and 6 mEq/L after 24 hours. </strong><strong>(Option A)</strong></li>\n<li>The rate of <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of sodium should not exceed 8mEq/L for any 24 hrs</li>\n<li>Water <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">deprivation</span> was earlier done, though aiding in the <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> is not feasible in most cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Na+ deficit calculation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Na+ deficit = <span class=\"customMeta\" data-dictid=\"2ffd6e5c4416927772003e0e7881e3\">TBW</span> x (140 - [Na+]) </strong></li>\n<li>TBW<strong> (males)</strong>= <strong>0.6</strong> x Body weight (in kgs) <strong>(Option C)</strong></li>\n<li>TBW <strong>(females)</strong>= <strong>0.5</strong> x Body weight (in kgs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osmotic <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Predominantly affects Pons, also called Central <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> myelinolysis.</li>\n<li>Clinically manifests 24 hours following rapid sodium correction. <strong>(Option B)</strong></li>\n<li><strong>Clinical features: </strong>Quadriplegia, dysarthria, dysphagia, altered mental status</li>\n<li><strong>Prevention:</strong> Addition of <span class=\"customMeta\" data-dictid=\"4a351f559e1692777185c262b059f3\">DDAVP</span> (Arginine Vasopressin) while initiating sodium correction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female post myomectomy was kept in post-op observation when she developed a headache and vomiting, and, 24 hours later, she developed two episodes of seizures. The clinician suspected Hyponatremia and decided to initiate sodium correction. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "3% normal saline 100 ml bolus over 10 mins", "correct": true}, {"label": "B", "text": "3% normal saline infusion at 0.5mEq/hr for 24 hours", "correct": false}, {"label": "C", "text": "5% Dextrose bolus followed by Normal saline infusion", "correct": false}, {"label": "D", "text": "5% Dextrose infusion only", "correct": false}], "correct_answer": "A. 3% normal saline 100 ml bolus over 10 mins", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fall in Na+ levels typically <strong>&lt; 125 mEq/L,</strong> leading to cerebral oedema <strong>within 48 hours</strong> of onset</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pathogenesis of &lt;span class=\" custommeta\"=\"\" data-dictid=\"4cdc8161f71692777180df58cafa93\"/>Acute hyponatremia\" data-author=\"Giuliani, Corinna &amp; Peri, Alessandro. (2015). Effects of Hyponatremia on the Brain. Journal of clinical medicine. 3. 1163-77. 10.3390/jcm3041163. \" data-hash=\"8527\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Effects-of-hyponatremia-on-the-brain-and-adaptive-mechanism-a-Normonatremia-brain_fig1_281846604\" data-tags=\"\" src=\"https://image.prepladder.com/notes/9dAV2AtWSaauIgNIuer71744289325.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Iatrogenic: <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <strong>premenopausal</strong> women, <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> with <span class=\"customMeta\" data-dictid=\"6c1412e72916927771893d06180642\">hypotonic</span> fluids, <span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\">colonoscopy</span> preparation</li>\n<li>Drugs: <strong>Thiazide</strong>, <strong>MDMA (Ecstasy)</strong> Abuse</li>\n<li><strong>Exercise-</strong>induced: seen in athletes in vigorous activity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<ul>\n<li>Due to rapid deterioration in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> Na+ levels, brain cell <span class=\"customMeta\" data-dictid=\"c623a72bdd16927771808d60122016\">adaptation</span> does not take place.</li>\n<li>Intrusion of water leads to cerebral edema, which usually develops within 24-48 hours following rapid fall of Na+.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache, nausea, vomiting, dizziness</li>\n<li><strong>Severe symptoms:</strong> seizures, altered level of consciousness, coma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>3% <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">Hypertonic</span> <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> 100 ml <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> over 10 mins</strong> (1-2 mEq/L rise is usually seen). <strong>(Option A)</strong></li>\n<li>Repeat <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> Na+ levels and clinically assess the patient, and repeat <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> if necessary.</li>\n<li>Increase <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> sodium by 4-6 mEq/L/hr.</li>\n<li>Slow <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> (infusion) is <strong>not</strong> recommended in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Hyponatremia. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female presented with complaints of lower back pain for 6 months. Her Hb count was low, and a peripheral blood smear revealed normocytic normochromic anaemia. No other abnormalities were found on the preliminary evaluation. Her renal and liver function tests were within normal limits. Bone marrow biopsy is as shown below. What is the most likely electrolyte imbalance seen in this patient?", "options": [{"label": "A", "text": "Hypotonic hyponatremia", "correct": false}, {"label": "B", "text": "Isotonic hyponatremia", "correct": true}, {"label": "C", "text": "Hypertonic hyponatremia", "correct": false}, {"label": "D", "text": "Hypernatremia", "correct": false}], "correct_answer": "B. Isotonic hyponatremia", "question_images": ["https://image.prepladder.com/notes/lHpLCUP1pzrV17ABDiiN1746006938.png"], "explanation_images": ["https://image.prepladder.com/notes/PGmq2aZNEkwn6fKgKfGd1745642803.png", "https://image.prepladder.com/notes/M2WrT3KJImmaMcDxXyUe1744288728.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypotonic hyponatremia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Isotonic hyponatremia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypertonic hyponatremia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diarrhea/vomiting</li>\n<li>Enterocutaneous fistula</li>\n<li>Cerebral <span class=\"customMeta\" data-dictid=\"a32272481a1692777198059baa2fd8\">salt wasting</span> syndrome</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multiple myeloma</li>\n<li>Hyperlipidemia</li>\n<li>Graft vs Host disease</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Exogenous <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> of Mannitol/glycine</li>\n<li>Radiocontrast dyes</li>\n<li>Hyperglycemic hyperosmolar state (HHS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Euvolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>SIADH</li>\n<li>Hypothyroidism</li>\n<li>Secondary hyperaldosteronism</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypervolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>AKI/CKD</li>\n<li>CHF</li>\n<li>Cirrhosis</li>\n<li>Nephrotic syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Values of serum Sodium and plasma Osmolality are, Na+: 130 mEq/L Osmolality: 310 mOsm/L Which among the following clinical scenarios is least likely to cause this derangement?", "options": [{"label": "A", "text": "A 60-year male with blood glucose &amp;gt; 500 mg/dL upon arrival", "correct": false}, {"label": "B", "text": "Patient developing headache and dizziness post-MRI with contrast", "correct": false}, {"label": "C", "text": "Exogenous infusion of mannitol to a patient with a head injury", "correct": false}, {"label": "D", "text": "A 40 year female excreting &amp;gt; 20 L urine per day with absence of pituitary bright spot on MRI", "correct": true}], "correct_answer": "D. A 40 year female excreting &gt; 20 L urine per day with absence of pituitary bright spot on MRI", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient admitted to ICU developed symptoms of headache, nausea, vomiting, and sudden onset seizures. On examination, the patient has bilateral pedal oedema. The Intensivist suspected an electrolyte abnormality and sent for serum and urine analysis (given below). What could be the likely cause leading to the patient's symptoms? Na+: 124 mEq/L, K+: 4.8 mEq/L, Cl-: 90 mEq/L, Urinary Na+: 25 mM.", "options": [{"label": "A", "text": "Acute kidney injury", "correct": true}, {"label": "B", "text": "Nephrotic syndrome", "correct": false}, {"label": "C", "text": "Liver failure", "correct": false}, {"label": "D", "text": "Congestive heart failure", "correct": false}], "correct_answer": "A. Acute kidney injury", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:163px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Na+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>135-145 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>K+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3.5-5 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cl-</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>98-106 mEq/L</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> (Hypotonic state)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TBW ↑↑; TBS ↑ (But sodium concentration ↓) </strong></p>\n<p>(TBW- Total body water, TBS- Total body sodium)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperaldosteronism</strong> secondary to massive <span class=\"customMeta\" data-dictid=\"a1146fb9d8169277718250cf1224a8\">ascites</span> - leading to increased activity of <strong>ENaC</strong> channels → Water <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> ↑↑ (in comparison to salt retention).</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>U.Na+ &gt; 20 mM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>U.Na+ &lt; 20 mM</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury (AKI)</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ascites:</p>\n<ul>\n<li>CHF</li>\n<li>Cirrhosis (Liver failure)</li>\n<li>Nephrotic syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 49-year-old lady with hypothyroidism is presenting with nausea and headache. Her serum sodium level is 126 mmol/L. What kind of hyponatremia is this most likely to be?", "options": [{"label": "A", "text": "Hypovolemic hyponatremia", "correct": false}, {"label": "B", "text": "Hypervolemic hyponatremia", "correct": false}, {"label": "C", "text": "Euvolemic hyponatremia", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. Euvolemic hyponatremia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "SIADH is an example of what kind of hyponatremia?", "options": [{"label": "A", "text": "Hypovolemic hyponatremia", "correct": false}, {"label": "B", "text": "Hypervolemic hyponatremia", "correct": false}, {"label": "C", "text": "Euvolemic hyponatremia", "correct": true}, {"label": "D", "text": "Any of the above", "correct": false}], "correct_answer": "C. Euvolemic hyponatremia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/wsqLSQUr2gbZcGklJuyH1744288853.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female is presenting with nausea, delirium, and headache. She has had loose stools for the past 2 days. What is the diagnosis?", "options": [{"label": "A", "text": "Hypovolemic hyponatremia", "correct": true}, {"label": "B", "text": "Hypervolemic hypernatremia", "correct": false}, {"label": "C", "text": "Hypovolemic hypernatremia", "correct": false}, {"label": "D", "text": "Euvolemic hyponatremia", "correct": false}], "correct_answer": "A. Hypovolemic hyponatremia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/M2WrT3KJImmaMcDxXyUe1744288728.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 40 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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Her urine dipstick shows 3+ protein. A subsequent 24-hour urine collection was done, and possible glomerular disease was suspected. What is the estimated protein quantity for this condition?", "options": [{"label": "A", "text": "0.5 g", "correct": false}, {"label": "B", "text": "0.8 g", "correct": false}, {"label": "C", "text": "1 g", "correct": false}, {"label": "D", "text": "2 g", "correct": true}], "correct_answer": "D. 2 g", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/fjN2SQU0T1KIzFpUv7H31744281484.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine <span class=\"customMeta\" data-dictid=\"1dd1a9a2f21692777186672cf2ab93\">Dipstick</span> test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a rapid and cost-effective tool for screening and monitoring various <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> abnormalities, aiding in the early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> diseases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disadvantages </strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Paraproteins </strong>(+ve charged protein) like Bence Jones proteins are missed in dipstick.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"1dd1a9a2f21692777186672cf2ab93\">dipstick</span> <strong>primarily detects albumin</strong> (a -<strong>ve charged </strong>protein), the most common <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> protein, and may also identify other proteins, but in smaller amounts.</li>\n<li>Results can be affected by factors such as<strong> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> pH, concentration, and temperature</strong>, leading to inconsistent readings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comparing the colour changes on each <span class=\"customMeta\" data-dictid=\"23e62c2aef16927771971f5c6bc3c6\">reagent</span> pad to the provided colour chart on the <span class=\"customMeta\" data-dictid=\"1dd1a9a2f21692777186672cf2ab93\">dipstick</span> packaging helps in assessing parameters like</p>\n<ul>\n<li>Proteins</li>\n<li>Glucose</li>\n<li>Ketones</li>\n<li>Blood</li>\n<li>pH</li>\n<li>Nitrites</li>\n<li>Leukocyte Esterase</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Urine test strip\" data-author=\"J3D3 - Own work\" data-hash=\"8447\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Urine_test_strip#/media/File:Chemstrip1.jpg\" data-tags=\"\" height=\"230\" src=\"https://image.prepladder.com/notes/fjN2SQU0T1KIzFpUv7H31744281484.png\" width=\"270\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"interpret a &lt;span class=\" custommeta\"=\"\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\"/>urine <span class=\"customMeta\" data-dictid=\"1dd1a9a2f21692777186672cf2ab93\">dipstick</span> result \" data-author=\"Hxa098020\" data-hash=\"8449\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Visually_read_a_urine_test_strip_by_comparing_it_with_the_color_key_provided_by_the_manufacturer._Color_chart_from_Urinox-10_urine_test_strips_by_Diagnox_is_shown_in_this_image.jpg\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/notes/RpDGfX54KTEn9wBhlIGy1744281541.png\" width=\"268\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal range of Proteinuria</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normal <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> in adults is<strong> &lt;150mg/day</strong></li>\n<li>Glomerular <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">Proteinuria</span> is<strong> &lt;30mg/day</strong></li>\n<li>Proteins from tubules are around<strong> 120 mg/day</strong> <strong>(Tamm Horsfall proteins/Uromodulin)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Values of Proteinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dipstick Reading</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PCR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 25 mg/mmol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>nil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>25 - 50 mg/mmol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate albuminuria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1+ to 2+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50 - 100 mg/mmol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive dipstick</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2+ to 3+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100 - 350 mg/mmol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Possible <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> disease, i.e.&gt; 1g protein in a day</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3+ to 4+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 350 mg/mmol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic range, i.e. &gt; 3.5 g protein in a day</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:368px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proteinuria in Dipstick</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protein Quantity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trace</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30 mg/dl</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-100 mg/dl</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100-300 mg/dl</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300-1000 mg/dl</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;1000 mg/dl</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old man presents with fatigue, weight loss, and recurrent infections. Laboratory tests reveal anaemia and a serum immunofixation shows a monoclonal band. Which of the following tests helps identify proteinuria in this condition?", "options": [{"label": "A", "text": "24-hour urine protein quantification", "correct": false}, {"label": "B", "text": "Urine dipstick", "correct": false}, {"label": "C", "text": "Urine microscopy", "correct": false}, {"label": "D", "text": "Urine electrophoresis", "correct": true}], "correct_answer": "D. Urine electrophoresis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/hTT0ACPCp28rgqJlsnWj1744281799.png", "https://image.prepladder.com/notes/vZXyoepNTxxGKVQRRGSi1744281925.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Electrophoresis - Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Electrophoresis - Multiple Myeloma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Electrophoresis - Normal\" data-author=\"Steven Fruitsmaak - Own work\" data-hash=\"8455\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Serum_protein_electrophoresis#/media/File:Serum_protein_electrophoresis_normal.PNG\" data-tags=\"\" height=\"252\" src=\"https://image.prepladder.com/notes/hTT0ACPCp28rgqJlsnWj1744281799.png\" width=\"520\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Electrophoresis - Multiple Myeloma\" data-author=\"Steven Fruitsmaak - Own work\" data-hash=\"8458\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Myeloma_protein#/media/File:Monoclonal_gammopathy_Multiple_Myeloma.png\" data-tags=\"\" height=\"267\" src=\"https://image.prepladder.com/notes/vZXyoepNTxxGKVQRRGSi1744281925.png\" width=\"580\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyaline casts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seen in normal individuals</li>\n<li>Composed of Tamm Horsfall Protein</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBC cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute glomerulonephritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WBC cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute/chronic pyelonephritis</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> nephritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muddy brown cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> necrosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Broad cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>(D. nephropathy) CKD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granular <span class=\"customMeta\" data-dictid=\"b8ccccd9b81692777202ca2fa976d6\">waxy</span> cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic glomerulonephritis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with oedema, fatigue and foamy urine. Laboratory tests show Urine dipstick: 2+ for protein Urine albumin: 100 mg/d Based on his clinical presentation and lab findings, what renal pathology should be suspected?", "options": [{"label": "A", "text": "Severe glomerulonephritis", "correct": false}, {"label": "B", "text": "Congestive heart failure", "correct": false}, {"label": "C", "text": "Multiple myeloma", "correct": false}, {"label": "D", "text": "Early stages of diabetes mellitus", "correct": true}], "correct_answer": "D. Early stages of diabetes mellitus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Albuminuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderately increased</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severely increased </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Albumin Excreted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30–300 mg/d</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300–3500 mg/d</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early stages of DM <strong>(Option D)</strong></li>\n<li>Early HTN</li>\n<li>Early stages of glomerulonephritis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Congestive <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> </strong><strong>(Option B)</strong></li>\n<li>Fever</li>\n<li>Exercise</li>\n<li>Diabetes Mellitus</li>\n<li>HTN</li>\n<li><strong>Multiple Myeloma</strong> <strong>(Option C)</strong></li>\n<li>Monoclonal <span class=\"customMeta\" data-dictid=\"b8941fc2071692777188c7fbafecd5\">Gammopathy</span> of Undetermined Significance (MGUS)</li>\n<li><strong>Severe Glomerulonephritis</strong> <strong>(Option A)</strong></li>\n<li>Orthostatic proteinuria</li>\n<li>Intermittent proteinuria</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:532px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AER</strong> <strong>= <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> albumin/urine <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> (mg/gm)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy presents to the clinic with complaints of generalised oedema, significant fatigue, and an increased weight over the past month; he mentions that he has recently noticed his urine appearing foamy. Urine Dipstick: 4+ for protein 24-Hour urine Protein: 5000 mg Serum Creatinine: 1.1 mg/dL What is the most likely underlying cause, considering these lab parameters?", "options": [{"label": "A", "text": "Diabetic Nephropathy", "correct": false}, {"label": "B", "text": "IgA nephropathy", "correct": false}, {"label": "C", "text": "Membranous nephropathy", "correct": false}, {"label": "D", "text": "Lipoid nephrosis", "correct": true}], "correct_answer": "D. Lipoid nephrosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:452px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> range Proteinuria</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diabetic nephropathy</li>\n<li>Minimal change disease</li>\n<li>Membranous glomerulopathy</li>\n<li>IgA nephropathy</li>\n<li>Amyloidosis</li>\n<li>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">glomerulosclerosis</span> (FSGS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serologic Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minimal Change</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allergy, atopy, NSAIDs, Hodgkin’s</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focal <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> Glomerulosclerosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>African Americans, HIV, Heroin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HIV Ab</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Membranous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Drugs: gold, penicillamine, NSAIDs, <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis, Malignancy: breast, lung, GI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hep B surface antigen, <span class=\"customMeta\" data-dictid=\"d3d938151416927771887e91804b5b\">Hep</span> C antibody, Anti-DNA Ab</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Membranoproliferative GN Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C4 Nephritic factor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C3↓, C4↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Membranoproliferative GN Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C3 Nephritic factor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C3↓, C4 normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryoglobulinemic MPGN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hepatitis C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-HCV antibody, <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> factor, C3↓, C4↓, CH 50↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amyloidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myeloma, <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis, bronchiectasis, Crohn’s disease, FMF</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SPEP, UPEP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetic Nephropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Other <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> microangiopathy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male, recovering post-operatively after ACL surgery, develops a fever, nausea, and cough. A urine dipstick reveals trace proteinuria. He has no history of hypertension or diabetes. What is the most likely cause of his proteinuria?", "options": [{"label": "A", "text": "Tubular proteinuria", "correct": false}, {"label": "B", "text": "Glomerular Proteinuria", "correct": false}, {"label": "C", "text": "Overload proteinuria", "correct": false}, {"label": "D", "text": "Functional proteinuria", "correct": true}], "correct_answer": "D. Functional proteinuria", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Proteinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transient</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, Stress, Dehydration, Cold exposure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orthostatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subtle <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> abnormality, Exaggerated <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> response</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Persistent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diabetes, Lupus, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>UTIs, Nephrolithiasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tubular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wilson Disease, Cystinosis, <span class=\"customMeta\" data-dictid=\"0834e545c9169277719383768d0ff2\">Nephrotoxic</span> medicines, <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">Interstitial</span> nephritis, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">Necrosis</span> (ATN)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glomerular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glomerular basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> damage, Minimal change disease, <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> Nephropathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overflow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple myeloma, Rhabdomyolysis</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification of Proteinuria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transient </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, Stress, Dehydration, Cold exposure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orthostatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subtle <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> abnormality, Exaggerated <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> response</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Persistent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diabetes, Lupus, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>UTI, Nephrolithiasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tubular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> necrosis, <span class=\"customMeta\" data-dictid=\"11a108da951692777201ccf7220331\">Tubulointerstitial</span> nephritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glomerular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome, Glomerulonephritis, and Immune <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> nephritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overflow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple myeloma, Hemoglobinuria, and Myoglobinuria</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents with dysuria, increased urinary frequency, and urgency. Laboratory tests show 6 red blood cells and 20 pus cells/HPF with no visible discolouration. She was treated for a UTI, and later, a couple of repeat urinalysis in consecutive weeks revealed the same RBC count without any discoloration. Which of the following best describes this finding?", "options": [{"label": "A", "text": "Significant hematuria", "correct": true}, {"label": "B", "text": "Normal finding", "correct": false}, {"label": "C", "text": "Gross hematuria", "correct": false}, {"label": "D", "text": "Drug-induced hematuria", "correct": false}], "correct_answer": "A. Significant hematuria", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significant <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is defined as the <strong>presence of more than 3 RBCs/HPF in a centrifuged <span class=\"customMeta\" data-dictid=\"c02ad9ae0f1692777198d76afc93c4\">specimen</span> at an interval of 1 week </strong>(or) <strong>More than 100 RBCs/HPF in a single analysis</strong> (or) <strong>Presence of <span class=\"customMeta\" data-dictid=\"2fb95074611692777188024c7d70a0\">gross hematuria</span> </strong>(Gross <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> can be significant hematuria, but not all significant <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> is gross hematuria).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Finding</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Is the presence of less than 3 RBCs/HPF</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isolated hematuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> alone without any other casts, cells or proteinuria.</li>\n<li>Seen in <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> bleeding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Hematuria</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <strong>red blood cells in the <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> that is visible to the naked eye</strong> causes the <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> to appear red, brown or pink.</li>\n<li>Examples: <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">Benign</span> <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> hyperplasia, <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> stones</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>False positive hematuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dipstick can be found positive for <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> in the case of myoglobinuria.</li>\n<li>Examples: Rhabdomyolysis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the emergency department with red urine (as shown below) for two days and mild flank pain. He has no prior urinary issues and reports no pain or trauma. Urine was sent for repeat analysis, and an ultrasound was recommended. What is the most common cause of hematuria in this case?", "options": [{"label": "A", "text": "IgA nephropathy", "correct": false}, {"label": "B", "text": "Glomerulonephritis", "correct": false}, {"label": "C", "text": "Nephrolithiasis", "correct": true}, {"label": "D", "text": "Clofazimine", "correct": false}], "correct_answer": "C. Nephrolithiasis", "question_images": ["https://image.prepladder.com/notes/hzXblTUbD3gHmRVLHfB51744282095.png"], "explanation_images": ["https://image.prepladder.com/notes/hzXblTUbD3gHmRVLHfB51744282095.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of Hematuria</strong><strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nephrolithiasis (Most common in adults)</strong></li>\n<li><strong>Trauma </strong></li>\n<li><strong>Renal tumour</strong></li>\n<li><strong>Glomerular diseases </strong>(like glomerulonephritis, small-vessel vasculitis, <span class=\"customMeta\" data-dictid=\"d9bf27b09416927771984cdc6c0bc4\">SLE</span> (Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus), etc.)</li>\n<li>Polyarteritis nodosa</li>\n<li>Vascular malformation</li>\n<li>Renal infarction</li>\n<li>Renal cysts</li>\n<li>Interstitial nephritis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pyelonephritis</li>\n<li>Cystitis</li>\n<li>Bladder tumour</li>\n<li>Urethritis</li>\n<li>BPH (benign prostatic hypertrophy)</li>\n<li>Prostrate cancer</li>\n<li>Urethritis</li>\n<li><strong>IgA <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> or Berger’s Disease </strong>\n<ul>\n<li>Incidental finding</li>\n<li>Initially <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> hematuria</li>\n<li>Gross <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> after infections like URTI</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents to her primary care physician with swelling in her legs and around her eyes that has worsened over the past two weeks. She reports feeling fatigued and experiencing foamy urine. Urinalysis reveals findings, as shown in the image below. Which of the following conditions exhibits similar urine findings?", "options": [{"label": "A", "text": "Alport disease", "correct": false}, {"label": "B", "text": "Gaucher’s disease", "correct": false}, {"label": "C", "text": "Fabry’s disease", "correct": true}, {"label": "D", "text": "Pompe disease", "correct": false}], "correct_answer": "C. Fabry’s disease", "question_images": ["https://image.prepladder.com/notes/zwz2lD5nEVrZhsckyWNv1744282584.png"], "explanation_images": ["https://image.prepladder.com/notes/76y1LsMv5yTp3bSCfaLh1744282744.png", "https://image.prepladder.com/notes/SrV4EA0AYb5PKO8hHrbK1745642227.png", "https://image.prepladder.com/notes/VD9tBgUSUx4Ijc0OeEPi1744283033.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sample </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conditions associated with Maltese cross appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nephrotic syndrome</strong></li>\n<li><strong>Fabry’s disease </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Babesiosis </strong></p>\n<ul>\n<li>A tick-borne intra-erythrocytic <span class=\"customMeta\" data-dictid=\"101b1e083716927771969fdfd388d4\">protozoan</span> <span class=\"customMeta\" data-dictid=\"c0433f52ad1692777194c2ffb6fc63\">parasitic</span> disease caused by<em> </em><strong><em>Babesia microti</em></strong><strong> (Ixodes as the vector).</strong></li>\n<li>Symptoms such as fever and <span class=\"customMeta\" data-dictid=\"851667fa1916927771918db28ab877\">malaise</span> typically develop 1 to 4 weeks after a <span class=\"customMeta\" data-dictid=\"63b7807cc41692777200fab227369f\">tick</span> bite.</li>\n<li><strong>Treatment: </strong>Quinine and clindamycin.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Babesia Peripheral smear\" data-author=\"LukaJovanovic947\" data-hash=\"8468\" data-license=\"CC BY-SA 4.0 \" data-source=\"https://commons.wikimedia.org/wiki/File:Babezioza.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/notes/VD9tBgUSUx4Ijc0OeEPi1744283033.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF (cerebrospinal fluid)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cryptococcosis</li>\n<li>Cryptococcal meningitis</li>\n</ul>\n<p>In these cases, <strong>Cryptococcus neoformans</strong> can be detected through <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> analysis, which may include India ink staining, <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> detection, or culture.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female visits her primary care physician for a routine check-up. She feels well and has no specific concerns. Routine investigations reveal her urinalysis shows a specific gravity of 1.032. What is the most likely cause of this finding?", "options": [{"label": "A", "text": "Dehydration", "correct": true}, {"label": "B", "text": "Psychogenic polydipsia", "correct": false}, {"label": "C", "text": "Diabetes insipidus", "correct": false}, {"label": "D", "text": "Renal tubular dysfunction", "correct": false}], "correct_answer": "A. Dehydration", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male with chronic kidney disease and recurrent renal stones visits the clinic for routine monitoring. He reports occasional flank pain and increased urinary frequency. Urinalysis shows cloudy urine with a pH of 9.0 and a specific gravity of 1.005. Which of the following conditions can lead to low urine pH?", "options": [{"label": "A", "text": "Vegetarian diet", "correct": false}, {"label": "B", "text": "Urinary tract infections", "correct": false}, {"label": "C", "text": "Renal tubular acidosis type 1", "correct": false}, {"label": "D", "text": "High protein diet", "correct": true}], "correct_answer": "D. High protein diet", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/PVfAWVuVtWbnUpQdOxnq1744283217.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acidic <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (low pH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (high pH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>High protein diet</strong> <strong>(Option D)</strong></li>\n<li>Starvation or fasting</li>\n<li>Dehydration</li>\n<li>Diabetic ketoacidosis</li>\n<li>Nephrolithiasis</li>\n<li>Metabolic acidosis</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> (Type 2 RTA)</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> <span class=\"customMeta\" data-dictid=\"26a46d0aaa169277720147f4f40f57\">type 4</span> (Type 4 RTA)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Vegetarian diet </strong><strong>(Option A) </strong></li>\n<li>Low protein diet</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD)</li>\n<li><strong>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</strong> <strong>(Option B) </strong></li>\n<li><strong>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> (Type 1 RTA)</strong> <strong>(Option C)</strong></li>\n<li>Metabolic alkalosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old boy with beta-thalassemia major, diagnosed at six months and dependent on regular blood transfusions, is brought in by his parents for a routine follow-up. Lab results show significantly elevated serum ferritin levels. The pediatrician starts treatment with Deferoxamine. What colour will his urine likely be?", "options": [{"label": "A", "text": "Red colour", "correct": false}, {"label": "B", "text": "Black colour", "correct": false}, {"label": "C", "text": "Pink colour", "correct": true}, {"label": "D", "text": "Cola colour", "correct": false}], "correct_answer": "C. Pink colour", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pale yellow </strong></p>\n<p><strong>(amber-yellow or straw-coloured)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pink </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Deferoxamine</strong></li>\n<li>Serratia Mascarenes (Pink diaper syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Black </strong><strong>(Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paroxysmal cold Haemoglobinuria (PCH)</li>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> Haemoglobinuria (PNH)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Black (on air exposure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alkaptonuria (can be prevented by vitamin C)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clofazimine</strong></li>\n<li>Porphyria</li>\n<li>Myoglobinuria</li>\n<li>Beetroot ingestion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cola colour </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glomerulonephritis (Hematuria)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yellow </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Jaundice (bilirubinuria)</li>\n<li>B-complex intake</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orange </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rifampicin </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Milky </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chyluria (lymphatic fluid in urine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cloudy or Opalascent </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pyuria (presence of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> cells)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29-year-old female presents to the emergency department with fever, chills, frequent urination, and severe right flank pain. Urinalysis reveals findings, as shown in the image. What is the most likely cause of her condition?", "options": [{"label": "A", "text": "Acute glomerulonephritis", "correct": false}, {"label": "B", "text": "Acute pyelonephritis", "correct": true}, {"label": "C", "text": "Acute tubular necrosis", "correct": false}, {"label": "D", "text": "Diabetic nephropathy", "correct": false}], "correct_answer": "B. Acute pyelonephritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/1tIc2r8vG0sVrmjXUwAg1744283795.png", "https://image.prepladder.com/notes/IsToQlDP4uT8pXhSsJSY1745642394.png", "https://image.prepladder.com/notes/NF2o6PLj2ogbKYOERIQM1745642377.png", "https://image.prepladder.com/notes/aNw4i6u5aOlJpx6hdpG41745642416.png", "https://image.prepladder.com/notes/JUOf7DQoNbkrcbVuUDo71744284425.png", "https://image.prepladder.com/notes/VlAi83JxFmTIul5IPU731744284558.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Urine casts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated conditions </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyaline cast </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hyaline cast \" data-author=\"Ajay Kumar Chaurasiya\" data-hash=\"8476\" data-license=\"CC BY-SA 4.0 \" data-source=\"https://commons.wikimedia.org/wiki/File:Hyaline_Cast_in_Urine_Microscopy.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/notes/1tIc2r8vG0sVrmjXUwAg1744283795.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is observed in healthy individuals and is composed of <strong>Tamm-Horsfall protein (produced by the kidney).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBC cast</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RBC cast\" data-author=\"Mohsenin V.\" data-hash=\"11315\" data-license=\"CC BY 4.0 \" data-source=\"https://commons.wikimedia.org/wiki/File:RTE_cast,_muddy_granular_cast,_WBC_cast_and_RBC_cast_in_urine.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/IsToQlDP4uT8pXhSsJSY1745642394.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute glomerulonephritis</strong> <strong>(Option A)</strong></li>\n<li>IgA nephropathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WBC cast</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"WBC cast\" data-author=\"Mohsenin V.\" data-hash=\"11314\" data-license=\"CC BY 4.0 \" data-source=\"https://commons.wikimedia.org/wiki/File:RTE_cast,_muddy_granular_cast,_WBC_cast_and_RBC_cast_in_urine.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/NF2o6PLj2ogbKYOERIQM1745642377.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute pyelonephritis</strong> <strong>(Option B)</strong></li>\n<li>Chronic pyelonephritis</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> nephritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muddy brown cast (renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> epithelial cast)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Muddy brown cast \" data-author=\"Mohsenin V.\" data-hash=\"11316\" data-license=\"CC BY 4.0 \" data-source=\"https://commons.wikimedia.org/wiki/File:RTE_cast,_muddy_granular_cast,_WBC_cast_and_RBC_cast_in_urine.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/aNw4i6u5aOlJpx6hdpG41745642416.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> </strong><strong>(Option C) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Broad casts</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Broad casts\" data-author=\"Dr. Jay Seltzer and Jose Poloni \" data-hash=\"8484\" data-license=\"\" data-source=\"https://nephsim.com/urine-gallery/\" data-tags=\"\" src=\"https://image.prepladder.com/notes/JUOf7DQoNbkrcbVuUDo71744284425.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD) (diabetic nephropathy)</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granular <span class=\"customMeta\" data-dictid=\"b8ccccd9b81692777202ca2fa976d6\">waxy</span> cast</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Granular &lt;span class=\" custommeta\"=\"\" data-dictid=\"b8ccccd9b81692777202ca2fa976d6\"/>waxy cast\" data-author=\"Chu-Su, Yu &amp; Shukuya, Kenichi &amp; Yokoyama, Takashi &amp; Lin, W.-C &amp; Chiang, Chih-Kang &amp; Lin, Chii-Wann. (2017). Enhancing the Detection of Dysmorphic Red Blood Cells and Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> Epithelial Cells with a Modified Urinalysis Protocol. Scientific Reports. 7. 40521. 10.1038/srep40521. \" data-hash=\"11317\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Casts-400-U-unstained-S-Sternheimer-stain-1-U-Hyaline-cast-the-matrix-of-the_fig2_312403107\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/vyl7UQIaX6RViaozbCRI1745642431.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic glomerulonephritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maltese cross cast</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Fabry’s disease-Maltese cross cast\" custommeta\"=\"\" data-author=\"Etter, Christoph &amp; Russi, Ruth &amp; Fogazzi, Giovanni &amp; Wuthrich, R. &amp; Serra, Andreas. (2009). Maltese cross-like crystals in the &lt;span class=\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\"/>urinary sediment of a diabetic patient. Clinical <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Journal. 2. 405-407. 10.1093/ndtplus/sfp062. \" data-hash=\"8486\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Urinary-sediment-analysis-of-patient-with-a-nephrotic-syndrome-by-A-phase-contrast_fig2_275289378\" data-tags=\"\" src=\"https://image.prepladder.com/notes/erOaxi8ifCbxlUNAq7Tb1744284737.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nephrotic syndrome</li>\n<li><strong>Fabry’s disease</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilirubin cast</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bilirubin cast\" data-author=\": Rieder, Hermann, 1858-1932 Delépine, Sheridan, 1855-\" data-hash=\"8485\" data-license=\"CC0\" data-source=\"https://www.flickr.com/photos/internetarchivebookimages/14779932501\" data-tags=\"\" src=\"https://image.prepladder.com/notes/VlAi83JxFmTIul5IPU731744284558.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bile <span class=\"customMeta\" data-dictid=\"6141777e151692777183431b973dcb\">cast nephropathy</span> (hyperbilirubinemia)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 22 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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He has a history of hypertension and diabetes for eight years. Examination and investigations revealed findings consistent with nephrotic syndrome. Which of the following is not a diagnostic characteristic of nephrotic syndrome?", "options": [{"label": "A", "text": "Proteinuria", "correct": false}, {"label": "B", "text": "Lipiduria", "correct": false}, {"label": "C", "text": "Hypoalbuminemia", "correct": false}, {"label": "D", "text": "Increased oncotic pressure", "correct": true}], "correct_answer": "D. Increased oncotic pressure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic criteria for <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Essential findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Proteinuria of <strong>&gt; 3.5 g/day </strong><strong>(Option A)</strong></li>\n<li>Urine PCR<strong> &gt; 2g protein/g of creatinine</strong></li>\n<li><strong>Hypoalbuminemia</strong> - <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">Albumin</span> <strong>&lt; 2.5 gm% </strong><strong>(Option C)</strong></li>\n<li>Oedema due to <strong>reduced <span class=\"customMeta\" data-dictid=\"5d369be246169277719451754ab37a\">oncotic</span> pressure</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypercholesterolemia</strong>,</li>\n<li><strong>Lipiduria</strong><strong> (Option B)</strong></li>\n</ul>\n<p>Urine microscopy: <strong>Oval fat bodies/Maltese cross bodies</strong></p>\n<ul>\n<li><strong>Low eGFR</strong></li>\n<li><strong>Hypercoagulability</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Minimal change disease</strong> (Most common in children)</li>\n<li><strong>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">Glomerulosclerosis</span> </strong>(Most common in adults)</li>\n<li><strong>Membranous <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">Glomerulosclerosis</span> </strong>(common in older populations)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>IgA <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> (rare)</li>\n<li>Amyloidosis</li>\n<li><strong>Diabetic <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> </strong>(Most common)</li>\n<li>Membranoproliferative Glomerulonephritis, like <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> nephritis</li>\n<li>HIV and COVID-19</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with complaints of bilateral swelling of the legs and has a history of nephrotic syndrome. Which of the following pathophysiological changes is primarily responsible for the fluid retention in his condition?", "options": [{"label": "A", "text": "Decreased production of aldosterone", "correct": false}, {"label": "B", "text": "Reduced permeability to proteins", "correct": false}, {"label": "C", "text": "Increased renal perfusion pressure", "correct": false}, {"label": "D", "text": "Glomerular sodium retention", "correct": true}], "correct_answer": "D. Glomerular sodium retention", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/p3GnVcCIObIGfLqC6FJ81744291536.png", "https://image.prepladder.com/notes/d12lNxxQJtU6D7lHLtqL1744291610.png", "https://image.prepladder.com/notes/PJfWaU9Srms5bVjya5Ds1744291716.png", "https://image.prepladder.com/notes/r6pVjVyObQQ1xUqheMpM1744291800.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Nephrotic Syndrome</strong></td>\n<td> </td>\n</tr>\n<tr>\n<td><strong>Clinical manifestations</strong></td>\n<td><strong>Pathophysiology</strong></td>\n</tr>\n<tr>\n<td><strong>Proteinuria</strong></td>\n<td>The damage to the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> barrier leads to <strong>increased <span class=\"customMeta\" data-dictid=\"1c7103a9b516927771955682b6aaa4\">permeability</span> to proteins</strong>. <strong>(Option B)</strong></td>\n</tr>\n<tr>\n<td><strong>Odema</strong></td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Odema\" data-author=\"NA\" data-hash=\"8549\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"229\" src=\"https://image.prepladder.com/notes/p3GnVcCIObIGfLqC6FJ81744291536.png\" width=\"600\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Hypoalbuminemia</strong></p>\n<br/>\n\t\t\t </td>\n<td>\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> loss of <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> being more than its <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by the liver.</li>\n<li><strong>Muehrcke's lines</strong> (linear white lines in the <span class=\"customMeta\" data-dictid=\"b343d5e0891692777193df04031c03\">nail bed</span> seen in hypoalbuminemia)\n\t\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Muehrckes lines\" data-author=\"Lyrl\" data-hash=\"8550\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Muehrcke%27s_nails\" data-tags=\"April2025\" height=\"338\" src=\"https://image.prepladder.com/notes/d12lNxxQJtU6D7lHLtqL1744291610.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Hyperlipidemia</strong></td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hyperlipidemia\" data-author=\"NA\" data-hash=\"8554\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"404\" src=\"https://image.prepladder.com/notes/PJfWaU9Srms5bVjya5Ds1744291716.png\" width=\"600\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Xanthoma</strong> and <strong>xanthelasma</strong> can be appreciated.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Xanthoma and xanthelasma\" data-author=\"Klaus D. Peter, Wiehl, Germany\" data-hash=\"8558\" data-license=\"CC BY 3.0 de\" data-source=\"https://en.wikipedia.org/wiki/Xanthelasma\" data-tags=\"April2025\" height=\"319\" src=\"https://image.prepladder.com/notes/r6pVjVyObQQ1xUqheMpM1744291800.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Hypercoagulability</strong></td>\n<td>\n<p>This can be due to factors like:</p>\n<ul>\n<li>Due to the loss of <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> proteins like Protein C/ Protein S/ <span class=\"customMeta\" data-dictid=\"fa202015a216927771814a0dc268ba\">Antithrombin</span> III</li>\n<li>Ferritin deficiency</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"14693f062c16927772024df5839c43\">factor V</span> Leiden mutation</li>\n<li>Increased production of <span class=\"customMeta\" data-dictid=\"ff2094828c1692777196941a65e6eb\">procoagulant</span> factors by the liver.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Infections</strong></td>\n<td>Loss of immunoglobulins in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> causes <strong>hypogammaglobulinemia</strong>, increasing <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> to infections.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman presents with signs of nephrotic syndrome and has a renal biopsy that confirms Focal Segmental Glomerulosclerosis (FSGS). She has no significant medical history and no history of drug use. Which of the following statements are true regarding this condition? Urine analysis shows nephrotic proteinuria and hematuria. Urine PCR is &amp;lt; 2 Podocyte foot process effacement is seen in electron microscopy Metolazone is contraindicated for refractory edema. More common in African-descent", "options": [{"label": "A", "text": "1,2,3", "correct": false}, {"label": "B", "text": "2,3,4", "correct": false}, {"label": "C", "text": "3,4,5", "correct": false}, {"label": "D", "text": "1,3,5", "correct": true}], "correct_answer": "D. 1,3,5", "question_images": [], "explanation_images": [], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> Glomerulosclerosis</strong></td>\n<td> </td>\n</tr>\n<tr>\n<td>\n<p><strong>Pathogenesis</strong></p>\n<p>(In primary condition)</p>\n<br/>\n\t\t\t </td>\n<td>\n<p>Podocyte injury ➜ Podocytopenia ➜ Synechiae formation between the <span class=\"customMeta\" data-dictid=\"187169ce3616927771888ae5db3ee0\">GBM</span> &amp; <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> epithelial cells ➜ Glomerulosclerosis.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Focal &lt;span class=\" custommeta\"=\"\" data-dictid=\"6c572343621692777198867cf8d853\"/>Segmental Glomerulosclerosis\" data-author=\"Nephron\" data-hash=\"8590\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Focal_segmental_glomerulosclerosis\" data-tags=\"April2025\" height=\"269\" src=\"https://image.prepladder.com/notes/laKdxZPX3RgO2Z8QVKmn1744293116.png\" width=\"400\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Clinical manifestation</strong></td>\n<td>\n<ul>\n<li><strong>Microscopic hematuria</strong></li>\n<li><strong>Nephrotic-range proteinuria</strong> (often significant) <strong>(Statement 1)</strong></li>\n<li><strong>Hypertension</strong></li>\n<li><strong>Edema</strong>, starting with <strong>periorbital swelling</strong></li>\n<li><strong>Declining eGFR</strong> over time</li>\n</ul>\n\t\t\tMore common in individuals of <strong>African-American <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> </strong><strong>(Statement 5)</strong></td>\n</tr>\n<tr>\n<td><strong>Investigations</strong></td>\n<td>\n<ul>\n<li><strong>Kidney function test: </strong>Reduced eGFR</li>\n<li><strong>Urine microscopy: </strong>Shows hematuria</li>\n<li><strong>Urine PCR:</strong> &gt;2 g/g proteinuria</li>\n<li><strong>Biopsy (USG-guided) Findings: (Diagnostic)</strong>\n<ul>\n<li><strong>Perihilar sclerosis</strong> with <strong>hyalinosis</strong></li>\n<li>Hyalinosis and <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">adherence</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> between <span class=\"customMeta\" data-dictid=\"121d2a043516927772012d5faa616f\">tuft</span> and Bowman’s capsule</li>\n<li><strong>Sclerosing tip </strong>forming <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">adherence</span> to <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> pole</li>\n</ul>\n</li>\n<li><strong>Electron microscopy:</strong></li>\n</ul>\n<strong>Podocyte <span class=\"customMeta\" data-dictid=\"ec47e26750169277720319eee489e6\">foot process</span> shows effacement</strong><strong> (Statement 3)</strong></td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>\n<ul>\n<li><strong>For Primary FSGS:</strong></li>\n</ul>\n<ul>\n<li>Proteinuria: <strong>Steroids &amp; Cyclosporin</strong> can help in <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> for people responding to steroids.</li>\n<li>HTN: <strong>ARB/ACEi</strong></li>\n<li>Edema: <strong>Thiazide diuretics</strong></li>\n<li> </li>\n<li>Refractory edema: <strong>Metolazone + Furosemide</strong> <strong>(Statement 4)</strong>\n<ul>\n<li><strong>Spironolactone</strong> can be initiated after the <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> subsides.</li>\n</ul>\n</li>\n<li><strong>Low salt diet</strong></li>\n<li><strong>For Secondary FSGS</strong>, management is based on the cause of the condition.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male visits the outpatient clinic with a 2-month history of worsening leg swelling and increased fatigue. He notes that his urine has been foamy for several weeks. On examination, he displays bilateral lower extremity edema and hypertension. A renal biopsy reveals focal segmental glomerulosclerosis (FSGS). Which of the following is not a cause of primary FSGS?", "options": [{"label": "A", "text": "Podocin mutation", "correct": false}, {"label": "B", "text": "APOL 1 mutation", "correct": false}, {"label": "C", "text": "TRPC6 gene mutation", "correct": false}, {"label": "D", "text": "HBB gene mutation", "correct": true}], "correct_answer": "D. HBB gene mutation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/HulLonKhomhLo7Dpdv3i1744293289.png", "https://image.prepladder.com/notes/FQ4B2Q74GGSQ975Dg88o1744293369.png", "https://image.prepladder.com/notes/NTu6FXx4nZxq0LYnpWeO1744293451.png", "https://image.prepladder.com/notes/D0dJwNjRRSl7jPubYV2N1744293515.png", "https://image.prepladder.com/notes/HjzRyNmK5UT7NsptEntl1745564485.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">Glomerulosclerosis</span> (FSGS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary FSGS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Secondary FSGS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mostly Idiopathic</li>\n<li>Can be due to mutations in\n\t\t\t\t<ul>\n<li><strong>APOL 1</strong>,</li>\n<li><strong>TRPC6</strong> (Autosomal dominant)</li>\n<li><strong>Podocin</strong> (autosomal recessive)</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sickle cell anemia</li>\n<li>HIV</li>\n<li>HBV</li>\n<li>Human <span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\">parvovirus</span> B19</li>\n<li>CMV</li>\n<li>EBV</li>\n<li>Reflux nephropathy</li>\n<li>Hypertensive nephrosclerosis</li>\n<li>Alport syndrome</li>\n<li>Drugs like\n\t\t\t\t<ul>\n<li>INF α</li>\n<li>Heroin</li>\n<li>Pamidronate</li>\n<li>Lithium</li>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly as <strong>Nephrotic syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mostly <strong>asymptomatic</strong> can present with <strong>nephrotic range proteinuria</strong> but not the syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunofluorescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of <strong>IgM + C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal to<strong> no change</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Morphological Variants of FSGS</strong></td>\n</tr>\n<tr>\n<td><strong>Classical variant</strong></td>\n<td>\n<ul>\n<li><strong>Most common</strong></li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> and <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> &amp; C3</li>\n<li><strong>Podocyte <span class=\"customMeta\" data-dictid=\"ec47e26750169277720319eee489e6\">foot process</span> effacement.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Tip variant</strong></td>\n<td>\n<ul>\n<li>Presence of at least one <strong>segmental <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> involving the tip. </strong></li>\n<li>Tip lesions can be <strong>cellular or sclerosing.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Tip variant\" data-author=\"Han, Man-Hoon &amp; Kim, Yong-Jin. \" data-hash=\"8591\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Tip-variant-of-FSGS-Foam-cell-accumulated-segment-prolapsed-into-the-tubular-pole-the_fig5_302634113\" data-tags=\"April2025\" height=\"225\" src=\"https://image.prepladder.com/notes/HulLonKhomhLo7Dpdv3i1744293289.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Perihilar variant</strong></td>\n<td>\n<ul>\n<li>Presence of <strong>at least one <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> </strong><strong>perihilar hyalinosis</strong></li>\n<li>Exclude the other types.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Perihilar variant\" data-author=\"Han, Man-Hoon &amp; Kim, Yong-Jin. \" data-hash=\"8593\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Perihilar-variant-of-FSGS-Sclerosis-is-observed-at-the-glomerular-vascular-pole-Hyaline_fig2_302634113\" data-tags=\"April2025\" height=\"226\" src=\"https://image.prepladder.com/notes/FQ4B2Q74GGSQ975Dg88o1744293369.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Cellular variant</strong></td>\n<td>\n<p>Occluding<strong> <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> endocapillary hypercellularity</strong> in at least 1 of the glomerulus.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Cellular variant\" data-author=\"Han, Man-Hoon &amp; Kim, Yong-Jin. \" data-hash=\"8595\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Cellular-variant-of-FSGS-Segment-is-expanded-by-endocapillary-foam-cells-Overlying_fig7_302634113\" data-tags=\"April2025\" height=\"225\" src=\"https://image.prepladder.com/notes/NTu6FXx4nZxq0LYnpWeO1744293451.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Collapsing variant</strong></td>\n<td>\n<ul>\n<li>Collapsed glomeruli.</li>\n<li><strong>Hyperplasia and <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> of podocytes </strong>(pseudo-crescent)</li>\n<li><strong>Microcysts</strong> within dilated tubules</li>\n<li>Electron microscopy: <strong>Interferon footprints</strong></li>\n<li>This has the <strong>worst prognosis</strong> and is <strong>commonly seen with </strong><strong>HIV</strong>, pamidronate, and <span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\">parvovirus</span> infection.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Collapsing variant\" data-author=\"Ramidi, Ganga &amp; Kurukumbi, Mohankumar &amp; Sealy, Peter.\" data-hash=\"8597\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Collapsing-variant-of-focal-segmental-glomerulosclerosis-FSGS-The-collapsing-form-of_fig2_49852598\" data-tags=\"April2025\" height=\"268\" src=\"https://image.prepladder.com/notes/D0dJwNjRRSl7jPubYV2N1744293515.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><img alt=\"Morphological Variants of FSGS\" data-author=\"\" data-hash=\"11258\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/HjzRyNmK5UT7NsptEntl1745564485.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man presents with worsening leg and abdominal swelling, frothy urine, and weight gain over two months. Examination shows significant edema and HTN. Lab tests indicate nephrotic range proteinuria and a renal biopsy reveals thickened glomerular capillary walls with subepithelial immune complex deposition. Which antibodies are most commonly associated with the primary form of this condition?", "options": [{"label": "A", "text": "Anti-CCP antibodies", "correct": false}, {"label": "B", "text": "Anti-Smith antibodies", "correct": false}, {"label": "C", "text": "Anti-HBc IgM antibodies", "correct": false}, {"label": "D", "text": "PLA2R antibodies", "correct": true}], "correct_answer": "D. PLA2R antibodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glomerulonephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>PLA2R antibodies</strong> (seen in 70%)</li>\n<li><strong>Anti - <span class=\"customMeta\" data-dictid=\"51032567aa1692777200d4ff73de22\">thrombospondin</span> 7a</strong> ( 3 - 10 %)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Infections</strong>: Syphilis, malaria, schistosomiasis, leprosy, filariasis, <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B and C .\n\t\t\t\t<ul>\n<li><strong>Anti-HBc <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> antibodies </strong><strong>(Option C)</strong> are indicative of recent <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B infection, specifically <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> the <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B core antigen.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Autoimmune conditions:</strong></li>\n</ul>\n<ul>\n<li>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> <strong>(Anti-CCP antibodies)</strong> <strong>(Option A)</strong></li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> cirrhosis</li>\n<li>Myasthenia gravis</li>\n<li>Hashimoto's thyroiditis</li>\n<li>SLE <strong>(Anti-Smith antibodies) </strong><strong>(Option B)</strong></li>\n</ul>\n<ul>\n<li><strong>Cancer</strong>: Lymphoma, leukemia, and other organ carcinomas (GI, prostate, breast, lung, bladder)</li>\n<li><strong>Drugs</strong>: Gold, mercury, d-penicillamine, NSAIDs, probenecid, captopril.</li>\n<li><strong>Other <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> conditions</strong>: Fanconi’s syndrome, Guillain-Barré Syndrome (GBS), sickle cell anemia, diabetes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male with a recent diagnosis of nephrotic syndrome is being evaluated for membranous nephropathy. Which of the following statements regarding membranous nephropathy is not true?", "options": [{"label": "A", "text": "Light microscopy reveals subepithelial immune complex deposits", "correct": true}, {"label": "B", "text": "Autoantibodies against PLA2R", "correct": false}, {"label": "C", "text": "Granular deposits are seen in Immunofluorescence", "correct": false}, {"label": "D", "text": "Increased risk of renal vein thrombosis", "correct": false}], "correct_answer": "A. Light microscopy reveals subepithelial immune complex deposits", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn is diagnosed with congenital nephrotic syndrome presenting with significant edema, low serum albumin, and a history of repeated infections. Which of the following is a common genetic mutation associated with this condition?", "options": [{"label": "A", "text": "WT1 gene", "correct": false}, {"label": "B", "text": "NPHS1 gene", "correct": true}, {"label": "C", "text": "NPHS2 gene", "correct": false}, {"label": "D", "text": "α-3 Integrin", "correct": false}], "correct_answer": "B. NPHS1 gene", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old boy presents with periorbital oedema and leg swelling that began a week ago. Laboratory tests reveal 4+ proteinuria and low serum albumin. Blood urea nitrogen (BUN) and creatinine levels are normal. Light microscopy of a renal biopsy reveals no glomerular lesions. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Focal Segmental Glomerulosclerosis", "correct": false}, {"label": "B", "text": "Lipoid nephrosis", "correct": true}, {"label": "C", "text": "Membranous Nephropathy", "correct": false}, {"label": "D", "text": "Diabetic Nephropathy", "correct": false}], "correct_answer": "B. Lipoid nephrosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/vjXYxJ6wjWkCS1vy1qLd1744293929.png", "https://image.prepladder.com/notes/XUPwCOiEuD4er3aUGzJ51744293983.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy with nephrotic syndrome has experienced multiple relapses over the past year. He responds well to treatment with prednisolone, but his symptoms recur shortly after tapering the medication. According to the clinical definition, what qualifies a patient as having frequent relapses of nephrotic syndrome?", "options": [{"label": "A", "text": "Two relapses within a year", "correct": false}, {"label": "B", "text": "Three or more relapses in any 12 months", "correct": true}, {"label": "C", "text": "Three or more relapses within a year after stopping treatment", "correct": false}, {"label": "D", "text": "Two relapses on a spacing of 6 months", "correct": false}], "correct_answer": "B. Three or more relapses in any 12 months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steroid-Responsive <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steroid-Resistant <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome that responds well to <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> treatment.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome that does not improve despite adequate <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> treatment (e.g., <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> at 2 mg/kg/day for 6 weeks).</p>\n<p><strong>Types:</strong></p>\n<ul>\n<li><strong>Initial <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Resistance:</strong> Lack of response from the onset.</li>\n<li><strong>Late <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Resistance:</strong> Resistance develops after initial response.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal Change <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome (MCNS) accounts for about 80% of cases in children.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is often associated with <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">Glomerulosclerosis</span> (FSGS) or genetic mutations affecting podocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosed without <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> biopsy; characterised by heavy proteinuria, low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> albumin, and no significant <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> damage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Further investigation (e.g., <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> biopsy) is required to determine the underlying cause.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Responds to high-dose corticosteroids (e.g., prednisolone), leading to <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> of <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> and oedema within 10-14 days.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment may include <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> agents, <span class=\"customMeta\" data-dictid=\"746f157681169277718323a004b1d4\">calcineurin</span> inhibitors, or other therapies, as corticosteroids are often ineffective.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old girl presents to the emergency department with complaints of dark, \"cola-colored\" urine, swelling of her legs, and a headache. Her blood pressure is 150/90 mmHg, and urinalysis reveals hematuria, red blood cell casts, and mild proteinuria. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Minimal Change Disease", "correct": false}, {"label": "B", "text": "Focal Segmental Glomerulosclerosis", "correct": false}, {"label": "C", "text": "Acute Post-Streptococcal Glomerulonephritis", "correct": true}, {"label": "D", "text": "Membranous Nephropathy", "correct": false}], "correct_answer": "C. Acute Post-Streptococcal Glomerulonephritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/fzopT9qIFtxyntsIvrD41744294359.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nephritic Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nephrotic Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glomerular <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> leading to <span class=\"customMeta\" data-dictid=\"187169ce3616927771888ae5db3ee0\">GBM</span> damage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Podocyte damage resulting in impaired charge barrier.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hematuria (dysmorphic RBCs)</li>\n<li>RBC casts</li>\n<li>Oliguria</li>\n<li>Hypertension</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Massive proteinuria</li>\n<li>Edema</li>\n<li>Hypoalbuminemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hematuria</li>\n<li>RBC casts</li>\n<li>Mild proteinuria</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Frothy <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> with <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> casts</li>\n<li>Massive proteinuria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proteinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subnephrotic range (&lt; 3.5 g/day)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Massive (&gt; 3.5 g/day) proteinuria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild or absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe edema, especially in the <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> region, legs, and abdomen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often elevated (d/t <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> release)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May or may not be elevated</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy is brought to the pediatric clinic by his mother, who reports he has felt unwell for the past week. He had a sore throat, cough, and fever 10 days ago and now has swelling around his eyes and legs. His urine sample looks dark (shown below). What parameters are commonly seen in this condition?", "options": [{"label": "A", "text": "Decreased serum creatinine levels", "correct": false}, {"label": "B", "text": "Decreased C4 levels", "correct": false}, {"label": "C", "text": "Decreased potassium levels", "correct": false}, {"label": "D", "text": "Decreased C3 levels", "correct": true}], "correct_answer": "D. Decreased C3 levels", "question_images": ["https://image.prepladder.com/notes/KpgHWDw0oFgtvsm4Hojz1744294482.png"], "explanation_images": ["https://image.prepladder.com/content/qeSOgOk7VdKr1GXS50Wl1739955729.png", "https://image.prepladder.com/notes/tLHVCiVHqWO9uWxgBZQ31744294793.png", "https://image.prepladder.com/notes/zdW5uPRKQSYoFRcQhi4C1744294861.png", "https://image.prepladder.com/notes/4yJXJ86uaKFAbVFCKpHB1745564610.png", "https://image.prepladder.com/notes/pvBzsHgCWeRHaCMt4b7G1744295006.png", "https://image.prepladder.com/notes/GELHqkQoeyAff8MueNwe1744295105.png", "https://image.prepladder.com/notes/HAYxg80pvuLx4yhLJMM21744295183.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Post-streptococcal <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> (PSGN)</strong></td>\n</tr>\n<tr>\n<td><strong>Cause</strong></td>\n<td><strong>Group A β-Hemolytic streptococci</strong></td>\n</tr>\n<tr>\n<td><strong>Pathogenesis</strong></td>\n<td>\n<p>Immune-complex mediated (<strong>Type III </strong>hypersensitivity reaction)</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"77\" src=\"https://image.prepladder.com/content/qeSOgOk7VdKr1GXS50Wl1739955729.png\" width=\"555\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Clinical manifestations</strong></td>\n<td>\n<ul>\n<li>It is more common in children and young adults.</li>\n<li>History of<strong> <span class=\"customMeta\" data-dictid=\"7e23404d13169277718994a4692d6d\">impetigo</span> (2-6 weeks) </strong>or <strong>pharyngitis (1-3 weeks</strong>).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Impetigo\" data-author=\"James Heilman, MD \" data-hash=\"8622\" data-license=\"CC-BY-SA-4.0\" data-source=\"https://en.wikipedia.org/wiki/Impetigo\" data-tags=\"April2025\" height=\"257\" src=\"https://image.prepladder.com/notes/tLHVCiVHqWO9uWxgBZQ31744294793.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Pulmonary oedema (shortness of breath, cough, chest pain)</li>\n<li>Periorbital and <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> oedema</li>\n<li>Hypertensive encephalopathy:\n\t\t\t\t<ul>\n<li>Abrupt rise in BP</li>\n<li>Headache</li>\n<li>Loss of consciousness</li>\n</ul>\n</li>\n<li>Features of <span class=\"customMeta\" data-dictid=\"42294b4a0b16927772016b8a93bba0\">uremia</span> include fatigue, weakness, confusion, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> over body parts, shortness of breath, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, nausea, and vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Test for antibodies</strong></td>\n<td>\n<ul>\n<li>Anti- DNAse</li>\n<li>Anti-Hyaluronidase</li>\n<li>ASO (antistreptolysin O) titer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Lab findings</strong></td>\n<td>\n<p><strong>Urine analysis: </strong>Red-colored urine, which turns dark (cola-colored) on standing (hematuria).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hematuria\" data-author=\"James Heilman, MD \" data-hash=\"8623\" data-license=\"CC-BY-SA-4.0\" data-source=\"https://en.wikipedia.org/wiki/Hematuria\" data-tags=\"April2025\" height=\"456\" src=\"https://image.prepladder.com/notes/zdW5uPRKQSYoFRcQhi4C1744294861.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Raised values of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function test (serum creatinine, urea, </strong>etc). <strong>(Option A) </strong></li>\n<li><strong>Raised <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> potassium</strong> <strong> (Option C)</strong></li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels of C3, <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> &amp; CH50</strong> <strong>(Option D)</strong></li>\n</ul>\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> C4 level.</strong> <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Pathological findings</strong></td>\n<td>\n<p><strong>Gross findings: </strong>Flea-bitten appearance of kidneys</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\" Flea-bitten appearance of kidneys\" data-author=\"Nzegwu, Martin\" data-hash=\"11259\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Flea-bitten-finely-granular-kidneys-of-malignant-hypertension_fig2_282505373\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/4yJXJ86uaKFAbVFCKpHB1745564610.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Light microscopy: </strong><strong>Hypercellular glomeruli</strong> (increased number of neutrophils, macrophages, endothelial and mesangial cells).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hypercellular glomeruli\" data-author=\"Nephron\" data-hash=\"8628\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.m.wikipedia.org/wiki/File:Post-infectious_glomerulonephritis_-_very_high_mag.jpg\" data-tags=\"April2025\" height=\"349\" src=\"https://image.prepladder.com/notes/pvBzsHgCWeRHaCMt4b7G1744295006.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Electron microscopy: </strong><strong>Subepithelial humps </strong>(due to immune complex deposition)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Subepithelial humps\" data-author=\"Kari, Jameela &amp; Bamaga, Ahmed &amp; Jalalah, Sawsan.\" data-hash=\"8630\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Transmission-electron-micrograph-showing-numerous-large-hump-like-dense-deposits-located_fig2_236614663\" data-tags=\"April2025\" height=\"270\" src=\"https://image.prepladder.com/notes/GELHqkQoeyAff8MueNwe1744295105.png\" width=\"250\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Immunofluorescence study: </strong>A <strong>starry-sky appearance </strong><strong>(Granular)</strong> is observed (due to immune complex deposition).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Starry sky appearance\" data-author=\"Kakajiwala, Aadil &amp; Bhatti, Tricia &amp; Kaplan, Bernard &amp; Ruebner, Rebecca &amp; Copelovitch, Lawrence.\" data-hash=\"8633\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/A-The-starry-sky-IF-pattern-shows-distinct-granular-staining-of-mesangial-areas-and_fig2_303363829\" data-tags=\"April2025\" height=\"219\" src=\"https://image.prepladder.com/notes/HAYxg80pvuLx4yhLJMM21744295183.png\" width=\"250\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Management </strong></td>\n<td>\n<ul>\n<li>Self-limiting disorder</li>\n<li>Conservative and supportive management involves:\n\t\t\t\t<ul>\n<li><strong>HTN crisis</strong>: <span class=\"customMeta\" data-dictid=\"5729c1fa1a16927771912963eea9a2\">Labetalol</span> (IV), sodium nitroprusside</li>\n<li><strong>Pulmonary edema: </strong>Furosemide</li>\n<li>Antibiotics (Benzathine penicillin)</li>\n<li>Dialysis if needed</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old boy is brought to the pediatric clinic by his mother, who reports episodes of blood in his urine starting two days after a common cold, along with occasional abdominal pain. The child is vitally stable. Investigations show hematuria with normal kidney function tests and C3 levels. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Minimal change disease", "correct": false}, {"label": "B", "text": "Berger’s disease", "correct": true}, {"label": "C", "text": "Alport syndrome", "correct": false}, {"label": "D", "text": "Henoch-Schonlein Purpura", "correct": false}], "correct_answer": "B. Berger’s disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/EPBSu8YXQl2tIPFKWl4n1744295444.png", "https://image.prepladder.com/notes/2c9Qz0BeTdP6NtcJ50t81744295525.png", "https://image.prepladder.com/notes/uE1THL44gEn2urJvXVwN1744295729.png", "https://image.prepladder.com/notes/mtkcPdFF2zi4INDEPGTe1744295801.png", "https://image.prepladder.com/notes/vbWjAFO0P8MfprasBvw81744295926.png", "https://image.prepladder.com/notes/6eXqnn8gBPP0Tbz9oUqG1744296156.png", "https://image.prepladder.com/notes/B5A3IqMdFsp9F5xTxkwX1744296390.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Berger's disease (IgA nephropathy)</strong></td>\n<td> </td>\n</tr>\n<tr>\n<td><strong>Pathophysiology</strong></td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bergers disease\" data-author=\"NA\" data-hash=\"8635\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"109\" src=\"https://image.prepladder.com/notes/EPBSu8YXQl2tIPFKWl4n1744295444.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Clinical features</strong></td>\n<td>\n<ul>\n<li>Incidental finding</li>\n<li>Macroscopic <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> (recurrent) following an upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infection (URTI)</li>\n<li>Asymptomatic <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> (persistent)</li>\n</ul>\n<ul>\n<li>If this patient develops an upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection (URTI), <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> can progress to <span class=\"customMeta\" data-dictid=\"f446058fd81692777191e035c08229\">macroscopic</span> (gross) <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> within 48 hours.</li>\n</ul>\n<ul>\n<li>Normal blood pressure</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Lab findings </strong></td>\n<td>\n<ul>\n<li>Normal values of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function test (serum creatinine, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> urea, etc.)</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> C3 level</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Pathological findings</strong></td>\n<td>\n<p><strong>Light microscopy: </strong>Mesangial proliferation.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Mesangial proliferation\" data-author=\"Daher, Elizabeth.\" data-hash=\"8636\" data-license=\" CC BY-NC\" data-source=\"https://www.researchgate.net/figure/Mesangial-cell-proliferation-PAS-400-x_fig1_329060257\" data-tags=\"April2025\" height=\"187\" src=\"https://image.prepladder.com/notes/2c9Qz0BeTdP6NtcJ50t81744295525.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Immunofluorescent microscopy:</strong> Mesangial deposition of IgA.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Mesangial deposition of IgA\" data-author=\"Tinawi, Mohammad.\" data-hash=\"8638\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Mesangial-immunoglobulin-A-IgA-deposits-on-immunofluorescence-microscopy-IF_fig1_340348574\" data-tags=\"April2025\" height=\"318\" src=\"https://image.prepladder.com/notes/uE1THL44gEn2urJvXVwN1744295729.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Management</strong></td>\n<td>\n<ul>\n<li>There is no <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> treatment, but the following drugs are used:\n\t\t\t\t<ul>\n<li>ACE-i (angiotensin-converting <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> inhibitors) like <span class=\"customMeta\" data-dictid=\"59583af20116927771833fb6c4c880\">captopril</span> and enalapril.</li>\n<li>Steroids (when the patient has recovered from URTI)</li>\n<li>Fish oil and <span class=\"customMeta\" data-dictid=\"68899ab3a11692777200d8823b50d8\">tonsillectomy</span> are suggested in studies.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents to the emergency department with severe fatigue, leg swelling, and decreased urine output following an upper respiratory infection two weeks ago. Urinalysis shows hematuria and proteinuria. The histopathological findings of renal biopsy are shown below. All of the following are associated with Type II of this condition, except,", "options": [{"label": "A", "text": "Henoch-Schönlein Purpura", "correct": false}, {"label": "B", "text": "Systemic lupus erythematosus", "correct": false}, {"label": "C", "text": "Wegener granulomatosis", "correct": true}, {"label": "D", "text": "Berger’s disease", "correct": false}], "correct_answer": "C. Wegener granulomatosis", "question_images": ["https://image.prepladder.com/notes/gN8KVdonZXVSTuoKwi5y1744296608.png"], "explanation_images": ["https://image.prepladder.com/notes/gN8KVdonZXVSTuoKwi5y1744296608.png", "https://image.prepladder.com/notes/C3Qs2XO16hWnUNl6BGIn1744376337.png", "https://image.prepladder.com/notes/Oxts4UXYpVCNKOyDzwEO1744296828.png", "https://image.prepladder.com/notes/pRSDZXiJcApx275UenJ51744296920.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:725px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I RPGN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II RPGN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III RPGN</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-GBM antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immune (antigen-antibody) Complex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pauci-immune</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goodpasture syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic</li>\n<li><strong>Post-streptococcal <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> (PSGN)</strong></li>\n<li>Lupus nephritis</li>\n<li>Henoch-Schönlein purpura</li>\n<li>IgA nephropathy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ANCA-associated</li>\n<li>Idiopathic</li>\n<li>Granulomatosis with <span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\">polyangiitis</span> (formerly Wegener granulomatosis)</li>\n<li>Microscopic polyangiitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Immunofluorescent microscopy</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Linear or ribbon-shaped appearance</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ribbon shaped appearance\" data-author=\"Ahmed, Mohanad &amp; Abdulhadi, Ahmed &amp; Eltazi, Isra &amp; Mohamed, Sabah &amp; Alhussein, Hussein &amp; Sibira, Rayan\" data-hash=\"8652\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Strong-linear-ribbon-like-appearance-IgG-2-in-the-GBM-the-glomerulus-is-compressed-by_fig4_363519778\" data-tags=\"April2025\" height=\"189\" src=\"https://image.prepladder.com/notes/Oxts4UXYpVCNKOyDzwEO1744296828.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It shows a<strong> starry sky (lumpy, bumpy, or granular) appearance or garland pattern.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Starry sky appearance\" data-author=\"Kakajiwala, Aadil &amp; Bhatti, Tricia &amp; Kaplan, Bernard &amp; Ruebner, Rebecca &amp; Copelovitch, Lawrence.\" data-hash=\"8655\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/A-The-starry-sky-IF-pattern-shows-distinct-granular-staining-of-mesangial-areas-and_fig2_303363829\" data-tags=\"April2025\" height=\"172\" src=\"https://image.prepladder.com/notes/pRSDZXiJcApx275UenJ51744296920.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-<br/>\n\t\t\t </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents to the emergency department with severe fatigue, hemoptysis, and shortness of breath over the past few days. He also reports recent leg swelling and decreased urine output. Investigations show hematuria and proteinuria, along with positive anti-GBM antibodies. Which chain of type IV collagen is defective in this condition?", "options": [{"label": "A", "text": "Alpha-3 chain", "correct": true}, {"label": "B", "text": "Alpha-4 chain", "correct": false}, {"label": "C", "text": "Alpha-5 chain", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "A. Alpha-3 chain", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Z46eaKbajcfAx4We6QpP1744297043.png", "https://image.prepladder.com/notes/h2IUhFfF2KnXxgxplDhE1744298755.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following diseases with their microscopic images: 1. Minimal change disease a. 2. Membranous nephropathy b. 3. Focal segmental glomerulosclerosis c. 4. Post-streptococcal glomerulonephritis d.", "options": [{"label": "A", "text": "1-d, 2-c, 3-a, 4-b", "correct": true}, {"label": "B", "text": "1-b, 2-a, 3-d, 4-c", "correct": false}, {"label": "C", "text": "1-c, 2-d, 3-b, 4-a", "correct": false}, {"label": "D", "text": "1-d, 2-a, 3-b, 4-c", "correct": false}], "correct_answer": "A. 1-d, 2-c, 3-a, 4-b", "question_images": ["https://image.prepladder.com/notes/S3xrHQ3MoxY2Sd4Nl6P31744300237.png", "https://image.prepladder.com/notes/63mKKLSUEuWZDn2Ch75z1744300145.png", "https://image.prepladder.com/notes/ADYWK9DQn0gBQnnCqR101744299729.png", "https://image.prepladder.com/notes/mtkcPdFF2zi4INDEPGTe1744295801.png"], "explanation_images": ["https://image.prepladder.com/notes/5PaEji8d3IVfc4kjmYEC1744300360.png", "https://image.prepladder.com/notes/mtkcPdFF2zi4INDEPGTe1744295801.png", "https://image.prepladder.com/notes/3g8Gvu3JgMPgASZwjIHs1744301435.png", "https://image.prepladder.com/notes/ADYWK9DQn0gBQnnCqR101744299729.png", "https://image.prepladder.com/notes/63mKKLSUEuWZDn2Ch75z1744300145.png", "https://image.prepladder.com/notes/c2XEjt6Kk1M535kfg0Xd1744300654.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td style=\"text-align:center\"><strong>Light microscopy</strong></td>\n<td style=\"text-align:center\"><strong>Fluorescence microscopy</strong></td>\n<td style=\"text-align:center\"><strong>Electron microscopy</strong></td>\n</tr>\n<tr>\n<td><strong>Minimal change disease (MCD)</strong></td>\n<td>\n<p>Normal structure with <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> deposits</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Minimal change disease\" data-author=\" Luis F. Arias, MD., PhD.,\" data-hash=\"8639\" data-license=\"NA\" data-source=\"https://www.kidneypathology.com/English_version/Minimal_change_disease.html\" data-tags=\"April2025\" height=\"222\" src=\"https://image.prepladder.com/notes/mtkcPdFF2zi4INDEPGTe1744295801.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td> </td>\n<td>\n<p>Podocyte effacement</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Minimal change disease Electron microscopy\" data-author=\"Husain, Sufia. \" data-hash=\"8743\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Minimal-change-disease-A-Light-microscopic-and-electron-microscopic-photomicrograph-of_fig3_382224660\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/3g8Gvu3JgMPgASZwjIHs1744301435.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Membranous <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> (MN)</strong></td>\n<td>\n<p>Diffuse <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> wall thickening.</p>\n<figure class=\"caption_element\"><img alt=\"Membranous nephropathy\" data-author=\"Nephron\" data-hash=\"8702\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Membranous_nephropathy_-_pas_-_very_high_mag.jpg\" data-tags=\"April2025\" height=\"222\" src=\"https://image.prepladder.com/notes/ADYWK9DQn0gBQnnCqR101744299729.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td>\n<p>Granular deposits of <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> and C3 along the GBM.</p>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Membranous &lt;span class=\" custommeta\"=\"\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\"/>nephropathy Fluorescence microscopy\" data-author=\"Roy, Guillaume &amp; Iordachescu, Ilinca &amp; Royal, Virginie &amp; Lamarche, Caroline &amp; Ahmad, Imran &amp; Nadeau-Fredette, Annie-Claire &amp; Laurin, Louis-Philippe.\" data-hash=\"8736\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Kidney-biopsy-findings-in-patient-8-with-membranous-nephropathy-A-On-light-microscopy_fig4_370853539\" data-tags=\"April2025\" height=\"198\" src=\"https://image.prepladder.com/notes/7uGtxTbs80xbXK3VTrlo1744301096.png\" width=\"200\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td>\n<p>Subepithelial deposits (Spike and <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> pattern)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Membranous &lt;span class=\" custommeta\"=\"\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\"/>nephropathy Electron microscopy\" data-author=\"Majoni, Sandawana &amp; Smith, Steven.\" data-hash=\"8744\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Stage-3-membranous-glomerulonephritis-with-medium-sized-subepithelial-dense-deposits-and_fig1_23316223\" data-tags=\"April2025\" height=\"202\" src=\"https://image.prepladder.com/notes/f1ZPlL0877YXT4ab2mqY1744301508.png\" width=\"260\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td><strong>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">glomerulosclerosis</span> (FSGS)</strong></td>\n<td>\n<p>Focal and <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> and <span class=\"customMeta\" data-dictid=\"3d16cd5c7a1692777189328d5cb04f\">hyalinosis</span> (segmental deposition of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> proteins along the <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> wall)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Focal &lt;span class=\" custommeta\"=\"\" data-dictid=\"6c572343621692777198867cf8d853\"/>segmental glomerulosclerosis\" data-author=\"Nephron\" data-hash=\"8718\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Focal_segmental_glomerulosclerosis\" data-tags=\"April2025\" height=\"202\" src=\"https://image.prepladder.com/notes/S3xrHQ3MoxY2Sd4Nl6P31744300237.png\" width=\"300\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td>\n<p>IgM and C3 in the <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> areas or mesangium.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Focal &lt;span class=\" custommeta\"=\"\" data-dictid=\"6c572343621692777198867cf8d853\"/>Segmental Glomerulosclerosis\" data-author=\"\" Cutrim ÉMM, Neves PDMM, Campos MAG, Wanderley DC, Teixeira-Júnior AAL, Muniz MPR - Cutrim ÉMM, Neves PDMM, Campos MAG, Wanderley DC, Teixeira-Júnior AAL, Muniz MPR\"\" data-hash=\"8739\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Focal_segmental_glomerulosclerosis\" data-tags=\"April2025\" height=\"152\" src=\"https://image.prepladder.com/notes/qbe7vuSWiGGE5J3bzAe61744301186.png\" width=\"200\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td>\n<p>Effacement of foot processes and epithelial <span class=\"customMeta\" data-dictid=\"c041cdff70169277718572d92a23df\">denudation</span> (due to <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> cell detachment)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Focal &lt;span class=\" custommeta\"=\"\" data-dictid=\"6c572343621692777198867cf8d853\"/>segmental glomerulosclerosis- Electron microscopy\" data-author=\"Tariq, Hassan &amp; Rafiq, Arsalan &amp; Franchin, Giovanni.\" data-hash=\"8749\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Ultrastructural-findings-of-focal-segmental-glomerulosclerosis-showing-podocyte-foot_fig4_265255031\" data-tags=\"April2025\" height=\"160\" src=\"https://image.prepladder.com/notes/3inSWvydMArLK7rBIwpr1744301608.png\" width=\"260\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Post-streptococcal <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> (PSGN)</strong></td>\n<td>\n<p>Hypercellular glomerulus,</p>\n<p>Polymorphonuclear cells infiltration</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Post streptococcal glomerulonephritis\" data-author=\"Nephron\" data-hash=\"8714\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Acute_proliferative_glomerulonephritis\" data-tags=\"April2025\" height=\"201\" src=\"https://image.prepladder.com/notes/63mKKLSUEuWZDn2Ch75z1744300145.png\" width=\"300\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n<br/>\n\t\t\t </td>\n<td>\n<p>Starry Sky appearance</p>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Post streptococcal &lt;span class=\" custommeta\"=\"\" data-dictid=\"d3658e1af116927771887bc5b8a57e\"/>glomerulonephritis Fluorescence microscopy\" data-author=\"Kakajiwala, Aadil &amp; Bhatti, Tricia &amp; Kaplan, Bernard &amp; Ruebner, Rebecca &amp; Copelovitch, Lawrence.\" data-hash=\"8740\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/A-Light-microscopy-hematoxylin-and-eosin-400-original-magnification-B_fig2_284879931\" data-tags=\"April2025\" height=\"150\" src=\"https://image.prepladder.com/notes/NyL0eQfz79ECFIqgYUDr1744301262.png\" width=\"200\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td>\n<p>Subepithelial humps: <span class=\"customMeta\" data-dictid=\"94aff4fd141692777199a78b5ed2eb\">Subepithelial</span> deposits ( IgG/ IgM) appear as humps</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Post streptococcal &lt;span class=\" custommeta\"=\"\" data-dictid=\"d3658e1af116927771887bc5b8a57e\"/>glomerulonephritis Electron microscopy\" data-author=\"Kari, Jameela &amp; Bamaga, Ahmed &amp; Jalalah, Sawsan.\" data-hash=\"8752\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Transmission-electron-micrograph-showing-numerous-large-hump-like-dense-deposits-located_fig2_236614663\" data-tags=\"April2025\" height=\"218\" src=\"https://image.prepladder.com/notes/7OclmihRk42DWnSBsPL81744301684.png\" width=\"200\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td><strong>Membranoproliferative <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> (MPGN)</strong></td>\n<td>\n<p>Mesangial ingrowth</p>\n<p>GBM splitting</p>\n<p>Tram-track Appearance</p>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Membranoproliferative glomerulonephritis\" data-author=\"Nephron\" data-hash=\"8727\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Membranoproliferative_glomerulonephritis\" data-tags=\"April2025\" height=\"392\" src=\"https://image.prepladder.com/notes/c2XEjt6Kk1M535kfg0Xd1744300654.png\" width=\"300\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n<td>\n<p>Granular</p>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Membranoproliferative &lt;span class=\" custommeta\"=\"\" data-dictid=\"d3658e1af116927771887bc5b8a57e\"/>glomerulonephritis Fluorescence microscopy\" data-author=\"Islam, SheikhMohammad &amp; Akhter, Selina &amp; Hossain, MohammadSowkat.\" data-hash=\"8741\" data-license=\"CC BY NC SA\" data-source=\"https://www.researchgate.net/figure/Mesangial-immunoglobulin-A-deposits-in-case-5-680-512-pixel_fig1_335427051\" data-tags=\"April2025\" height=\"177\" src=\"https://image.prepladder.com/notes/ba2rNc0f9EB9ib5vCZR31744301331.png\" width=\"250\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td>\n<p><strong>Type I</strong> - <span class=\"customMeta\" data-dictid=\"debc628674169277719936b6424a58\">Subendothelial</span> <span class=\"customMeta\" data-dictid=\"e02c7dfea516927771894c64e8013a\">IC</span> deposits</p>\n<strong>Type II</strong> - <span class=\"customMeta\" data-dictid=\"9ab9c0fe2f169277719065b8b974d7\">Intramembranous</span> deposits, also called dense deposit disease</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 51 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "In the given acid-base nomogram diagram, areas marked A and D indicated which of the following conditions?", "options": [{"label": "A", "text": "Chronic respiratory acidosis, acute metabolic alkalosis", "correct": false}, {"label": "B", "text": "Acute metabolic alkalosis, acute respiratory acidosis", "correct": false}, {"label": "C", "text": "Acute respiratory acidosis, acute respiratory alkalosis", "correct": true}, {"label": "D", "text": "Acute respiratory acidosis, acute metabolic alkalosis", "correct": false}], "correct_answer": "C. Acute respiratory acidosis, acute respiratory alkalosis", "question_images": ["https://image.prepladder.com/notes/CFeRnxIkOmu2wnCLQmc81746526901.png"], "explanation_images": ["https://image.prepladder.com/notes/FK1y1gArcFQAhrogb2f71746526924.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prediction of Compensation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Range of Values (pH, HCO₃⁻, PaCO₂)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PaCO₂</strong> = (1.5 × HCO₃⁻) + 8 ± 2 /</p>\n<p><strong>PaCO₂</strong> ↓ 1.25 mmHg per mmol/L ↓ in HCO₃⁻ /</p>\n<p><strong>PaCO₂</strong> = HCO₃⁻ + 15</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low, Low, Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PaCO₂</strong> ↑ 0.75 mmHg per mmol/L ↑ in HCO₃⁻</p>\n<p><strong>PaCO₂</strong> ↑ 6 mmHg per 10 mmol/L ↑ in HCO₃⁻</p>\n<p><strong>PaCO₂</strong> = HCO₃⁻ + 15</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High, High, High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute:</strong> HCO₃⁻ ↓ 0.2 mmol/L per mmHg ↓ in PaCO₂ <strong>Chronic:</strong> HCO₃⁻ ↓ 0.4 mmol/L per mmHg ↓ in PaCO₂</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High, Low, Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute:</strong> HCO₃⁻ ↑ 0.1 mmol/L per mmHg ↑ in PaCO₂</p>\n<p><strong>Chronic:</strong> HCO₃⁻ ↑ 0.4 mmol/L per mmHg ↑ in PaCO₂</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low, High, High</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the urinary crystal shown below:", "options": [{"label": "A", "text": "Calcium oxalate", "correct": true}, {"label": "B", "text": "Calcium phosphate", "correct": false}, {"label": "C", "text": "Uric acid", "correct": false}, {"label": "D", "text": "Cysteine", "correct": false}], "correct_answer": "A. Calcium oxalate", "question_images": ["https://image.prepladder.com/notes/ZvEfQW0vnPhRQJwMnKpx1745342842.png"], "explanation_images": ["https://image.prepladder.com/notes/ZvEfQW0vnPhRQJwMnKpx1745342842.png", "https://image.prepladder.com/notes/LkWKjzaJxiM87EUhunxx1745343730.png", "https://image.prepladder.com/notes/La1RWfi7AQ07LsWW58XX1745343827.png", "https://image.prepladder.com/notes/Or4JuCopbWMYvLF15QWA1745343880.png", "https://image.prepladder.com/notes/iXmvISExp2KRZRCqFrat1745343913.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:93px\">\n<p style=\"text-align:center\"><strong>Stone type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:127px\">\n<p style=\"text-align:center\"><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray, CT Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine crystal shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:93px\">\n<p><strong>Calcium oxalate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Calcium oxalate\" data-author=\"Nair, Sreeja &amp; George, Jacob &amp; Kumar, Sajeev &amp; Gracious, Noble. (2014). Acute Oxalate Nephropathy following Ingestion of Averrhoa bilimbi Juice. Case reports in nephrology. 2014. 240936. 10.1155/2014/240936. \" data-hash=\"11060\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Calcium-oxalate-crystals-in-urine-in-high-power-view_fig4_263743484\" data-tags=\"April2025\" height=\"131\" src=\"https://image.prepladder.com/notes/ZvEfQW0vnPhRQJwMnKpx1745342842.png\" width=\"137\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium oxalate</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiopaque</p>\n<p>Hyperdense</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Envelope/ <span class=\"customMeta\" data-dictid=\"2a7733c0fd1692777186e80fb2ccb5\">dumbbell</span> shaped </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common (80%)</li>\n<li>Risk factors: Ethylene <span class=\"customMeta\" data-dictid=\"7451dcad4f1692777188609e12be1d\">glycol</span> ingestion</li>\n<li>Seen in <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> urine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:93px\">\n<p><strong>Calcium <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Calcium phosphate\" data-author=\"Lee, A-Jin &amp; Yoo, Eun‐Hyung &amp; Bae, Young‐Cheol &amp; Jung, Sang &amp; Jeon, Chang-Ho. (2022). Differential identification of urine crystals with morphologic characteristics and solubility test. Journal of Clinical Laboratory Analysis. 36. 10.1002/jcla.24707. \" data-hash=\"11063\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Two-calcium-phosphate-crystals-A-amorphous-calcium-phosphate-with-a-large-plate_fig2_363906476\" data-tags=\"April2025\" height=\"126\" src=\"https://image.prepladder.com/notes/LkWKjzaJxiM87EUhunxx1745343730.png\" width=\"133\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium phosphate</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiopaque</p>\n<p>Hyperdense</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wedge shaped prism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with increased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> pH</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:93px\">\n<p><strong>Ammonium <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> (struvite)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ammonium magnesium phosphate\" data-author=\"Joel Mills\" data-hash=\"11065\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Struvite_crystals_dog_with_scale_1.JPG\" data-tags=\"April2025\" height=\"108\" src=\"https://image.prepladder.com/notes/La1RWfi7AQ07LsWW58XX1745343827.png\" width=\"131\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urease+ infection</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiopaque</p>\n<p>Hyperdense</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coffin lid shaped</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Forms <strong>staghorn</strong> calculi</li>\n<li>Caused by Proteus, Klebsiella leading to <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> alkalinization.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:93px\">\n<p><strong>Uric acid (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Uric acid\" data-author=\"Crop by Mikael Häggström of original by Klinkhardt, Julius (1810-1881)\" data-hash=\"11066\" data-license=\"https://commons.wikimedia.org/wiki/File:Uric_acid_crystal.jpg\" data-source=\"https://commons.wikimedia.org/wiki/File:Uric_acid_crystal.jpg\" data-tags=\"April2025\" height=\"88\" src=\"https://image.prepladder.com/notes/Or4JuCopbWMYvLF15QWA1745343880.png\" width=\"132\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uric acid</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiolucent </strong></p>\n<p>Visible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rhomboid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk factors: low <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> volume, <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> pH, <span class=\"customMeta\" data-dictid=\"e22be927921692777189c58bef4715\">hyperuricemia</span> leukemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:93px\">\n<p><strong>Cystine (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Cystine \" data-author=\"Lance Wheeler\" data-hash=\"11068\" data-license=\"CC BY-SA 4.0 \" data-source=\"https://commons.wikimedia.org/wiki/File:Cystine_Crystals_in_Canine_Urine_Sediment.jpg\" data-tags=\"April2025\" height=\"104\" src=\"https://image.prepladder.com/notes/iXmvISExp2KRZRCqFrat1745343913.png\" width=\"137\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cystine</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiopaque</p>\n<p>Radiodense</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hexagonal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hereditary <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in reabsorbing cystine, ornithine, lysine, arginine<strong> (COLA)</strong></li>\n<li>Sodium <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> <span class=\"customMeta\" data-dictid=\"4e995cdee9169277719375efd43d38\">nitroprusside</span> test positive</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not true about syndrome of inappropriate antidiuretic hormone secretion (SIADH)?", "options": [{"label": "A", "text": "Urinary sodium &amp;lt;20 mEq/L", "correct": true}, {"label": "B", "text": "Serum sodium &amp;lt;135 mEq/L", "correct": false}, {"label": "C", "text": "Urine osmolality &amp;gt;100 mOsm/kg", "correct": false}, {"label": "D", "text": "Patient can be clinically euvolemic to hypervolemic", "correct": false}], "correct_answer": "A. Urinary sodium &lt;20 mEq/L", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\"&gt;Urinary&lt;/span&gt; sodium &amp;lt;20 mEq/L</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)</li><li>↳ Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)</li><li>↳ Definition Excessive ADH release leading to impaired water excretion and hyponatremia with euvolemia or hypervolemia. (Option D)</li><li>↳ Definition</li><li>↳ Definition</li><li>↳ Definition</li><li>↳ Excessive ADH release leading to impaired water excretion and hyponatremia with euvolemia or hypervolemia. (Option D)</li><li>↳ Excessive ADH release leading to impaired water excretion and hyponatremia with euvolemia or hypervolemia. (Option D)</li><li>↳ hyponatremia with euvolemia or hypervolemia. (Option D)</li><li>↳ Etiology CNS disturbances: Stroke, infection, subarachnoid hemorrhage, etc. Malignancies: Small cell lung cancer (most common), other cancers. Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia (Option A ruled out), respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ Etiology</li><li>↳ Etiology</li><li>↳ Etiology</li><li>↳ CNS disturbances: Stroke, infection, subarachnoid hemorrhage, etc. Malignancies: Small cell lung cancer (most common), other cancers. Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia (Option A ruled out), respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ CNS disturbances: Stroke, infection, subarachnoid hemorrhage, etc. Malignancies: Small cell lung cancer (most common), other cancers. Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc. Surgery: Pain-induced ADH hypersecretion. Pulmonary diseases: Pneumonia (Option A ruled out), respiratory failure, etc. Hormone deficiency: Hypopituitarism, hypothyroidism. HIV: Associated with infections. Hereditary SIADH: V2 receptor mutation.</li><li>↳ CNS disturbances: Stroke, infection, subarachnoid hemorrhage, etc.</li><li>↳ CNS disturbances:</li><li>↳ Malignancies: Small cell lung cancer (most common), other cancers.</li><li>↳ Malignancies:</li><li>↳ Drugs: Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc.</li><li>↳ Drugs:</li><li>↳ Surgery: Pain-induced ADH hypersecretion.</li><li>↳ Surgery:</li><li>↳ Pulmonary diseases: Pneumonia (Option A ruled out), respiratory failure, etc.</li><li>↳ Pulmonary diseases:</li><li>↳ Hormone deficiency: Hypopituitarism, hypothyroidism.</li><li>↳ Hormone deficiency:</li><li>↳ HIV: Associated with infections.</li><li>↳ HIV:</li><li>↳ Hereditary SIADH: V2 receptor mutation.</li><li>↳ Hereditary SIADH:</li><li>↳ Pathophysiology ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ Pathophysiology</li><li>↳ Pathophysiology</li><li>↳ Pathophysiology</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia. Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ ADH function: Regulates water balance by controlling plasma osmolality; excess ADH causes water retention, leading to hyponatremia.</li><li>↳ ADH function:</li><li>↳ Volume regulation: In hypovolemia, ADH release is driven by volume receptors, worsening hyponatremia.</li><li>↳ Volume regulation:</li><li>↳ Clinical Presentation Acute hyponatremia: Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms (nausea, confusion, falls in elderly).</li><li>↳ Clinical Presentation</li><li>↳ Clinical Presentation</li><li>↳ Clinical Presentation</li><li>↳ Acute hyponatremia: Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms (nausea, confusion, falls in elderly).</li><li>↳ Acute hyponatremia: Nausea, vomiting, headache, seizures, coma. Chronic hyponatremia: Nonspecific symptoms (nausea, confusion, falls in elderly).</li><li>↳ Acute hyponatremia: Nausea, vomiting, headache, seizures, coma.</li><li>↳ Acute hyponatremia:</li><li>↳ Chronic hyponatremia: Nonspecific symptoms (nausea, confusion, falls in elderly).</li><li>↳ Chronic hyponatremia:</li><li>↳ Diagnosis Schwartz and Bartter Criteria: Serum sodium &lt;135 mEq/L (Option B) Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg (Option C) The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, drugs that impair renal water excretion.)</li><li>↳ Diagnosis</li><li>↳ Diagnosis</li><li>↳ Diagnosis</li><li>↳ Schwartz and Bartter Criteria: Serum sodium &lt;135 mEq/L (Option B) Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg (Option C) The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, drugs that impair renal water excretion.)</li><li>↳ Schwartz and Bartter Criteria:</li><li>↳ Schwartz and Bartter Criteria:</li><li>↳ Serum sodium &lt;135 mEq/L (Option B) Serum osmolality &lt;275 mOsm/kg Urine sodium &gt;40 mEq/L Urine osmolality &gt;100 mOsm/kg (Option C) The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range) The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, drugs that impair renal water excretion.)</li><li>↳ Serum sodium &lt;135 mEq/L (Option B)</li><li>↳ Serum sodium &lt;135 mEq/L (Option B)</li><li>↳ Serum osmolality &lt;275 mOsm/kg</li><li>↳ Urine sodium &gt;40 mEq/L</li><li>↳ Urine sodium &gt;40 mEq/L</li><li>↳ Urine osmolality &gt;100 mOsm/kg (Option C)</li><li>↳ Urine osmolality &gt;100 mOsm/kg (Option C)</li><li>↳ The absence of clinical evidence of volume depletion (like normal skin turgor, blood pressure within the reference range)</li><li>↳ The absence of hyponatremia due to other causes (like adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, drugs that impair renal water excretion.)</li><li>↳ Tests: Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Tests: Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Tests:</li><li>↳ Tests:</li><li>↳ Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Renal function, serum osmolality, cortisol levels, thyroid tests, imaging for underlying causes.</li><li>↳ Management Fluid restriction: For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Management</li><li>↳ Management</li><li>↳ Management</li><li>↳ Fluid restriction: For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Fluid restriction: For mild to moderate symptoms. Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs). Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Fluid restriction: For mild to moderate symptoms.</li><li>↳ Fluid restriction:</li><li>↳ Hypertonic saline (3%): For severe hyponatremia, with careful correction rate (&lt;8 mEq/L in 24 hrs).</li><li>↳ Hypertonic saline (3%):</li><li>↳ Medications: Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Medications:</li><li>↳ Vasopressin receptor antagonists (Conivaptan, Tolvaptan) Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Vasopressin receptor antagonists (Conivaptan, Tolvaptan)</li><li>↳ Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li><li>↳ Complications Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Complications</li><li>↳ Complications</li><li>↳ Complications</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction. Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Osmotic demyelination syndrome: Risk from rapid sodium correction.</li><li>↳ Osmotic demyelination syndrome:</li><li>↳ Severe hyponatremia: Can lead to seizures, coma, and death in acute cases.</li><li>↳ Severe hyponatremia:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Syndrome of Inappropriate <span class=\"customMeta\" data-dictid=\"27bd08bbaa16927771812e98e16787\">Antidiuretic</span> Hormone <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">Secretion</span> (SIADH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excessive <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> release leading to impaired water <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> and <strong>hyponatremia with <span class=\"customMeta\" data-dictid=\"159ab75ed316927771879ce7b3cb84\">euvolemia</span> or hypervolemia. (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CNS disturbances:</strong> Stroke, infection, <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> hemorrhage, etc.</li>\n<li><strong>Malignancies: </strong>Small cell lung cancer (most common), other cancers.</li>\n<li><strong>Drugs:</strong> Carbamazepine, oxcarbazepine, SSRIs, \"Ecstasy\", NSAIDs, etc.</li>\n<li><strong>Surgery:</strong> Pain-induced <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> hypersecretion.</li>\n<li><strong>Pulmonary diseases:</strong> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> (Option A ruled out), <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, etc.</li>\n<li><strong>Hormone deficiency:</strong> Hypopituitarism, hypothyroidism.</li>\n<li><strong>HIV:</strong> Associated with infections.</li>\n<li><strong>Hereditary SIADH:</strong> V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> mutation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>ADH function: </strong>Regulates <span class=\"customMeta\" data-dictid=\"2108d4f8a21692777202226f391d3b\">water balance</span> by controlling <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolality; <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> causes water retention, leading to hyponatremia.</li>\n<li><strong>Volume regulation:</strong> In hypovolemia, <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> release is driven by volume receptors, worsening hyponatremia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Acute hyponatremia:</strong> Nausea, vomiting, headache, seizures, coma.</li>\n<li><strong>Chronic hyponatremia: </strong>Nonspecific symptoms (nausea, confusion, falls in elderly).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schwartz and Bartter Criteria:</strong></p>\n<ul>\n<li><strong>Serum sodium &lt;135 mEq/L (Option B)</strong></li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> &lt;275 mOsm/kg</li>\n<li><strong>Urine sodium &gt;40 mEq/L</strong></li>\n<li><strong>Urine <span class=\"customMeta\" data-dictid=\"84beb7db6216927771943b5795a1c5\">osmolality</span> &gt;100 mOsm/kg (Option C)</strong></li>\n<li>The absence of clinical evidence of volume <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> (like normal skin turgor, <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> within the reference range)</li>\n<li>The absence of <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> due to other causes (like <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, hypothyroidism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure, <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> insufficiency, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease with salt wastage, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> disease, drugs that impair <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> water excretion.)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tests:</strong></p>\n<ul>\n<li>Renal function, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> osmolality, <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tests, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for underlying causes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fluid restriction: </strong>For mild to moderate symptoms.</li>\n<li><strong>Hypertonic <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> (3%): </strong>For severe hyponatremia, with careful <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> rate (&lt;8 mEq/L in 24 hrs).</li>\n<li><strong>Medications:</strong>\n<ul>\n<li>Vasopressin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists (Conivaptan, Tolvaptan)</li>\n<li>Other: Loop diuretics, salt tablets, demeclocycline, lithium.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Osmotic <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> syndrome:</strong> Risk from rapid sodium correction.</li>\n<li><strong>Severe hyponatremia:</strong> Can lead to seizures, coma, and death in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with complaints of episodes of palpitations, headache, and profuse sweating for the past few days. MIBG scan shows a deep-seated tumour in the adrenal medulla. Which of the following statements is incorrect regarding the condition described?", "options": [{"label": "A", "text": "Diagnosed by urine VMA &amp;amp; catecholamines", "correct": false}, {"label": "B", "text": "Surgical excision is the definitive treatment", "correct": false}, {"label": "C", "text": "Propranolol is given initially to manage hypertension", "correct": true}, {"label": "D", "text": "Can present as hypertension alone and sometimes with vomiting and pain abdomen", "correct": false}], "correct_answer": "C. Propranolol is given initially to manage hypertension", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZZMtGSltLFROAnsRKX2g1745407683.png", "https://image.prepladder.com/content/L4kPhRFo36q9Balp9cyY1745407705.png", "https://image.prepladder.com/content/8WaUxO3HdLreFBrjUWsA1745407720.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pheochromocytoma </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pheochromocytomas are rare tumours arising from <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> medulla.</li>\n<li>The clinical features result from excessive <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of catecholamines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histology of the <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> characteristically shows zellballen nests of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells with strong positivity to chromogranin, synaptophysin, CD56, and focally to S100.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Paraganglioma#/media/File:Carotid_body_tumour_2_intermed_mag.jpg\" data-tags=\"\" height=\"267\" src=\"https://image.prepladder.com/content/ZZMtGSltLFROAnsRKX2g1745407683.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells in the <span class=\"customMeta\" data-dictid=\"5d5198131c16927771873e61ef8092\">extra-adrenal</span> tissue is the only <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> characteristic of the <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the entity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Classical <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> </strong>\n<ul>\n<li>Episode of palpitation</li>\n<li>Headache</li>\n<li>Profuse sweating</li>\n</ul>\n</li>\n<li><strong>The dominant sign is Hypertension</strong></li>\n<li><strong>Vomiting </strong><strong>(Option D)</strong></li>\n<li><strong>Pain abdomen</strong></li>\n<li>Tachycardia</li>\n<li>Anxiety</li>\n<li>Subcutaneous neurofibromas</li>\n<li>Cafe-au-lait macules</li>\n<li>Thyroid mass</li>\n<li>Axillary freckling</li>\n<li>Lisch nodules on the iris</li>\n<li>Retinal angiomas</li>\n<li>Abdominal mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> can be established by biochemical confirmation of <span class=\"customMeta\" data-dictid=\"0f03f178b51692777189f3658408a0\">hypersecretion</span> of metanephrines and catecholamines.</li>\n</ul>\n<p><strong>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> test </strong></p>\n<ul>\n<li><strong>Catecholamines </strong><strong>(Option A)</strong></li>\n<li>Fractionated metanephrines</li>\n<li>Total metanephrines</li>\n<li><strong>Vanillylmandelic acid</strong> (VMA) (a <span class=\"customMeta\" data-dictid=\"fceb6bf8d01692777192b8b179f554\">metabolite</span> of <span class=\"customMeta\" data-dictid=\"35b6a8aeb416927771805fcc2e7dfb\">adrenaline</span> and noradrenaline) <strong>(Option A)</strong></li>\n</ul>\n<p><strong>Imaging</strong>:</p>\n<ul>\n<li>CT scan of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> to locate the tumour.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Campos A, Weerakkody Y, et al. Pheochromocytoma. Reference article, Radiopaedia.org (Accessed on 29 Nov 2024) https://doi.org/10.53347/rID-8642\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/phaeochromocytoma-1\" data-tags=\"\" height=\"219\" src=\"https://image.prepladder.com/content/L4kPhRFo36q9Balp9cyY1745407705.png\" width=\"331\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>18F-FDG PET <span class=\"customMeta\" data-dictid=\"c497b556951692777198b599e4ba86\">scanning</span> is recommended for metastatic disease.</li>\n<li>MIBG scintigraphy</li>\n<li>Somatostatin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> scintigraphy</li>\n<li>Gallium DOTATATE PET scanning</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"orge A. Carrasquillo, Clara C. Chen, Abhishek Jha, Alexander Ling, Frank I. Lin, Daniel A. Pryma and Karel Pacak Journal of Nuclear Medicine August 2021, 62 (8) 1033-1042; DOI: https://doi.org/10.2967/jnumed.120.259689\" data-hash=\"\" data-license=\"NA\" data-source=\"https://jnm.snmjournals.org/content/62/8/1033\" data-tags=\"\" height=\"280\" src=\"https://image.prepladder.com/content/8WaUxO3HdLreFBrjUWsA1745407720.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperthyroidism</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</li>\n<li>Hyperaldosteronism</li>\n<li>Cardiomyopathy</li>\n<li>Postural <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> syndrome (POTS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> is <strong>surgical resection.</strong> <strong>(Option B)</strong></li>\n<li>Preoperative preparation of the patient has to be considered, and <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> should be consistently &lt; 160/90 mm Hg.</li>\n<li>Blood pressure is controlled by alpha-adrenergic blockers (phenoxybenzamine 0.5-4 mg/kg of body weight) <strong>(vs Option C)</strong></li>\n<li>Oral Prazosin or IV <span class=\"customMeta\" data-dictid=\"4b193b485f169277719585706f10f3\">phentolamine</span> can be used to control paroxysm.</li>\n</ul>\n<p><strong>Unilateral Pheochromocytoma:</strong></p>\n<ul>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> adrenalectomy: Preferred treatment for most <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> pheochromocytomas.</li>\n<li>Open adrenalectomy</li>\n</ul>\n<p><strong>Bilateral pheochromocytomas: </strong></p>\n<ul>\n<li>Bilateral total <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> is associated with a lifelong need for <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> replacement with long-term side effects.</li>\n<li>Bilateral partial or <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> sparing <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> (open or laparoscopic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myocardial infarction</li>\n<li>Cardiogenic shock</li>\n<li>Renal Failure</li>\n<li>Pulmonary edema</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</li>\n<li>Lactic acidosis</li>\n<li>Hypertensive retinopathy</li>\n<li>Hypertensive encephalopathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a seizure. On evaluation, urine osmolality is 1000 mOsm/kg, and serum osmolality is 270 mOsm/kg. Which electrolyte abnormality can be expected in this patient?", "options": [{"label": "A", "text": "Hypernatremia", "correct": false}, {"label": "B", "text": "Hyponatremia", "correct": true}, {"label": "C", "text": "Hyperkalaemia", "correct": false}, {"label": "D", "text": "Hypokalaemia", "correct": false}], "correct_answer": "B. Hyponatremia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hemodialysis is an indication for all the below conditions except?", "options": [{"label": "A", "text": "Uremic encephalopathy", "correct": true}, {"label": "B", "text": "Peripheral neuropathy", "correct": false}, {"label": "C", "text": "Metabolic acidosis", "correct": false}, {"label": "D", "text": "Uremic pericarditis", "correct": false}], "correct_answer": "A. Uremic encephalopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute (AKI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chronic(CKD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluid Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pulmonary edema</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pulmonary Edema</li>\n<li>Severe Hypertension</li>\n<li>Edema resistant to diuretics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>&gt;6.5 mmol/L</strong> with<strong> <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> changes (Broad QRS)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Potassium resistant to treatment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uraemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pericarditis (Option D)</strong></li>\n<li><strong>Encephalopathy (Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uremic syndrome (anorexia, nausea, lethargy, etc.), typically when eGFR &lt; 10 mL/min/1.73 m²</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe acidosis(<strong>H+ &gt; 79 nmol/L</strong>; pH &lt; 7.1)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> resistant to <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> therapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relative indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bleeding <span class=\"customMeta\" data-dictid=\"a6116aa50e1692777186cfd59c5257\">diathesis</span> due to uremia-induced <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> dysfunction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intractable <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> despite <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> and iron supplementation</li>\n<li>Hyperphosphatemia despite <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> binders</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options represents the most severe manifestation of Chronic Kidney Disease (CKD)?", "options": [{"label": "A", "text": "Decreased GFR", "correct": false}, {"label": "B", "text": "Increased creatinine", "correct": false}, {"label": "C", "text": "Hyperkalaemia", "correct": true}, {"label": "D", "text": "Proteinuria", "correct": false}], "correct_answer": "C. Hyperkalaemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease</strong></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Leading causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Diabetic nephropathy</strong> (Most common)</li>\n<li>Glomerulonephritis</li>\n<li>Hypertension</li>\n<li>Ischemic heart disease (Cardiorenal syndrome)</li>\n<li>Autosomal dominant <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</li>\n<li>Tubulointerstitial <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Weight loss</li>\n<li>Nausea</li>\n<li><strong>Electrolyte Imbalances</strong></li>\n<li>Hiccups (urea irritates <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa)</li>\n<li>Pedal oedema</li>\n<li>Muscle cramping and twitching</li>\n<li>Pruritus and skin pigmentation</li>\n<li>Uremic fetor</li>\n<li>Restless leg syndrome</li>\n<li>Uremic pericarditis</li>\n<li>Hypertension</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fluid and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> electrolytes in CKD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electrolyte Imbalances </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypervolemic hyponatremia: </strong></p>\n<ul>\n<li>High circulating <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> levels.</li>\n<li>Increase in water &gt; sodium retention.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Water restriction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Patiromer</strong></li>\n<li>Calcium resonium</li>\n<li>Sodium polystyrene</li>\n<li>Calcium <span class=\"customMeta\" data-dictid=\"ff3235f97616927771884121a800e7\">gluconate</span> or <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> (for <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> protection).</li>\n<li>Insulin and <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> (to shift <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> back into cells)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypokalemia (rare): </strong>Usually due to overuse of diuretics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increase dietary <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> and reduce the dose of diuretics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperphosphatemia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sevelamer </strong></li>\n<li>Calcium <span class=\"customMeta\" data-dictid=\"47765053a81692777180738f50cd4e\">acetate</span> or carbonate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypocalcemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Paricalcitol </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old man presents to the casualty with severe shortness of breath and fatigue for the past 3 hours. He reports a history of vomiting and epigastric pain 2 days back, for which he took an anti-emetic. His past medical history is significant for hypertension and diabetes mellitus type 1. As the CBG valve of this patient showed 356mg/dL, the physician advises immediate ABG analysis, which reveals a pH=7.32, pCO 2 =38mEq/L, and HCO 3 -=15mEq/L. This report showed a type of acidosis with an increased anion gap. Which of the following conditions does not belong to the same classification of metabolic acidosis as in this patient?", "options": [{"label": "A", "text": "Renal failure", "correct": false}, {"label": "B", "text": "Lactic acidosis", "correct": false}, {"label": "C", "text": "Renal aciduria", "correct": true}, {"label": "D", "text": "Aspirin poisoning", "correct": false}], "correct_answer": "C. Renal aciduria", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (MUDPILES)</strong></p>\n<p><strong>(HAGMA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-anion gap (USED PART)</strong></p>\n<p><strong>(NAGMA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>M</strong>ethanol poisoning</li>\n<li><strong>U</strong>remia: AKI, CKD<strong> (Option A)</strong></li>\n<li><strong>D</strong>iabetic ketoacidosis</li>\n<li><strong>P</strong>aracetamol poisoning</li>\n<li><strong>I</strong>ron and isoniazid</li>\n<li><strong>L</strong>actic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> <strong>(Option B)</strong></li>\n<li><strong>E</strong>thylene <span class=\"customMeta\" data-dictid=\"7451dcad4f1692777188609e12be1d\">glycol</span> poisoning</li>\n<li><strong>S</strong>alicylate <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> <strong>(Option D) </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>U</strong>: <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> / Ureterenterostomy</li>\n<li><strong>S</strong>: Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> Fistula, <strong>S</strong>pironolactone and K-sparing diuretics, <strong>S</strong>aline <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> (rapid infusion)</li>\n<li><strong>E</strong>: Extra Chloride</li>\n<li><strong>D</strong>: Diarrhea</li>\n<li><strong>P</strong>: Pancreatic fistula</li>\n<li><strong>A</strong>: Addison, Acetazolamide</li>\n<li><strong>R: <span class=\"customMeta\" data-dictid=\"9ff00b798416927771974cced89037\">RTA</span> (Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> )</strong></li>\n<li><strong>T</strong>: Tenofovir, Topiramate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reduced <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap: </strong>Multiple <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> and <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">nephrotic</span> syndrome</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29-year-old male patient presents with multiple oral and genital ulcers. The patient claims these ulcers resolve spontaneously and that she experiences such episodes at least four times a year. Ocular examination reveals features of anterior uveitis. What is the likely diagnosis?", "options": [{"label": "A", "text": "Rheumatoid arthritis", "correct": false}, {"label": "B", "text": "Psoriatic arthritis", "correct": false}, {"label": "C", "text": "SLE", "correct": false}, {"label": "D", "text": "Behcet’s disease", "correct": true}], "correct_answer": "D. Behcet’s disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/x81YlCZJWegIooOY02F61745477699.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Behcet’s Disease- <span class=\"customMeta\" data-dictid=\"715b4caf0316927771943797627d8d\">Pathogenesis</span> and Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>T-cell mediated immunity</li>\n<li>Th1 cell activation</li>\n<li>Elevated cytokines (IL-1, TNF-α)</li>\n<li>Neutrophilic vasculitis</li>\n<li>No specific autoantibodies</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Auto-inflammatory rather than autoimmune</li>\n<li>Affects vessels of all sizes</li>\n<li>Treatment targets inflammation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mucocutaneous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral ulcers (97-99%)</li>\n<li>Genital ulcers (&gt;80%)</li>\n<li>Erythema nodosum</li>\n<li>Pathergy reaction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often initial presentation</li>\n<li>Oral ulcers heal without scarring</li>\n<li>Genital ulcers leave scars</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Major Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uveitis (&gt;50%)</li>\n<li>Vascular (25%)</li>\n<li>Neurologic (5-10%)</li>\n<li>Arthritis (non-erosive)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More severe in males</li>\n<li>Ocular disease can cause blindness</li>\n<li>Vascular involvement can be fatal</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements correctly describes an ideal candidate for a renal graft transplant in a patient with diabetic nephropathy?", "options": [{"label": "A", "text": "The survival rate of graft is 95% in the first year", "correct": false}, {"label": "B", "text": "The transplantation is cost effective after the second transplant year", "correct": true}, {"label": "C", "text": "The life expectancy is doubled in a diabetic patient with renal transplant", "correct": false}, {"label": "D", "text": "The treatment of chronic rejection has improved over the last 10 years", "correct": false}], "correct_answer": "B. The transplantation is cost effective after the second transplant year", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cQZCppJOQWdrgT9UyDPl1745479447.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the sodium deficit in the patient, who weighs 60 kg, using the provided serum electrolyte values: pH of 7.42, sodium (Na+) level of 120 mEq/L, and serum chloride (CI-) level of 90 mEq/L.", "options": [{"label": "A", "text": "20 mEq", "correct": false}, {"label": "B", "text": "200 mEq", "correct": false}, {"label": "C", "text": "400 mEq", "correct": false}, {"label": "D", "text": "720 mEq", "correct": true}], "correct_answer": "D. 720 mEq", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As per KDIGO, which of the following falls under G3b?", "options": [{"label": "A", "text": "45-59", "correct": false}, {"label": "B", "text": "60-89", "correct": false}, {"label": "C", "text": "30-44", "correct": true}, {"label": "D", "text": "15-29", "correct": false}], "correct_answer": "C. 30-44", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/guYjpvXsFEx0BGmqotaL1741867068.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td rowspan=\"10\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>G</strong></p>\n<p><strong>F</strong></p>\n<p><strong>R</strong></p>\n</td>\n<td colspan=\"3\" rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p style=\"text-align: center;\"><strong>The <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> of CKD, according to</strong></p>\n<p style=\"text-align: center;\"><strong>KDIGO 2012 <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Persistent <span class=\"customMeta\" data-dictid=\"98ed15279f169277718118ace5f595\">albuminuria</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>A1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>A3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal to mild increase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate increase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe increase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;30mg/g</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-300 mg/g</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;300mg/g</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or high</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;=90</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mildly decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60-89</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G3a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate decrease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>45-59</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G3b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate to severe decrease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-44</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe decrease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-29</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kidney failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;15</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very high risk</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mutation in the gene for the aquaporin channel leads to which of the following conditions?", "options": [{"label": "A", "text": "Liddle’s syndrome", "correct": false}, {"label": "B", "text": "Nephrogenic DI", "correct": true}, {"label": "C", "text": "Cystic fibrosis", "correct": false}, {"label": "D", "text": "Barter syndrome", "correct": false}], "correct_answer": "B. Nephrogenic DI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"8544e173991692777193d9a5472b4f\"&gt;Nephrogenic&lt;/span&gt; DI</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Central DI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nephrogenic DI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Polydipsia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gestational DI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deficiency of <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> (Arginine vasopressin) <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Kidneys are unable to respond to AVP, even if levels are normal.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excessive water intake, suppressing <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> secretion.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased activity of <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> degrading <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired</strong>: Head trauma, tumours, granulomas, infections, inflammation, toxins, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> events, hypoxia.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired</strong>: Drugs (lithium, demeclocycline), <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders (hypercalcaemia, hypokalaemia), obstruction, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> issues, granulomas, tumours, and infiltration.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dipsogenic</strong>: Inappropriate thirst, head trauma, brain diseases.</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"6937cb294a1692777201467ccb0597\">vasopressinase</span> activity.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psychogenic</strong>: Psychiatric conditions, <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> water drinking.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the AVP–neurophysin II or WFS1 genes.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic:</strong> Mutations in the <strong>V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> or aquaporin-2 genes.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iatrogenic</strong>: Belief in the health benefits of excessive water intake.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Basal <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> AVP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low or undetectable (&lt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or elevated (&gt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low due to <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> by excessive water intake.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low due to increased degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L) but can temporarily concentrate with fluid deprivation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluid <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> increases <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> in severe CDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> has no effect on severe NDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plasma <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> and sodium increase above normal without <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> concentration.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not typically performed during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot absent or small.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright- spot may be faint or absent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not routinely used for diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Desmopressin (DDAVP) Trial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abolishes <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> and polydipsia; reduces <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No effect on <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, fluid intake, or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eliminates <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> but not polydipsia, leading to hyponatremia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective in controlling symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma Copeptin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low or undetectable.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be normal or elevated.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suppressed due to low AVP.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be low due to <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thiazide diuretics, amiloride, low-sodium diet, <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> inhibitors.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behavioral therapy, education about overhydration.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lifelong treatment usually needed for <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> CDI</li>\n<li>Genetic forms may improve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependent on the underlying cause</li>\n<li>Lithium-induced NDI may persist.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependent on behavioural <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> and addressing the underlying cause.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually, it resolves after delivery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents to the OPD with palpitation and weight loss. On examination of her legs the following lesion was found which on applying pressure, the indentation does not persist on release. ECG shows sinus rhythm. What is the probable cause of the oedema?", "options": [{"label": "A", "text": "Myxedema", "correct": false}, {"label": "B", "text": "Nephrotic syndrome", "correct": true}, {"label": "C", "text": "Chronic lymphangitis", "correct": false}, {"label": "D", "text": "Dilated cardiomyopathy", "correct": false}], "correct_answer": "B. Nephrotic syndrome", "question_images": ["https://image.prepladder.com/content/l0EfSFDEiq8fyKh0FjpW1746791038.png"], "explanation_images": ["https://image.prepladder.com/content/N6GdjNeNOMz3no5pa9Iy1746791107.png", "https://image.prepladder.com/content/vaLPjxJ4VSnuMkMKLr9s1746791121.png", "https://image.prepladder.com/content/WHwc9sGjhs5eJ3uqXSzm1746791137.png", "https://image.prepladder.com/content/FA87StRmTwp6FmT3sNu31746791150.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Nephrotic Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical manifestations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proteinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The damage to the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> barrier leads to <strong>increased <span class=\"customMeta\" data-dictid=\"1c7103a9b516927771955682b6aaa4\">permeability</span> to proteins</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Odema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"330\" src=\"https://image.prepladder.com/content/N6GdjNeNOMz3no5pa9Iy1746791107.png\" width=\"866\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypoalbuminemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> loss of <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> being more than its <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by the liver.</li>\n<li>Muehrcke's lines (linear white lines in the <span class=\"customMeta\" data-dictid=\"b343d5e0891692777193df04031c03\">nail bed</span> seen in hypoalbuminemia)</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Lyrl\" data-hash=\"\" data-license=\"OPEN ACCESS \" data-source=\"https://en.wikipedia.org/wiki/Muehrcke%27s_nails\" data-tags=\"\" height=\"269\" src=\"https://image.prepladder.com/content/vaLPjxJ4VSnuMkMKLr9s1746791121.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperlipidemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"540\" src=\"https://image.prepladder.com/content/WHwc9sGjhs5eJ3uqXSzm1746791137.png\" width=\"801\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>Xanthoma and <span class=\"customMeta\" data-dictid=\"10bddad16c16927772022ef59afac7\">xanthelasma</span> can be appreciated.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Klaus D. Peter, Wiehl, Germany\" data-hash=\"\" data-license=\"CC BY 3.0 de\" data-source=\"https://en.wikipedia.org/wiki/Xanthelasma\" data-tags=\"\" height=\"256\" src=\"https://image.prepladder.com/content/FA87StRmTwp6FmT3sNu31746791150.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypercoagulability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This can be due to factors like:</p>\n<ul>\n<li>Due to the loss of <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> proteins like Protein C/ Protein S/ Antithrombin III</li>\n<li>Ferritin deficiency</li>\n<li>History of factor V Leiden mutation</li>\n<li>Increased production of <span class=\"customMeta\" data-dictid=\"ff2094828c1692777196941a65e6eb\">procoagulant</span> factors by the liver.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of immunoglobulins in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> causes <strong>hypogammaglobulinemia</strong>, increasing <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> to infections.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnostic criteria for <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Essential findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Proteinuria of &gt; 3.5 g/day</li>\n<li>Urine PCR &gt; 2g protein/g of creatinine</li>\n<li>Hypoalbuminemia - <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">Albumin</span> &lt; 2.5 gm%</li>\n<li><strong>Oedema due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"5d369be246169277719451754ab37a\">oncotic</span> pressure</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypercholesterolemia,</li>\n<li>Lipiduria\n\t\t\t\t<ul>\n<li>Urine microscopy: Oval fat bodies/Maltese cross bodies</li>\n</ul>\n</li>\n<li>Low eGFR</li>\n<li>Hypercoagulability</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A hepatitis B-positive person came to your OPD on routine urine massive proteinuria (&amp;gt; 3.5 g/day). Further renal biopsy was performed as below. Identify the disease.", "options": [{"label": "A", "text": "Focal segmental glomerulosclerosis", "correct": false}, {"label": "B", "text": "Membranous glomerulonephritis", "correct": true}, {"label": "C", "text": "Membranoproliferative glomerulonephritis", "correct": false}, {"label": "D", "text": "Minimal change disease", "correct": false}], "correct_answer": "B. Membranous glomerulonephritis", "question_images": ["https://image.prepladder.com/content/4lQjkA1DJ0i52C02YaYd1746792742.png"], "explanation_images": ["https://image.prepladder.com/content/nzsX9IlwQVNjYwFA717f1746792818.png", "https://image.prepladder.com/content/64rffmZYbAIIGTmgVEZY1746792831.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following agents is most likely causing the condition in a 60-year-old woman, who had a kidney transplant 2 months ago, and is now experiencing a high fever, severe difficulty in breathing, and a dry cough with a hacking sound? A chest x-ray shows widespread interstitial infiltrates in both lungs, and urine examination reveals the presence of cells with an 'owl-eye' appearance.", "options": [{"label": "A", "text": "Adenovirus", "correct": false}, {"label": "B", "text": "Cytomegalovirus", "correct": true}, {"label": "C", "text": "Influenza virus", "correct": false}, {"label": "D", "text": "Respiratory syncytial", "correct": false}], "correct_answer": "B. Cytomegalovirus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications following <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> transplant</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graft rejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperacute, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> and chronic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Opportunistic infections</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>&lt; 1 Month: </strong>Wound infection, HSV, UTI, Oral candidiasis</li>\n<li><strong>1-6 Months: CMV</strong> (most common), HBV, HCV, Pneumocystis carinii, Listeria</li>\n<li><strong>&gt;6 Months: BK Virus</strong>, Aspergillus, Nocardia, HBV, HCV, HZV</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypercalcemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This may indicate failure of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> post-transplant.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common post-transplant, often due to <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> medications. Gastrointestinal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> can occur from <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic hepatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Particularly from <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B virus, which can progress over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin and lip cancers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Most common malignancy</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>The leading causes of death among <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplant recipients include:</strong></p>\n<ul>\n<li>Cardiovascular events (29%)</li>\n<li>Infections (18%)</li>\n<li>Malignancies (17%)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient exhibits symptoms of increased urination, nighttime urination, and involuntary urination, along with a recorded 24-hour urine volume of 7 litres. He has a urine osmolarity of 260 mOsm/L. The ADH assay shows a recorded value of 0.8 pg/ml, and an MRI of the brain reveals the absence of a bright spot on T1-weighted imaging. What is the probable diagnosis?", "options": [{"label": "A", "text": "Nephrogenic DI", "correct": false}, {"label": "B", "text": "Primary polydipsia", "correct": false}, {"label": "C", "text": "Pituitary DI", "correct": true}, {"label": "D", "text": "Mannitol infusion", "correct": false}], "correct_answer": "C. Pituitary DI", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:783px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Central DI</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nephrogenic <span class=\"customMeta\" data-dictid=\"7194dbeaed1692777186e2554f8ebf\">DI</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary Polydipsia</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gestational DI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deficiency of AVP (Arginine vasopressin) <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from the <strong>pituitary gland</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Kidneys are unable to respond to AVP, even if levels are normal.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excessive water <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> suppresses AVP secretion.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased activity of <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> degrading AVP during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired</strong>: Head trauma, tumours, granulomas, infections, inflammation, toxins, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> events, hypoxia.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired</strong>: Drugs (lithium, demeclocycline), <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders (hypercalcaemia, hypokalaemia), obstruction, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> issues, granulomas, tumours, and infiltration.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dipsogenic</strong>: Inappropriate thirst, head trauma, brain diseases.</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"6937cb294a1692777201467ccb0597\">vasopressinase</span> activity.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psychogenic</strong>: Psychiatric conditions, <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> water drinking.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the AVP–neurophysin II or WFS1 genes.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> or aquaporin-2 genes.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iatrogenic</strong>: Belief in the health benefits of excessive water intake.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Basal <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> AVP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low or undetectable (&lt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or elevated (&gt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low due to <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> by excessive water intake.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low due to increased degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L) but can temporarily concentrate with fluid deprivation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluid <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> increases <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> in severe CDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> does not affect severe NDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plasma <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> and sodium increase above normal without <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> concentration.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not typically performed during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot absent or small.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright- spot may be faint or absent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not routinely used for diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Desmopressin (DDAVP) Trial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abolishes <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> and polydipsia; reduces <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No effect on <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, fluid intake, or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eliminates <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> but not polydipsia, leading to hyponatremia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective in controlling symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma Copeptin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low or undetectable.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be normal or elevated.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suppressed due to low AVP.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be low due to AVP degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thiazide diuretics, amiloride, low-sodium diet, <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> inhibitors.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behavioural therapy, education about overhydration.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lifelong treatment is usually needed for <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> CDI</li>\n<li>Genetic forms may improve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependent on the underlying cause</li>\n<li>Lithium-induced NDI may persist.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependent on behavioural <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> and addressing the underlying cause.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually, it resolves after delivery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old male child presents with headache and cola-colored urine. His parents report throat pain 2 weeks ago. On examination, red blood cells are present in urine and his KFT is increased two fold. What is the likely diagnosis?", "options": [{"label": "A", "text": "Minimal change disease", "correct": false}, {"label": "B", "text": "Membranous Glomerulonephritis", "correct": false}, {"label": "C", "text": "Post-infectious Glomerulonephritis", "correct": true}, {"label": "D", "text": "IgA nephropathy", "correct": false}], "correct_answer": "C. Post-infectious Glomerulonephritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tCmHWFzweLQymn7MJIQm1747982840.png", "https://image.prepladder.com/content/IHnxGoHjNHS2ZpVaA1gu1747051514.png", "https://image.prepladder.com/content/5YwQHFjtEIUhDsI3AaVr1747051514.png", "https://image.prepladder.com/content/tJHKjgVn4qO2Dfvo2pOI1747051514.png", "https://image.prepladder.com/content/9tu8mPAQcWxI32jdmM7q1747051514.png", "https://image.prepladder.com/content/qOmkDcvg7oeBgHdxVoxH1747051514.png", "https://image.prepladder.com/content/1696QmTYNswxCG2cPM9p1747051514.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:712px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Post-streptococcal <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> (PSGN)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Group A β-Hemolytic streptococci</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immune-complex mediated (<strong>Type III </strong>hypersensitivity reaction)</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1176\" src=\"https://image.prepladder.com/content/tCmHWFzweLQymn7MJIQm1747982840.png\" width=\"6811\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is more common in children and young adults.</li>\n<li>History of<strong> <span class=\"customMeta\" data-dictid=\"7e23404d13169277718994a4692d6d\">impetigo</span> (2-6 weeks) </strong>or <strong>pharyngitis (1-3 weeks</strong>).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"CC-BY-SA-4.0\" data-source=\"https://en.wikipedia.org/wiki/Impetigo\" data-tags=\"\" height=\"559\" src=\"https://image.prepladder.com/content/IHnxGoHjNHS2ZpVaA1gu1747051514.png\" width=\"491\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Pulmonary oedema (shortness of breath, cough, chest pain)</li>\n<li>Periorbital and <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> oedema</li>\n<li>Hypertensive encephalopathy:\n\t\t\t\t<ul>\n<li>Abrupt rise in BP</li>\n<li>Headache</li>\n<li>Loss of consciousness</li>\n</ul>\n</li>\n<li>Features of <span class=\"customMeta\" data-dictid=\"42294b4a0b16927772016b8a93bba0\">uremia</span> include fatigue, weakness, confusion, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> over body parts, shortness of breath, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, nausea, and vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Test for antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti- DNAse</li>\n<li>Anti-Hyaluronidase</li>\n<li>ASO (antistreptolysin O) titer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab findings </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Urine analysis: </strong>Red-colored urine, which turns dark (<strong>cola-colored</strong>) on standing (<strong>hematuria</strong>).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"CC-BY-SA-4.0\" data-source=\"https://en.wikipedia.org/wiki/Hematuria\" data-tags=\"\" height=\"470\" src=\"https://image.prepladder.com/content/5YwQHFjtEIUhDsI3AaVr1747051514.png\" width=\"315\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Raised values of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function test</strong> (serum creatinine, urea, etc).</li>\n<li>Raised <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> potassium</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels of C3, IgG &amp; CH50</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> C4 level.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathological findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gross findings: </strong>Flea-bitten appearance of kidneys</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nzegwu, Martin\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Flea-bitten-finely-granular-kidneys-of-malignant-hypertension_fig2_282505373\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/tJHKjgVn4qO2Dfvo2pOI1747051514.png\" width=\"465\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Light microscopy: Hypercellular glomeruli</strong> (increased number of neutrophils, macrophages, endothelial and mesangial cells).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.m.wikipedia.org/wiki/File:Post-infectious_glomerulonephritis_-_very_high_mag.jpg\" data-tags=\"\" height=\"413\" src=\"https://image.prepladder.com/content/9tu8mPAQcWxI32jdmM7q1747051514.png\" width=\"472\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Electron microscopy: Subepithelial humps </strong>(due to immune complex deposition)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kari, Jameela &amp; Bamaga, Ahmed &amp; Jalalah, Sawsan.\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Transmission-electron-micrograph-showing-numerous-large-hump-like-dense-deposits-located_fig2_236614663\" data-tags=\"\" height=\"445\" src=\"https://image.prepladder.com/content/qOmkDcvg7oeBgHdxVoxH1747051514.png\" width=\"412\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Immunofluorescence study: </strong>A <strong>starry-sky appearance (Granular)</strong> is observed (due to immune complex deposition).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kakajiwala, Aadil &amp; Bhatti, Tricia &amp; Kaplan, Bernard &amp; Ruebner, Rebecca &amp; Copelovitch, Lawrence.\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/A-The-starry-sky-IF-pattern-shows-distinct-granular-staining-of-mesangial-areas-and_fig2_303363829\" data-tags=\"\" height=\"521\" src=\"https://image.prepladder.com/content/1696QmTYNswxCG2cPM9p1747051514.png\" width=\"593\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Self-limiting disorder</li>\n<li>Conservative and supportive management involves:\n\t\t\t\t<ul>\n<li><strong>HTN crisis</strong>: Labetalol (IV), sodium nitroprusside</li>\n<li><strong>Pulmonary edema: </strong>Furosemide</li>\n<li>Antibiotics (Benzathine penicillin)</li>\n<li>Dialysis if needed</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "AKIN and RIFLE criteria are used classify—", "options": [{"label": "A", "text": "Acute kidney injury", "correct": true}, {"label": "B", "text": "Chronic renal failure", "correct": false}, {"label": "C", "text": "Acute glomerulonephritis", "correct": false}, {"label": "D", "text": "Nephrotic syndrome", "correct": false}], "correct_answer": "A. Acute kidney injury", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<thead>\n<tr>\n<td>\n<p><strong>Criteria</strong></p>\n</td>\n<td>\n<p><strong>AKI (Acute <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Injury) Criteria</strong></p>\n</td>\n<td>\n<p><strong>RIFLE Criteria</strong></p>\n</td>\n<td>\n<p><strong>KDIGO Criteria</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Definition</p>\n</td>\n<td>\n<p>A sudden decrease in <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function or <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage that occurs within a short period, typically within 48 hours to 7 days.</p>\n</td>\n<td>\n<p>RIFLE stands for Risk, Injury, Failure, Loss, End-stage <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, representing different stages of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury.</p>\n</td>\n<td>\n<p>KDIGO provides guidelines for the evaluation and management of chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease and <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Parameters</p>\n</td>\n<td>\n<p>- Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> level by 0.3 mg/dL (26.5 μmol/L) within 48 hours</p>\n</td>\n<td>\n<p>- Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> level by ≥1.5 times from baseline</p>\n</td>\n<td>\n<p>- Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> level by ≥0.3 mg/dL (26.5 μmol/L) within 48 hours or increase by ≥1.5 times from baseline</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>- Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> level to ≥1.5 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> within the past 7 days</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> output &lt;0.5 mL/kg/h for ≥6 hours (Oliguria)</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> output &lt;0.5 mL/kg/h for 6 hours or longer</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> output &lt;0.5 mL/kg/h for 6 hours or longer</p>\n</td>\n<td> </td>\n<td> </td>\n</tr>\n<tr>\n<td>\n<p>Classification</p>\n</td>\n<td>\n<p>AKI is classified into three stages:</p>\n</td>\n<td>\n<p>RIFLE criteria are categorized into three levels:</p>\n</td>\n<td>\n<p>KDIGO criteria are categorized into three stages:</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>- Stage 1: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> by 0.3 mg/dL or more or increase to 1.5-1.9 times the <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.5 mL/kg/h for 6-12 hours</p>\n</td>\n<td>\n<p>- Risk: <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> increase ≥1.5 times or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.5 mL/kg/h for 6 hours</p>\n</td>\n<td>\n<p>- Stage 1: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> by ≥0.3 mg/dL (26.5 μmol/L) or increase by ≥1.5-1.9 times from baseline</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>- Stage 2: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> to 2.0-2.9 times the <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.5 mL/kg/h for ≥12 hours</p>\n</td>\n<td>\n<p>- Injury: <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> increase ≥2 times or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.5 mL/kg/h for 12 hours</p>\n</td>\n<td>\n<p>- Stage 2: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> by ≥2.0-2.9 times from baseline</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>- Stage 3: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> to ≥3 times the <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or increase to ≥4.0 mg/dL or <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> replacement therapy or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.3 mL/kg/h for ≥24 hours</p>\n</td>\n<td>\n<p>- Failure: <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> increase ≥3 times or <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> replacement therapy or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.3 mL/kg/h for ≥24 hours</p>\n</td>\n<td>\n<p>- Stage 3: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> to ≥3 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or increase to ≥4.0 mg/dL (354 μmol/L) or <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> replacement therapy or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.3 mL/kg/h for ≥24 hours</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Purpose</p>\n</td>\n<td>\n<p>To identify and diagnose <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury, monitor its progression, and guide treatment decisions.</p>\n</td>\n<td>\n<p>To assess the severity of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury,</p>\n</td>\n<td> </td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the ICU, a patient experiencing renal failure presents with vomiting. Analysis of arterial blood gases reveals a pH level of 7.4, sodium (Na+) concentration of 14 mEq/L, chloride (CI-) concentration of 100 mEq/L, bicarbonate (HCO3-) concentration of 24 mEq/L, and a partial pressure of carbon dioxide (PaCO2) of 40 mmHg. What metabolic abnormality is most likely occurring?", "options": [{"label": "A", "text": "Normal ABG", "correct": false}, {"label": "B", "text": "Normal anion gap, metabolic acidosis", "correct": false}, {"label": "C", "text": "High anion gap metabolic acidosis with metabolic alkalosis", "correct": true}, {"label": "D", "text": "High anion gap metabolic alkalosis with normal metabolic acidosis", "correct": false}], "correct_answer": "C. High anion gap metabolic acidosis with metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<thead>\n<tr>\n<td>\n<p><strong>Parameter</strong></p>\n</td>\n<td>\n<p><strong>Normal Range</strong></p>\n</td>\n<td>\n<p><strong>Interpretation</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>pH</p>\n</td>\n<td>\n<p>7.35 - 7.45</p>\n</td>\n<td>\n<p>&lt;7.35: Acidemia, &gt;7.45: Alkalemia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>PaCO2</p>\n</td>\n<td>\n<p>35 - 45 mmHg</p>\n</td>\n<td>\n<p>&lt;35 mmHg: <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> alkalosis, &gt;45 mmHg: <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> acidosis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>HCO3-</p>\n</td>\n<td>\n<p>22 - 26 mEq/L</p>\n</td>\n<td>\n<p>&lt;22 mEq/L: <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> acidosis, &gt;26 mEq/L: <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> alkalosis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>PaO2</p>\n</td>\n<td>\n<p>75 - 100 mmHg</p>\n</td>\n<td>\n<p>Low PaO2 may indicate hypoxemia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>SaO2</p>\n</td>\n<td>\n<p>&gt;95%</p>\n</td>\n<td>\n<p>Measures <span class=\"customMeta\" data-dictid=\"b98c3a8ea216927771949889d9505f\">oxygen saturation</span> in arterial blood</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Base <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">Excess</span> (BE)</p>\n</td>\n<td>\n<p>-2 to +2 mEq/L</p>\n</td>\n<td>\n<p>Negative BE: <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> acidosis, Positive BE: <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> alkalosis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>O2 Saturation</p>\n</td>\n<td>\n<p>&gt;95%</p>\n</td>\n<td>\n<p>Measures <span class=\"customMeta\" data-dictid=\"b98c3a8ea216927771949889d9505f\">oxygen saturation</span> in arterial blood</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All the following are features of polycystic disease of kidneys except :", "options": [{"label": "A", "text": "Hematuria", "correct": false}, {"label": "B", "text": "Hypertension", "correct": false}, {"label": "C", "text": "Renal failure", "correct": false}, {"label": "D", "text": "Erythrocytosis", "correct": true}], "correct_answer": "D. Erythrocytosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Erythrocytosis: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable reason for the quadriparesis developed by a 60-year-old patient after being treated with a significant amount of hypertonic fluids for 24 hours following a history of hyponatremia?", "options": [{"label": "A", "text": "Brain infarct", "correct": false}, {"label": "B", "text": "Brainstem injury", "correct": false}, {"label": "C", "text": "Central pontine myelinolysis", "correct": true}, {"label": "D", "text": "Rare cause of hypernatremia", "correct": false}], "correct_answer": "C. Central pontine myelinolysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "AKIN and RIFLE criteria is used for classification of which of the folowing coditions?", "options": [{"label": "A", "text": "Acute kidney injury", "correct": true}, {"label": "B", "text": "Chronic kidney failure", "correct": false}, {"label": "C", "text": "Acute glomerulonephritis", "correct": false}, {"label": "D", "text": "Nephrotic syndrome", "correct": false}], "correct_answer": "A. Acute kidney injury", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>SCr/GFR Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Urine Output (UO) Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>R</strong>isk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> × 1.5 or ↓ <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> &gt; 25%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.5 mL/kg/h for 6 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>I</strong>njury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> × 2 or ↓ <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> &gt; 50%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.5 mL/kg/h for 12 hours</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>F</strong>ailure</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> × 3 or ↓ <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> &gt; 75%</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">Baseline <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> ≥ 353.6 μmol/L (≥ 4 mg/dL) +</p>\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> &gt; 44.2 μmol/L (&gt; 0.5 mg/dL)</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.3 mL/kg/h for 24 hours</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">Anuria for 12 hours</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>L</strong>oss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Function</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Complete loss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function for &gt; 4 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>E</strong>nd-Stage <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Complete loss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function for &gt; 3 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">Creatinine</span> (SCr) Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Urine Output (UO) Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> ≥ 26.5 μmol/L (≥ 0.3 mg/dL)</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> 150–200% (1.5–2 times)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.5 mL/kg/h for &gt; 6 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> &gt; 200–300% (&gt; 2–3 times)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.5 mL/kg/h for &gt; 12 hours</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>3</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Baseline <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> ≥ 353.6 μmol/L (≥ 4 mg/dL) +</p>\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> ≥ 44.2 μmol/L (≥ 0.5 mg/dL)</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> &gt; 300% (&gt; 3 times)</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">Patients requiring <strong>Renal Replacement Therapy (RRT)</strong>, regardless of <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> or UO at the time of initiation.</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.3 mL/kg/h for 24 hours or</p>\n<p style=\"text-align: center;\">Anuria for 12 hours</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has undergone an acute renal allograft transplantation. What would indicate its rejection?", "options": [{"label": "A", "text": "Rise of creatinine by more than 10% is suggestive of acute rejection.", "correct": false}, {"label": "B", "text": "Rise of creatinine by more than 5% is suggestive of acute rejection.", "correct": false}, {"label": "C", "text": "Serum creatinine does not rise in acute renal allograft rejection.", "correct": false}, {"label": "D", "text": "Any rise in serum creatinine will be suggestive of acute renal allograft rejection.", "correct": true}], "correct_answer": "D. Any rise in serum creatinine will be suggestive of acute renal allograft rejection.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:713px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Rejection</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hyperacute Rejection</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute Rejection</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic Rejection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">Cellular</span> Rejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute Antibody-Mediated Rejection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs immediately after transplant.</li>\n<li>Mediated by preformed antibodies against <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> endothelial cells.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs within days to weeks after transplant.</li>\n<li>Mediated by CD8+ T cells and CD4+ T cells.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibodies bind to <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> endothelial cells, leading to <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> and inflammation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Develops over months to years.</li>\n<li>Mediated by T cells.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minutes to hours after transplant.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Days to weeks after transplant.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Days to months after transplant.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Months to years after transplant.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">Hypersensitivity</span> Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type 2 (Cytotoxic Hypersensitivity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type 4 (Cell-mediated Hypersensitivity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type 2 (Cytotoxic Hypersensitivity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type 4 (Cell-mediated Hypersensitivity)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunologic Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pre-existing antibodies <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> complement.</li>\n<li>Causes endothelial injury and thrombosis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CD8+ T cells destroy <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> cells.</li>\n<li>CD4+ T cells induce inflammation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibodies against <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> antigens <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> complement.</li>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> inflammation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T cell-mediated response causes <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and dysfunction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No treatment.</li>\n<li>Requires <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> removal.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunosuppressive therapy (steroids, antithymocyte globulin).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plasmapheresis, IVIG, rituximab, steroids.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment.</li>\n<li>Supportive care and immunosuppression.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presents with hematuria. Which of the following are seen in glomerular hematuria? Statements: Brown-colored urine Dysuria absent Crystals present Edema rare", "options": [{"label": "A", "text": "1 only", "correct": false}, {"label": "B", "text": "1, 2", "correct": false}, {"label": "C", "text": "1, 2, 3", "correct": false}, {"label": "D", "text": "1, 2, 4", "correct": true}], "correct_answer": "D. 1, 2, 4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for nephrotic syndrome in children?", "options": [{"label": "A", "text": "Steroids", "correct": true}, {"label": "B", "text": "Steroids and cyclophosphamide", "correct": false}, {"label": "C", "text": "Cyclophosphamide", "correct": false}, {"label": "D", "text": "ACE inhibitors", "correct": false}], "correct_answer": "A. Steroids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steroid-Responsive <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steroid-Resistant <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome that responds well to <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> treatment.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome that does not improve despite adequate <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> treatment (e.g., <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> at 2 mg/kg/day for 6 weeks).</p>\n<p><strong>Types:</strong></p>\n<ul>\n<li><strong>Initial <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Resistance:</strong> Lack of response from the onset.</li>\n<li><strong>Late <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Resistance:</strong> Resistance develops after initial response.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minimal Change <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome (MCNS)</strong> accounts for about 80% of cases in children.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is often associated with <strong>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">Glomerulosclerosis</span> (FSGS) </strong>or genetic mutations affecting podocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosed without <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> biopsy; characterised by heavy proteinuria, low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> albumin, and no significant <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> damage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Further investigation (e.g., <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> biopsy) is required to determine the underlying cause.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Responds to high-dose corticosteroids (e.g., prednisolone)</strong><strong>,</strong> leading to <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> of <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> and oedema within 10-14 days.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment may include <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> agents, <span class=\"customMeta\" data-dictid=\"746f157681169277718323a004b1d4\">calcineurin</span> inhibitors, or other therapies, as corticosteroids are often ineffective.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman with a history of type 2 diabetes presents for a routine follow-up. Her serum creatinine and potassium levels are normal, but she has microalbuminuria and an HbA1c of 8%. Her blood pressure and pulse are within normal limits, and she is currently on metformin for diabetes management. What should be the next step in her management?", "options": [{"label": "A", "text": "Begin a thiazide diuretic", "correct": false}, {"label": "B", "text": "Start insulin therapy", "correct": false}, {"label": "C", "text": "Stop Metformin and start a different OHA", "correct": false}, {"label": "D", "text": "Start an ACE inhibitor", "correct": true}], "correct_answer": "D. Start an ACE inhibitor", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">Hypoglycemic</span> agents (OHAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>SGLT2 inhibitors </strong>lower the risk of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> events and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure; they are also recently approved for HFpEF.</li>\n<li>For HbA1C &lt; 9.5%, OHAs can be used</li>\n<li><strong>Metformin</strong> is <strong>withheld</strong> if <strong>eGFR is &lt; 30 mL/min/1.73 m2 </strong><strong>(Option C)</strong>, and drugs safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure can be used like\n\t\t\t\t<ul>\n<li>Glipizide</li>\n<li>Linagliptin</li>\n<li>Repaglinide</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80% of the calculated dose is started if <strong>HbA1C &gt; 9.5% </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antihypertensives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In the presence of microalbuminuria, ACEi and ARBs have shown evidence to slow the <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> if started in early stages.</li>\n<li>In hypertension, for BP &gt; 130/90, ACEi or ARBs are preferred</li>\n<li>If BP is still not under control, <strong>Calcium channel <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> (CCB)</strong> can be added</li>\n<li><strong>Thiazide diuretic</strong> - in the presence of oedema <strong>(Option A)</strong></li>\n<li>If eGFR &lt;30 ml/min, then the <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> used - <strong>Metolazone.</strong></li>\n<li>ACEi/ARB <span class=\"customMeta\" data-dictid=\"89f5610ffd1692777184b03f1f88cc\">comes</span> with a <span class=\"customMeta\" data-dictid=\"79506a117416927771988bbe7a8302\">side effect</span> of hyperkalemia; hence, regular monitoring of <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> is necessary.</li>\n<li>In the presence of <strong>hyperkalemia</strong>, ACEi/ARB is replaced by CCB</li>\n<li><strong>Alpha <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> (Prazosin) </strong>- <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> in ESRD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>K Binding resins</strong> (Bind to <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and promote its excretion)</p>\n<ul>\n<li>Sodium <span class=\"customMeta\" data-dictid=\"8904ca22bf1692777196567c8fff23\">polystyrene</span> sulfonate</li>\n<li>Patiromer</li>\n<li>Sodium zirconate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Transplant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>If eGFR is &lt; 20 mL/min/1.73</strong><strong>m2</strong><strong>.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is most likely based on the lab values given? Blood pH: 7.3 (indicating mild acidosis) Sodium (Na+): 134 mEq/L (mildly decreased) Potassium (K+): 2.8 mEq/L (hypokalemia) Chloride (Cl-): 113 mEq/L (elevated) Bicarbonate (HCO₃⁻): 12 mEq/L (low, indicating metabolic acidosis) Blood Urea Nitrogen (BUN): 3 mg/dL (low-normal) Creatinine: 0.6 mg/dL (normal) Urinary pH: 9.4 (alkaline)", "options": [{"label": "A", "text": "Renal Tubular Acidosis (RTA) Type 1 (Distal RTA)", "correct": true}, {"label": "B", "text": "Renal Tubular Acidosis (RTA) Type 2 (Proximal RTA)", "correct": false}, {"label": "C", "text": "Renal Tubular Acidosis (RTA) Type 4", "correct": false}, {"label": "D", "text": "High Anion Gap Metabolic Acidosis (HAGMA)", "correct": false}], "correct_answer": "A. Renal Tubular Acidosis (RTA) Type 1 (Distal RTA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aPIbgtXbuRmXX7JVgpJE1724926964.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"9ff00b798416927771974cced89037\"&gt;RTA&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\"&gt;Type 1&lt;/span&gt; (Distal RTA)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient having hypertension is on thiazides and is complaining of fatigue and hypokalemia. Which of the following drugs can prevent potassium loss?", "options": [{"label": "A", "text": "Furosemide", "correct": false}, {"label": "B", "text": "Amiloride", "correct": true}, {"label": "C", "text": "Acetazolamide", "correct": false}, {"label": "D", "text": "Indapamide", "correct": false}], "correct_answer": "B. Amiloride", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors </strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tubule, decreasing <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> reabsorption</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acetazolamide, Methazolamide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glaucoma, Altitude sickness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metabolic acidosis, Hypokalemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Loop diuretics </strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit the Na-K-2Cl <span class=\"customMeta\" data-dictid=\"1bede64bc91692777199b477cf43f1\">symporter</span> in the thick <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> loop of Henle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Furosemide, Bumetanide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, Chronic heart failure, Hypercalcemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia, <strong>Ototoxicity, </strong>Metabolic alkalosis,</p>\n<p>Hyperglycemia,</p>\n<p>Hyperuricemia</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Thiazide diuretics </strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit sodium <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hydrochlorothiazide, Chlorthalidone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension, Edema</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia, Hyponatremia,</p>\n<p>Hyperglycemia</p>\n<p>Hyperuricemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Potassium-sparing</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit sodium channels in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"32562f5afa1692777193c891837db9\">nephron</span> or block <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spironolactone, Amiloride</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart failure, Hyperaldosteronism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperkalemia, Gynecomastia (for Spironolactone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Osmotic diuretics </strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increase <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> of the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> filtrate, inhibiting water reabsorption.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mannitol, Glycerin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cerebral oedema, Acute glaucoma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dehydration, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">Electrolyte</span> imbalance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-year-old child with a history of GTCS came with an episode of convulsions for more than 45 minutes. What will be the appropriate management for this patient?", "options": [{"label": "A", "text": "Lorazepam followed by levetiracetam", "correct": true}, {"label": "B", "text": "Valproate followed by gabapentin", "correct": false}, {"label": "C", "text": "Carbamazepine followed by lorazepam", "correct": false}, {"label": "D", "text": "Levetiracetam followed by valproate", "correct": false}], "correct_answer": "A. Lorazepam followed by levetiracetam", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zLthToiJueyjVjgJFVAs1747295716.png", "https://image.prepladder.com/notes/JYUAe9j4BLAKRJ35iSc91747663677.png", "https://image.prepladder.com/notes/VJTut5lrv4lOfpNdEarU1747663700.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of seizure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anti-epileptic drug</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Partial or <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> seizure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lamotrigine</li>\n<li>Oxcarbazepine</li>\n<li>Eslicarbazepine</li>\n<li>Carbamazepine</li>\n<li>Phenytoin</li>\n<li>Levetiracetam</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generalized <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> clonic seizure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Valproate</li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absence seizure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ethosuximide</li>\n<li>Valproate</li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Febrile seizure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diazepam (rectal) (drug of choice)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Status epilepticus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lorazepam (drug of choice)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Juvenile myoclonic <span class=\"customMeta\" data-dictid=\"7546d26cea1692777187c257d4e14c\">epilepsy</span> (Janz syndrome)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug of choice: Valproate &gt; Lamotrigine &gt; Topiramate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lennox Gestaut syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Valproate (first line drug)</strong></p>\n<p style=\"text-align: center;\"><img alt=\"Lennox Gestaut \" data-author=\"\" data-hash=\"13024\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"598\" src=\"https://image.prepladder.com/notes/JYUAe9j4BLAKRJ35iSc91747663677.png\" width=\"300\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dravet's syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Valproate (drug of choice)</strong></p>\n<p style=\"text-align:center\"><img alt=\"Dravet syndrome management\" data-author=\"\" data-hash=\"13025\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"104\" src=\"https://image.prepladder.com/notes/VJTut5lrv4lOfpNdEarU1747663700.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infantile <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> ( also known as West syndrome or Hypsarrhythmia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occasional episodes: </strong></p>\n<ul>\n<li><strong>Drug of choice: ACTH hormone +/- glucocorticoids</strong></li>\n</ul>\n<p> </p>\n<p><strong>Associated with <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> (lifelong seizures):</strong></p>\n<ul>\n<li><strong>Drug of choice: Vigabatrin</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Levetiracetam (safest in pregnancy)</strong></li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male is admitted to the medicine ward with complaints of vomiting and diarrhea. Lab investigations reveal a serum potassium level of 3.2 mEq/L. All of the following can be signs of underlying dyselectrolytemia except:", "options": [{"label": "A", "text": "Ventricular tachycardia", "correct": false}, {"label": "B", "text": "Quadriplegia", "correct": false}, {"label": "C", "text": "Diabetes insipidus", "correct": false}, {"label": "D", "text": "Cerebral edema", "correct": true}], "correct_answer": "D. Cerebral edema", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Cerebral edema: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most likely condition responsible for a 35-year-old male experiencing nausea, diarrhea, and vomiting, with ABG results indicating pH of 7.55, PCO2 of 50 mmHg, and HCO3- of 44 mmol?", "options": [{"label": "A", "text": "Respiratory Acidosis", "correct": false}, {"label": "B", "text": "Respiratory Alkalosis", "correct": false}, {"label": "C", "text": "Metabolic Acidosis", "correct": false}, {"label": "D", "text": "Metabolic Alkalosis", "correct": true}], "correct_answer": "D. Metabolic Alkalosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Metabolic Alk\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>DISORDER</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>PREDICTION OF COMPENSATION</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>RANGE OF VALUES</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HCO<sub>3</sub> <sup>–</sup></strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>PaCO<sub>2</sub></strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metabolic acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PaCO<sub>2</sub> = (1.5 × HCO<sub>3</sub> <sup>–</sup> ) + 8 ± 2</p>\n<p>Or</p>\n<p>↓ 1.25 mmHg per mmol/L ↓ in [HCO<sub>3</sub> <sup>–</sup> ]</p>\n<p>Or</p>\n<p>PaCO<sub>2</sub> = [HCO<sub>3</sub> <sup>–</sup>] + 15</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metabolic alkalosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PaCO<sub>2</sub> will ↑ 0.75 mmHg per mmol/L ↑ in [HCO<sub>3</sub> <sup>–</sup> ]</p>\n<p>Or</p>\n<p>↑ 6 mmHg per 10 mmol/L ↑ in [HCO<sub>3</sub> <sup>–</sup> ]</p>\n<p>Or</p>\n<p>PaCO<sub>2</sub> = [HCO<sub>3</sub> <sup>–</sup> ] + 15</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory alkalosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>[HCO<sub>3</sub> <sup>–</sup>] will ↓ 0.2 mmol/L per mmHg ↓ in PaCO<sub>2</sub></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>[HCO<sub>3</sub> <sup>–</sup> ] will ↓ 0.4 mmol/L per mmHg ↓ in PaCO<sub>2</sub></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>Acute</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>[HCO<sub>3</sub> <sup>–</sup>] will ↑ 0.1 mmol/L per mmHg ↑ in PaCO<sub>2</sub></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>[HCO<sub>3</sub> <sup>–</sup> ] will ↑ 0.4 mmol/L per mmHg ↑ in PaCO<sub>2</sub></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "\"Which of the following best characterizes the acid-base status of a 45-year-old diabetic patient presenting to the emergency department with abdominal pain, tachypnea, and tachycardia, whose arterial blood gas analysis reveals the following: pH: 7.34 Sodium (Na): 135 Potassium (K): 5 Bicarbonate (HCO3): 12 Chloride (Cl): 92 RBS = 450 mg/dl", "options": [{"label": "A", "text": "Non-Anion Gap Metabolic Acidosis (NAGMA)", "correct": false}, {"label": "B", "text": "High Anion Gap Metabolic Acidosis (HAGMA)", "correct": true}, {"label": "C", "text": "Compensated Metabolic Alkalosis", "correct": false}, {"label": "D", "text": "Respiratory Acidosis", "correct": false}], "correct_answer": "B. High Anion Gap Metabolic Acidosis (HAGMA)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with complaints of pain in the flank region with hematuria. On investigation, an X-ray shows multiple calcifications (stones) in both kidneys. What is the probable diagnosis?", "options": [{"label": "A", "text": "Parathyroid Adenoma", "correct": false}, {"label": "B", "text": "Renal calculi", "correct": true}, {"label": "C", "text": "Polycystic kidney disease", "correct": false}, {"label": "D", "text": "CKD", "correct": false}], "correct_answer": "B. Renal calculi", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KUHvhO7ApFEUAkycHlIX1745930726.png"], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\"&gt;Renal&lt;/span&gt; calculi</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Medical management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Surgical Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Analgesics</strong> like diclofenac, ketorolac, tramadol</li>\n<li><strong>Fluid therapy:</strong> IVF (intravenous fluids) are administered to prevent dehydration</li>\n<li><strong>Alpha 1 blocker:</strong> Tamsulosin (relaxes <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and expels the stone).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Extracorporeal shock wave <span class=\"customMeta\" data-dictid=\"6713a50e721692777191903bb2160c\">lithotripsy</span> (ESWL): </strong>Indicated if the size of the calculi<strong> &lt;2 cm</strong>. (Contraindicated in pregnancy and <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> diathesis).</li>\n<li><strong>PCNL (Percutaneous nephrolithotomy): </strong>If the size is &gt;2 cm.</li>\n<li><strong>Uretrorenoscopy</strong></li>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"544d770dfc1692777190622242d004\">intrarenal</span> surgery</strong></li>\n<li>Pyelolithotomy and <span class=\"customMeta\" data-dictid=\"5dda24df28169277719383e298df18\">nephrolithotomy</span> (rarely used).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient developed hyperpigmentation of distal fingers after being hospitalized post-adrenalectomy. What could be the possible cause?", "options": [{"label": "A", "text": "Addison’s disease", "correct": false}, {"label": "B", "text": "Conn's syndrome", "correct": false}, {"label": "C", "text": "Nelson syndrome", "correct": true}, {"label": "D", "text": "Cushing syndrome", "correct": false}], "correct_answer": "C. Nelson syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Nelson syndrome</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nelson's syndrome</strong> is a condition that typically occurs <strong>after <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> adrenalectomy</strong> for the treatment of <strong>Cushing's disease</strong> (pituitary-dependent Cushing’s syndrome). The removal of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> glands leads to a lack of <span class=\"customMeta\" data-dictid=\"267c66363316927771936565b4c6a4\">negative feedback</span> on the pituitary, resulting in <strong>increased <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of ACTH</strong>. Over time, the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> may develop a <strong>pituitary adenoma</strong> (or <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of an existing adenoma), which secretes <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> in excess.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prophylactic radiation therapy may be indicated to prevent the development of Nelson’s syndrome after adrenalectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperpigmentation</li>\n<li>Bitemporal hemianopia</li>\n<li>Progressive visual loss in cases of large tumours</li>\n<li>Headache</li>\n<li>Weakness and fatigue</li>\n<li>Inhibition of the release of other <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Evaluation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> Levels:</strong>\n<ul>\n<li>Very high levels.</li>\n<li>Diagnosis confirmed by an <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> increase &gt;30% of the initial result on three consecutive samples after <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> adrenalectomy.</li>\n</ul>\n</li>\n<li>Decreased levels of <strong>anterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones</strong>.</li>\n<li><strong>Brain <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> </strong>shows <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> tumours or <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of existing tumours.</li>\n<li>Screening:\n\t\t\t\t<ul>\n<li>Regular screening with <strong>fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> levels</strong> and brain <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> in patients after <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> adrenalectomy.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgical Removal of the Tumor</li>\n<li>Radiotherapy / Radiosurgery</li>\n<li>Medical Treatment</li>\n<li>Hormonal Replacement Therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "23 year old person with a history of flank Pain and fatigue and history of red coloured urine. On investigation there were more than 20 RBC/ hpf and microscopy showed dysmorphic RBC. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Minimal change disease", "correct": false}, {"label": "B", "text": "PSGN", "correct": true}, {"label": "C", "text": "UTI", "correct": false}, {"label": "D", "text": "Bladder calculi", "correct": false}], "correct_answer": "B. PSGN", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - PSGN\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with hyperkalemia and elevated urea levels underwent dialysis. Towards the end of the session, she became drowsy and had a sudden seizure episode. On examination, the patient was hypotensive. What is the treatment for this condition?", "options": [{"label": "A", "text": "Bumetanide", "correct": false}, {"label": "B", "text": "Ethacrynic acid", "correct": false}, {"label": "C", "text": "Nesiritide", "correct": false}, {"label": "D", "text": "IV Mannitol", "correct": true}], "correct_answer": "D. IV Mannitol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - IV Mannitol:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications associated with Hemodialysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>During treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Between treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hypotension:</strong> <strong>The most common <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> during hemodialysis</strong>, especially in patients with diabetes mellitus.</li>\n<li><strong>Muscle cramps</strong>.</li>\n<li><strong>Anaphylactoid reactions: </strong>These reactions, particularly to the dialyser, are most common during its first use and are often associated with <strong>bio <span class=\"customMeta\" data-dictid=\"10dcdd93561692777190d73418c5a7\">incompatible</span> cellulosic-containing membranes.</strong></li>\n<li><strong>Cardiac arrhythmias: </strong>D/t <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> &amp; acid-base shifts.</li>\n<li><strong>Hemorrhage: </strong>D/t <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> &amp; <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> needle disconnection.</li>\n<li><strong>Air embolism: </strong>D/t faulty lines &amp; equipment malfunction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pulmonary oedema</strong> (D/t fluid overload).</li>\n<li><strong>Systemic sepsis: </strong>Usually involves <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> access devices (catheter or fistula).</li>\n<li><strong>Dialysis <span class=\"customMeta\" data-dictid=\"6020176bfd16927771866a4128521e\">disequilibrium</span> syndrome </strong>typically occurs during or after a patient's first <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">dialysis</span> session. It presents with confusion, restlessness, headache, and muscle twitching. It is caused by a <strong>urea <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between the <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> and blood that raises <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure.</strong></li>\n<li><strong>Amyloidosis (</strong>D/t<strong> <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> 2 microglobulin</strong>)</li>\n<li><strong>Carpal tunnel syndrome (</strong>due to <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> deposition in the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> retinaculum).</li>\n<li><strong>Peripheral neuropathy</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following medications is not employed for the urgent (immediate) treatment of hyperkalemia?", "options": [{"label": "A", "text": "10% calcium gluconate over 10 min", "correct": false}, {"label": "B", "text": "Salbutamol nebulisation", "correct": false}, {"label": "C", "text": "Insulin-dextrose", "correct": false}, {"label": "D", "text": "Injection MgSO4", "correct": true}], "correct_answer": "D. Injection MgSO4", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate <span class=\"customMeta\" data-dictid=\"99de407a1516927771818ac910ab5f\">antagonism</span> of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium gluconate: </strong></p>\n<ul>\n<li>Dose: 10 mL of 10% IV <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> gluconate</li>\n<li>DOC in management of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> severe <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> <strong>(K+ &gt; 6.5 mEq/L)</strong></li>\n<li>DOC in <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">Hyperkalemia</span> with <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Redistribution of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> K+ </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular Insulin:</strong></p>\n<ul>\n<li>10 U of IV Regular insulin</li>\n<li>Usually followed by 50 mL 50% Dextrose</li>\n<li>Most effective drug</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Removal of K+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sodium <span class=\"customMeta\" data-dictid=\"8904ca22bf1692777196567c8fff23\">polystyrene</span> sulfonate:</strong> ADR - Intestinal necrosis</li>\n<li><strong>Sodium zirconate (ZS-9):</strong> more safer</li>\n<li><strong>Patiromer:</strong> Oral novel <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> binder</li>\n<li><strong>Loop &amp; <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">Thiazide</span> diuretics: </strong>Furosemide, Hydrochlorothiazide</li>\n<li><strong>Hemodialysis: </strong>Most effective for K+ elimination, done for <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> hyperkalemia.</li>\n<li><strong>Sodium bicarbonate</strong> (NaHCO3) &amp; <strong>IV Normal saline</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following aid in the localization of the lesion to the spinal cord except?", "options": [{"label": "A", "text": "Contralateral hemiplegia", "correct": true}, {"label": "B", "text": "Fasciculation at the level of lesion", "correct": false}, {"label": "C", "text": "Upper motor neuron lesion and lower motor neuron lesion", "correct": false}, {"label": "D", "text": "Bladder involvement", "correct": false}], "correct_answer": "A. Contralateral hemiplegia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An increased anion gap is seen in:", "options": [{"label": "A", "text": "Respiratory acidosis", "correct": false}, {"label": "B", "text": "Respiratory alkalosis", "correct": false}, {"label": "C", "text": "Metabolic acidosis", "correct": true}, {"label": "D", "text": "Metabolic alkalosis", "correct": false}], "correct_answer": "C. Metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic acidosis </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High anion gap </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-anion gap </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>M</strong>ethanol poisoning</li>\n<li><strong>U</strong>remia: AKI, CKD</li>\n<li><strong>D</strong>iabetic ketoacidosis</li>\n<li><strong>P</strong>aracetamol poisoning</li>\n<li><strong>I</strong>ron and isoniazid</li>\n<li><strong>L</strong>actic acidosis</li>\n<li><strong>E</strong>thylene glycol poisoning</li>\n<li><strong>S</strong>alicylate poisoning</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>H</strong>yperchloremia</li>\n<li><strong>A</strong>ddison's disease</li>\n<li><strong>R</strong>enal tubular acidosis</li>\n<li><strong>D</strong>iarrhoea and conditions causing GI loss of HCO3- (ureterosigmoidostomy or external bowel drainage)</li>\n<li><strong>A</strong>cetazolamide</li>\n<li><strong>S</strong>pironolactone and K-sparing diuretics</li>\n<li><strong>S</strong>aline infusion (rapid infusion )</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reduced anion gap: </strong>Multiple myeloma and nephrotic syndrome</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable cause of the muteness, quadriplegia, and rigidity observed in an elderly female patient who had a previous medical history of severe vomiting and was aggressively treated for severe dehydration at a different hospital one week ago?", "options": [{"label": "A", "text": "Malignant hyperthermia", "correct": false}, {"label": "B", "text": "Severe catatonia", "correct": false}, {"label": "C", "text": "Rapid sodium correction", "correct": true}, {"label": "D", "text": "Neuroleptic malignant syndrome", "correct": false}], "correct_answer": "C. Rapid sodium correction", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ry9FsPCqONlCWdeZkziT1745310185.png"], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Etiology</td>\n<td>Rapid <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of chronic hyponatremia</td>\n</tr>\n<tr>\n<td>Common in</td>\n<td>Alcoholics, malnourished, post-liver transplant</td>\n</tr>\n<tr>\n<td>Neurological features</td>\n<td>Dysarthria, mutism, quadriplegia, <span class=\"customMeta\" data-dictid=\"ff28d82b771692777196e11af7eb88\">pseudobulbar</span> palsy</td>\n</tr>\n<tr>\n<td>Imaging</td>\n<td>MRI shows symmetric lesions in central pons</td>\n</tr>\n<tr>\n<td>Prevention</td>\n<td>Limit sodium <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> to ≤8–10 mEq/L in 24 hrs</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a cause of chronic bipedal edema?", "options": [{"label": "A", "text": "Chronic liver disease", "correct": false}, {"label": "B", "text": "Nephrotic syndrome", "correct": false}, {"label": "C", "text": "Chronic venous insufficiency", "correct": true}, {"label": "D", "text": "Lupus nephritis", "correct": false}], "correct_answer": "C. Chronic venous insufficiency", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mgNtnrD9u05S3xHruxlW1718002931.png"], "explanation": "<p>Correct Option C - Chronic &lt;span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\"&gt;venous&lt;/span&gt; insufficiency: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In methanol intoxication, which of the subsequent electrolyte abnormalities is observed?", "options": [{"label": "A", "text": "Metabolic alkalosis with high anion gap", "correct": false}, {"label": "B", "text": "Metabolic acidosis with high anion gap", "correct": true}, {"label": "C", "text": "Metabolic acidosis with normal anion gap", "correct": false}, {"label": "D", "text": "Metabolic alkalosis with normal anion gap", "correct": false}], "correct_answer": "B. Metabolic acidosis with high anion gap", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of High-Anion Gap <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ketoacidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diabetic</p>\n<p>Alcoholic</p>\n<p>Starvation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ethylene glycol</p>\n<p>Methanol - Salicylates</p>\n<p>Propylene glycol</p>\n<p>Pyroglutamic acid (5-oxoproline)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute and chronic</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with hypokalemic metabolic alkalosis with hypertension?", "options": [{"label": "A", "text": "Barter syndrome", "correct": false}, {"label": "B", "text": "Liddle syndrome", "correct": true}, {"label": "C", "text": "Gitelman syndrome", "correct": false}, {"label": "D", "text": "Gordon syndrome", "correct": false}], "correct_answer": "B. Liddle syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YQK8sLhQPBiTAd9Na67z1747056619.png", "https://image.prepladder.com/notes/kwuE9yR3qOtD2sxiq6OH1747056657.png", "https://image.prepladder.com/notes/Xa8BPpc7Jw9Fj39p51PS1747056699.png", "https://image.prepladder.com/notes/ne333tjNDhc9D8NSZFDE1747125601.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:1000px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Renal Tubular Syndromes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Defect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Seen in </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Effects </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fanconi Syndrome </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalised <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in <strong>PCT</strong></p>\n<figure class=\"caption_element\"><img alt=\"Fanconi_s Syndrome\" data-author=\"NA\" data-hash=\"12605\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/YQK8sLhQPBiTAd9Na67z1747056619.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Childhood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hereditary defects (wilson disease, tyrosinemia, <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> storage disease, cystinosis)</li>\n<li>Multiple myeloma</li>\n<li>Ischemia</li>\n<li>Nephrotoxic drugs (ifosfamide, cisplatin, tenofovir, expired tetracycline)</li>\n<li>Lead poisoning</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> (proximal RTA)</li>\n<li>Hypophosphatemia</li>\n<li>Phosphaturia</li>\n<li>Osteopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gitelman Syndrome (Option C)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reabsorptive <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> of NaCl- in<strong> DCT.</strong></li>\n<li>Mimics chronic <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> use.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Gitelman\" data-author=\"NA\" data-hash=\"12606\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/kwuE9yR3qOtD2sxiq6OH1747056657.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Late childhood or adulthood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypokalemia</strong></li>\n<li><strong>Hypomagnesemia </strong></li>\n<li><strong>Metabolic alkalosis</strong></li>\n<li><strong>Hypocalciuria </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bartter Syndrome (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reabsorptive <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in<strong> thick <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> loop of Henle.</strong></li>\n<li>Affects Na+/K+/2Cl- cotransporter.</li>\n<li>Mimics chronic loop <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> use.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bartter \" data-author=\"NA\" data-hash=\"12607\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/Xa8BPpc7Jw9Fj39p51PS1747056699.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Childhood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypokalemia</strong></li>\n<li><strong>Metabolic alkalosis</strong></li>\n<li><strong>Hypercalciuria </strong></li>\n<li><strong>Hyperchloremia </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liddle Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gain of function <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> → ↑ Na+ <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in <strong>collecting tubules</strong> (↑ activity of Na+ channel)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\" Liddle Syndrome\" data-author=\"NA\" data-hash=\"12667\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/ne333tjNDhc9D8NSZFDE1747125601.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Childhood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypertension</strong></li>\n<li><strong>Hypokalemia</strong></li>\n<li><strong>Metabolic <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> </strong></li>\n<li>Hypoaldosteronism</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ https://www.sciencedirect.com/topics/medicine-and-dentistry/fanconi-syndrome</li><li>↳ https://www.msdmanuals.com/professional/pediatrics/congenital-renal-transport-abnormalities/bartter-syndrome-and-gitelman-syndrome#Etiology_v1098222</li><li>↳ https://www.ncbi.nlm.nih.gov/books/NBK536911/#</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with chronic kidney disease came with complaints of vomiting and diarrhea . His blood gas reports show pH = 7.40, HC0 3 - = 23 mEq/L, Na + = 145 mEq/L, anion gap= 100 mEq/L . What is your probable diagnosis ?", "options": [{"label": "A", "text": "No acid base abnormality", "correct": false}, {"label": "B", "text": "Respiratory acidosis", "correct": false}, {"label": "C", "text": "Metabolic alkalosis", "correct": false}, {"label": "D", "text": "High anion gap metabolic acidosis with metabolic alkalosis", "correct": true}], "correct_answer": "D. High anion gap metabolic acidosis with metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - High &lt;span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\"&gt;anion&lt;/span&gt; gap &lt;span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\"&gt;metabolic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\"&gt;acidosis&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\"&gt;metabolic&lt;/span&gt; alk\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Na<sup>+</sup></strong></td>\n<td>Within normal range</td>\n</tr>\n<tr>\n<td><strong>pH</strong></td>\n<td>Within normal range</td>\n</tr>\n<tr>\n<td><strong>HCO<sub>3</sub></strong></td>\n<td>Within <span class=\"customMeta\" data-dictid=\"f3ae79c18b1692777193468a9fd567\">normal range</span> (Indicates <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> as it is not reciprocally reduced)</td>\n</tr>\n<tr>\n<td><strong>Anion gap</strong></td>\n<td>Increased (indicates <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis)</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "AKIN and RIFLE criteria are used to classify which of the following conditions?", "options": [{"label": "A", "text": "Acute kidney injury", "correct": true}, {"label": "B", "text": "Chronic renal failure", "correct": false}, {"label": "C", "text": "Acute glomerulonephritis", "correct": false}, {"label": "D", "text": "Nephrotic syndrome", "correct": false}], "correct_answer": "A. Acute kidney injury", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Acute &lt;span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\"&gt;kidney&lt;/span&gt; injury:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>AKIN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>RIFLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on changes in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> and <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on changes in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> creatinine, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, and GFR.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serum Creatinine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ≥0.3 mg/dL within 48 hours or ≥1.5 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> within 7 days.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>R (Risk): Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ≥1.5 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> decrease &gt;25%.</p>\n<p>I (Injury): Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ≥2 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> decrease &gt;50%.</p>\n<p>F (Failure): Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ≥3 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> decrease &gt;75%.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urine Output</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output (&lt;0.5 mL/kg/hour for &gt;6 hours).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>O (Loss): Persistent <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury with complete loss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function for &gt;4 weeks.</p>\n<p>E (End-stage <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease): Persistent <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury with complete loss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function for &gt;3 months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staging</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AKIN stage 1: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ≥0.3 mg/dL or ≥1.5 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.5 mL/kg/hour for 6-12 hours.</p>\n<p>AKIN stage 2: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ≥2 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.5 mL/kg/hour for ≥12 hours.</p>\n<p>AKIN stage 3: Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ≥3 times <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> or <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> ≥4.0 mg/dL or <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> replacement therapy (RRT) or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output &lt;0.3 mL/kg/hour for ≥24 hours or <span class=\"customMeta\" data-dictid=\"44c00aef45169277718165c67e8271\">anuria</span> for ≥12 hours.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RIFLE classifies severity based on the R, I, F, O, and E criteria.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical Application</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in research, clinical trials, and clinical practice for AKI diagnosis and staging.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Widely used in research, clinical trials, and clinical practice for AKI diagnosis, classification, and outcome assessment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limitations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Relies on <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> and <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, which can be influenced by factors such as age, muscle mass, fluid status, and medications.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar limitations as AKIN criteria.</p>\n<p>More recent studies suggest that RIFLE may be more predictive of mortality and need for RRT.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5 year old child presents to the OPD with pedal edema and facial puffiness for the past 5 days. BP was 126/80 mm Hg, proteinuria 3+. Urine examination shows 100 RBCs/hpf . What is the most likely diagnosis ?", "options": [{"label": "A", "text": "Post-streptococcal glomerulonephritis", "correct": true}, {"label": "B", "text": "Minimal change disease", "correct": false}, {"label": "C", "text": "Membranous glomerulonephritis", "correct": false}, {"label": "D", "text": "Focal segmental glomerulosclerosis", "correct": false}], "correct_answer": "A. Post-streptococcal glomerulonephritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/c9INubzvyXzGAP8LRGqr1713269117.png"], "explanation": "<p>Correct Option A - Post-streptococcal glomeruloneph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the anion gap from the following values: Na + = 137 mmol/L K + = 4 mmol/L CI - = 100 mmol/L HCO 3 - = 15 mmol/L", "options": [{"label": "A", "text": "26 mmol/L", "correct": true}, {"label": "B", "text": "16 mmol/L", "correct": false}, {"label": "C", "text": "10 mmol/L", "correct": false}, {"label": "D", "text": "12 mmol/L", "correct": false}], "correct_answer": "A. 26 mmol/L", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 22 mmol/L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rinku devi, a 26 years old female, labourer by occupation presented to you with complains of pain abdomen, nausea and restlessness since 4 hours . She gives h/o 2 episodes of hematuria. USG showed a 3×3 cm stone in Right renal pelvis . There is no evidence of hydronephrosis . Which of following is the best procedure for management of this patient?", "options": [{"label": "A", "text": "ESWL", "correct": false}, {"label": "B", "text": "PCNL", "correct": true}, {"label": "C", "text": "Antegrade Pyeloplasty", "correct": false}, {"label": "D", "text": "Retrograde pyeloplasty", "correct": false}], "correct_answer": "B. PCNL", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - PCNL\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who has symptoms of frequent urination, nocturia, and enuresis, along with a 24-hour urine volume of 7 liters, a urine osmolarity of 260 mOsm/L, an ADH assay result of 0.8 pg/ml, and a brain MRI showing no bright spot on T1 weighted images?", "options": [{"label": "A", "text": "Nephrogenic DI", "correct": false}, {"label": "B", "text": "Primary polydipsia", "correct": false}, {"label": "C", "text": "Pituitary DI", "correct": true}, {"label": "D", "text": "Mannitol infusion", "correct": false}], "correct_answer": "C. Pituitary DI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\"&gt;Pituitary&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"7194dbeaed1692777186e2554f8ebf\"&gt;DI&lt;/span&gt; (diabetes insipidus)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10 year old male child was brought with complains of headache, cola colored urine. His parents give history of throat pain 2 weeks ago . On examination, red blood cells casts are present in urine and his KFT is increased two fold. What is the likely diagnosis?", "options": [{"label": "A", "text": "Minimal change disease", "correct": false}, {"label": "B", "text": "Membranous Glomerulopathy", "correct": false}, {"label": "C", "text": "Post infectious Glomerulonephritis", "correct": true}, {"label": "D", "text": "IgA nephropathy", "correct": false}], "correct_answer": "C. Post infectious Glomerulonephritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cGf2DvrnVDlW3D7Yixfi1713269330.png"], "explanation": "<p>Correct Option C - Post &lt;span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\"&gt;infectious&lt;/span&gt; Glomeruloneph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 61 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 12 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 42-year-old woman comes to the OPD due to the passage of blood in her urine, along with complaints of left flank pain, fatigue and generalised weakness. She has a history of recurrent renal stones. USG confirmed the presence of renal stones in her left renal pelvis. Lab reports show the following values. Based on the values given below, what is the most likely diagnosis? Blood pH - 7.29 Serum sodium - 144 mEq/L Serum potassium - 3.1 mEq/L Serum bicarbonate - 9 mEq/L Urine pH - 5.8 Urine calcium - elevated Urine citrate - low Normal anion gap", "options": [{"label": "A", "text": "Type 2 Renal tubular acidosis", "correct": false}, {"label": "B", "text": "Hyperparathyroidism", "correct": false}, {"label": "C", "text": "Type 1 Renal tubular acidosis", "correct": true}, {"label": "D", "text": "Hypoaldosteronism", "correct": false}], "correct_answer": "C. Type 1 Renal tubular acidosis", "question_images": [], "explanation_images": [], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Type 1 <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis</strong></td>\n<td> </td>\n</tr>\n<tr>\n<td><strong>Defect </strong></td>\n<td>\n<ul>\n<li>Inability of the <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> <span class=\"customMeta\" data-dictid=\"cfd35769b016927771901681bcc115\">intercalated</span> cells (DCT) to <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> H+ into <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> ➜ <strong>Metabolic acidosis</strong></li>\n<li>￬ H+ <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> leads to ￬ K+ <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> ➜ <strong>Hypokalemia</strong></li>\n</ul>\n<p><img alt=\"Type 1 &lt;span class=\" custommeta\"=\"\" data-dictid=\"b9356afdba16927771979d068c6587\"/>renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> \" data-author=\"\" data-hash=\"8420\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"531\" src=\"https://image.prepladder.com/notes/P5k1cj5pstPpIuHdSo6C1744277453.png\" width=\"531\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td><strong>Serum electrolytes</strong></td>\n<td>Hypokalemia</td>\n</tr>\n<tr>\n<td><strong>Urine changes </strong></td>\n<td>Hypocitraturia, hypercalciuria, pH&gt; 5.5</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:520px\"><strong>Causes</strong></td>\n<td>\n<ul>\n<li>Amphotericin B</li>\n<li>Analgesic toxicity</li>\n<li>Lithium toxicity</li>\n<li>Autoimmunity (Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Erythematosus, Sjogren's syndrome)</li>\n<li>Hyperglobulinemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Association </strong></td>\n<td>\n<ul>\n<li><strong>Nephrolithiasis </strong></li>\n<li>Nephrocalcinosis</li>\n<li>Osteopenia / <span class=\"customMeta\" data-dictid=\"fc9f873eb21692777194d3feb4e68d\">osteomalacia</span> / Rickets</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Management </strong></td>\n<td>\n<ul>\n<li>Oral sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> ➜ Neutralizes acidosis</li>\n<li>Treating <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> (potassium citrate)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old woman comes to the OPD for a regular annual check-up. Her blood tests reveal a serum bicarbonate level of 12 mEq/L, serum potassium of 3.2 mEq/L, and a normal anion gap metabolic acidosis. Urine pH is 5.2, and aminoaciduria and glycosuria are detected despite normal blood glucose levels. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Distal Renal tubular acidosis", "correct": false}, {"label": "B", "text": "Proximal Renal tubular acidosis", "correct": true}, {"label": "C", "text": "Generalised Renal tubular acidosis", "correct": false}, {"label": "D", "text": "Bartter syndrome", "correct": false}], "correct_answer": "B. Proximal Renal tubular acidosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/hqNXbRnVwmweqATpq8WA1746520065.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Type 2 <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis</strong></td>\n<td> </td>\n</tr>\n<tr>\n<td><strong>Defect </strong></td>\n<td>\n<p>Defective<strong> HCO3- reabsorption</strong> in the <strong>PCT </strong>➜ <strong>Metabolic acidosis</strong></p>\n<p><img alt=\"IM335-Proximal (Type 2 ) RTA\" data-author=\"\" data-hash=\"12163\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/hqNXbRnVwmweqATpq8WA1746520065.png\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Serum electrolytes</strong></td>\n<td>\n<p><strong>Hypokalemia</strong></p>\n<p>Due to ￪ HCO3⁻ loss ➜ Higher sodium delivery to the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">tubule</span> ➜ Increased <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> ➜ Hypokalemia</p>\n</td>\n</tr>\n<tr>\n<td><strong>Urine changes</strong></td>\n<td><strong>Glycosuria</strong>, <strong>aminoaciduria</strong>, <strong>phosphaturia</strong> (Fanconi syndrome) <strong>pH&lt; 5.5</strong></td>\n</tr>\n<tr>\n<td><strong>Causes</strong></td>\n<td>\n<ul>\n<li>Fanconi syndrome</li>\n<li>Wilson's disease</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> (Paraproteinaemia)</li>\n<li>Heavy metals (Lead, cadmium, mercury)</li>\n<li>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors</li>\n<li>Tenofovir, topiramate</li>\n<li>Expired tetracycline</li>\n<li>Galactosemia</li>\n<li>Cystinosis</li>\n<li>Cisplatin therapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Association</strong></td>\n<td>Hypophosphatemic <span class=\"customMeta\" data-dictid=\"3bbd4ac09b16927771974d75a8b355\">rickets</span> in Fanconi syndrome</td>\n</tr>\n<tr>\n<td><strong>Treatment </strong></td>\n<td>\n<p>Oral sodium bicarbonate</p>\n<p>Thiazide diuretics</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with a 10-year history of type 2 diabetes presents with generalised weakness, muscle cramps, and fatigue for the past 3 weeks. He has hypertension and chronic kidney disease and is currently taking metformin, spironolactone, and furosemide. If diagnosed with Type 4 renal tubular acidosis, which finding would be least likely in his investigation report?", "options": [{"label": "A", "text": "Hypoaldosteronism", "correct": false}, {"label": "B", "text": "Hypokalemia", "correct": true}, {"label": "C", "text": "Low urinary ammonium", "correct": false}, {"label": "D", "text": "Normal urinary calcium", "correct": false}], "correct_answer": "B. Hypokalemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4 <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Defect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoaldosteronism or <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> resistance <strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum electrolytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperkalemia</strong><strong> (Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine changes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"3719e878a4169277718109b2d3f67e\">ammonium</span> </strong><strong>(Option C)</strong><strong>, pH&lt; 5.5, normal <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> calcium</strong><strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypoaldosteronism\n\t\t\t\t<ul>\n<li>Diabetic hypo-reninism</li>\n<li>HIV associated nephropathy</li>\n<li>ACE inhibitors / ARB</li>\n<li>Cyclosporine, NSAIDs</li>\n<li>Adrenal insufficiency</li>\n</ul>\n</li>\n<li>Aldosterone resistance\n\t\t\t\t<ul>\n<li>K+ sparing diuretics</li>\n<li>Obstructive nephropathy</li>\n<li>Trimethoprim-sulfamethoxazole (TMP-SMX)</li>\n</ul>\n</li>\n<li>Renal transplant rejection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Furosemide (for hyperkalemia)</p>\n<p>Dietary <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> restriction</p>\n<p>Mineralocorticoid replacement: <strong>Fludrocortisone</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following types of renal tubular acidosis (RTA) with their mechanism of action, RTA type 1 a. Epithelial sodium channels resistance to aldosterone 2. RTA type 2 b. Damage to alpha intercalated cells 3. RTA type 4 c. Generalized dysfunctioning of proximal convoluted tubule", "options": [{"label": "A", "text": "1-a, 2-b, 3-c", "correct": false}, {"label": "B", "text": "1-b, 2-c, 3-a", "correct": true}, {"label": "C", "text": "1-c, 2-b, 3-a", "correct": false}, {"label": "D", "text": "1-c, 2-a, 3-b", "correct": false}], "correct_answer": "B. 1-b, 2-c, 3-a", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:752px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RTA type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RTA type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RTA type 4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DCT (distal <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCT (proximal <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DCT (distal <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Damage to <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> <span class=\"customMeta\" data-dictid=\"cfd35769b016927771901681bcc115\">intercalated</span> cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalized dysfunctioning of <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epithelial sodium channels resistance to aldosterone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about renal tubular acidosis (RTA) is incorrect?", "options": [{"label": "A", "text": "Hydrogen ion retention occurs in Type 1 RTA", "correct": false}, {"label": "B", "text": "Excess bicarbonate loss occurs in Type 2 RTA", "correct": false}, {"label": "C", "text": "Hyperkalemia is a characteristic feature of Type 4 RTA", "correct": false}, {"label": "D", "text": "Increased urinary ammonium excretion is seen in Type 4 RTA", "correct": true}], "correct_answer": "D. Increased urinary ammonium excretion is seen in Type 4 RTA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:677px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Potassium </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bicarbonate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hydrogen ion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ammonium </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chloride</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↑ (retained)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↓ (lost in urine)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↑</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>↑ (retained)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RTA type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RTA type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RTA type 4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability of the <strong>alpha <span class=\"customMeta\" data-dictid=\"cfd35769b016927771901681bcc115\">intercalated</span> </strong>cells (DCT) to <strong>secrete H+</strong> into the urine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defective<strong> HCO3- reabsorption</strong> in the <strong>PCT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypoaldosteronism</strong> or <strong>aldosterone resistance </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum electrolytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypokalemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypokalemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine changes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypocitraturia</strong>, <strong>hypercalciuria</strong></p>\n<p><strong>pH&gt; 5.5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glycosuria</strong>, <strong>aminoaciduria</strong>, <strong>phosphaturia</strong></p>\n<p><strong>pH&lt; 5.5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low ammonium</strong></p>\n<p><strong>pH&lt; 5.5 </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Amphotericin B <span class=\"customMeta\" data-dictid=\"fe706b145216927771819c62504cd8\">Analgesic</span> toxicity</li>\n<li>Lithium <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> Autoimmunity - SLE, Sjogrens</li>\n<li>Hyperglobulinemia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fanconi syndrome</li>\n<li>Wilson's disease</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> - paraproteinaemia</li>\n<li>Heavy metals - lead, cadmium, mercury</li>\n<li>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitor</li>\n<li>Tenofovir, topiramate</li>\n<li>Expired tetracycline</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypoaldosteronism\n\t\t\t\t<ul>\n<li>Diabetic hypo-reninism</li>\n<li>HIV associated nephropathy</li>\n<li>ACE inhibitors / ARB</li>\n<li>Cyclosporine, NSAIDs</li>\n<li>Adrenal insufficiency</li>\n</ul>\n</li>\n<li>Aldosterone resistance\n\t\t\t\t<ul>\n<li>K+ sparing diuretics</li>\n<li>Obstructive nephropathy</li>\n<li>TMP-SMX</li>\n</ul>\n</li>\n<li>Renal transplant rejection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nephrolithiasis</li>\n<li>Nephrocalcinosis</li>\n<li>osteomalacia / rickets</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypophosphatemic <span class=\"customMeta\" data-dictid=\"3bbd4ac09b16927771974d75a8b355\">rickets</span> in Fanconi syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old woman is brought to the emergency department by her family due to 2 days of persistent vomiting, nausea, confusion, and deep, rapid breathing. Her family reports that she has been lethargic and disoriented, with increasing difficulty responding to questions. She has a 10-year history of type 2 diabetes mellitus. Based on the lab findings given below, identify the type of metabolic disorder. Blood pH - 7.28 Sodium - 140 mEq/L Potassium - 5.4 mEq/L Bicarbonate - 10 mEq/L Chloride - 98 mEq/l pCO2 - 22 mm hg pO2 - 95 mmHg RBS - 382 mg/dL", "options": [{"label": "A", "text": "High anion gap metabolic acidosis", "correct": true}, {"label": "B", "text": "Non anion gap metabolic acidosis", "correct": false}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Metabolic alkalosis", "correct": false}], "correct_answer": "A. High anion gap metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-anion gap </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>M</strong>ethanol poisoning</li>\n<li><strong>U</strong>remia: AKI, CKD</li>\n<li><strong>D</strong>iabetic ketoacidosis</li>\n<li><strong>P</strong>aracetamol poisoning</li>\n<li><strong>I</strong>ron and isoniazid</li>\n<li><strong>L</strong>actic acidosis</li>\n<li><strong>E</strong>thylene <span class=\"customMeta\" data-dictid=\"7451dcad4f1692777188609e12be1d\">glycol</span> poisoning</li>\n<li><strong>S</strong>alicylate poisoning</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>H</strong>yperchloremia</li>\n<li><strong>A</strong>ddison's disease</li>\n<li><strong>R</strong>enal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis</li>\n<li><strong>D</strong>iarrhoea and conditions causing GI loss of HCO3- (ureterosigmoidostomy or external <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> drainage)</li>\n<li><strong>A</strong>cetazolamide</li>\n<li><strong>S</strong>pironolactone and K-sparing diuretics</li>\n<li><strong>S</strong>aline <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> (rapid <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> )</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reduced <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap: </strong>Multiple <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> and <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">nephrotic</span> syndrome</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Clinical question A 32-year-old woman presents with fatigue, muscle weakness, recurrent kidney stones, a history of recurrent UTIs, occasional nausea, vomiting, tingling in her hands and feet, and bone pain. Laboratory results show serum bicarbonate = 15 mEq/L, serum potassium = 1.9 mEq/L, and urine pH = 6. Which of the following is true regarding the anion gap in this condition?", "options": [{"label": "A", "text": "High in both plasma and urine", "correct": false}, {"label": "B", "text": "High in plasma, normal in urine", "correct": false}, {"label": "C", "text": "Normal in plasma, high in urine", "correct": true}, {"label": "D", "text": "Normal in both plasma and urine", "correct": false}], "correct_answer": "C. Normal in plasma, high in urine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anion gap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RTA </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diarrhea </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman presents to the clinic for evaluation of resistant hypertension, with blood pressure readings consistently around 170/110 mmHg despite treatment. O/E, the physician notes a bruit over the right flank. Renal imaging shows the finding, as given in the image. What is the most common cause of the condition in this patient?", "options": [{"label": "A", "text": "Fibromuscular dysplasia", "correct": false}, {"label": "B", "text": "Atherosclerosis", "correct": true}, {"label": "C", "text": "Takayasu arteritis", "correct": false}, {"label": "D", "text": "Thromboembolism", "correct": false}], "correct_answer": "B. Atherosclerosis", "question_images": ["https://image.prepladder.com/notes/Jwu5Yhdctgvt92tObQVU1746007143.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male presents with resistant high blood pressure despite multiple antihypertensive medications. Imaging studies show an asymmetric shrunken kidney on the left side. Which of the following diagnostic methods is considered the gold standard for confirming the suspected condition?", "options": [{"label": "A", "text": "Captopril Renography", "correct": false}, {"label": "B", "text": "Magnetic resonance angiography (MRA)", "correct": false}, {"label": "C", "text": "Computed tomographic angiography (CTA)", "correct": false}, {"label": "D", "text": "Intraarterial angiography", "correct": true}], "correct_answer": "D. Intraarterial angiography", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with resistant hypertension, and imaging studies reveal findings in the renal arteries, as shown in the image. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Medical therapy with CCBs", "correct": false}, {"label": "B", "text": "Percutaneous renal artery angioplasty", "correct": true}, {"label": "C", "text": "Statin + Aspirin", "correct": false}, {"label": "D", "text": "Observation and Low-salt diet", "correct": false}], "correct_answer": "B. Percutaneous renal artery angioplasty", "question_images": ["https://image.prepladder.com/notes/MJ7eFzRkLobo9wZ41WvA1746007057.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old male presents with hypertension that remains uncontrolled despite being treated with a combination of a calcium channel blocker (CCB) and an angiotensin receptor blocker (ARB). What is the next best step in management?", "options": [{"label": "A", "text": "Add Captopril", "correct": false}, {"label": "B", "text": "Add spironolactone", "correct": false}, {"label": "C", "text": "Add Hydrochlorothiazide", "correct": true}, {"label": "D", "text": "Add Labetalol", "correct": false}], "correct_answer": "C. Add Hydrochlorothiazide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with severe hypertension (BP 220/140 mmHg), headache, and altered mental status. Fundoscopy shows retinal haemorrhages, and laboratory tests indicate elevated serum creatinine. What histopathological finding is most likely seen in the kidney of this patient?", "options": [{"label": "A", "text": "Fibrinoid necrosis", "correct": true}, {"label": "B", "text": "Hyaline arteriolosclerosis", "correct": false}, {"label": "C", "text": "Diffuse glomerulosclerosis", "correct": false}, {"label": "D", "text": "Tubulointerstitial fibrosis", "correct": false}], "correct_answer": "A. Fibrinoid necrosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/2F44NwWfEl3A3Cmc2YVo1745642052.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 22 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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On further questioning, the patient admits to experiencing neck pain following a minor car accident a week ago. Physical examination confirms the presence of ptosis, miosis, and anhidrosis on the right side of the face. What is the most likely site of the lesion?", "options": [{"label": "A", "text": "Cervical spinal cord injury (C8-T1)", "correct": false}, {"label": "B", "text": "Internal carotid artery dissection", "correct": true}, {"label": "C", "text": "Pancoast tumor at the apex of the lung", "correct": false}, {"label": "D", "text": "Lesion of the superior orbital fissure", "correct": false}], "correct_answer": "B. Internal carotid artery dissection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old man presents to the clinic with the complaints of right sided weakness and difficulty speaking. His speech is slow, effortful, and fragmented with short sentences, but his comprehension is not affected. Which of the following type of aphasia is this patient suffering from?", "options": [{"label": "A", "text": "Wernicke’s Aphasia", "correct": false}, {"label": "B", "text": "Broca’s Aphasia", "correct": true}, {"label": "C", "text": "Global Aphasia", "correct": false}, {"label": "D", "text": "Conduction Aphasia", "correct": false}], "correct_answer": "B. Broca’s Aphasia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Qgqrzb944OcSyjPev4O71744368967.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old male presents with acute onset weakness of the right side of the body. On examination: Right-sided complete hemiplegia Right-sided ptosis and dilated pupil Eye deviated outward and downward No sensory deficits Normal consciousness level Which type of hemiplegia is most likely in this patient?", "options": [{"label": "A", "text": "Weber's hemiplegia", "correct": true}, {"label": "B", "text": "Medial medullary hemiplegia", "correct": false}, {"label": "C", "text": "Millard-Gubler hemiplegia", "correct": false}, {"label": "D", "text": "Pure motor hemiplegia (capsular)", "correct": false}], "correct_answer": "A. Weber's hemiplegia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Hemiplegia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Additional Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weber's Hemiplegia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Midbrain (crus cerebri)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CN III <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> hemiplegia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ptosis, dilated pupil, outward/downward eye deviation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medial <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">Medullary</span> Hemiplegia</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial medulla</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CN XII <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> hemiplegia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tongue <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> to <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> side</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Millard-Gubler Hemiplegia</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pons</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CN VI, VII <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> hemiplegia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facial weakness and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> palsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pure Motor Hemiplegia</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Internal capsule</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only motor deficits</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cortical Level Hemiplegia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Motor <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> (precentral gyrus)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Segmental weakness, often associated with <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MCA territory most commonly involved</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman presents to the emergency department with dizziness, difficulty swallowing, and right-sided facial numbness. On examination, she has ataxia, and when asked to stick out her tongue, it deviates to the right. Additionally, she experiences nystagmus and has a diminished gag reflex. What type of stroke is this patient most likely experiencing?", "options": [{"label": "A", "text": "Weber Syndrome", "correct": false}, {"label": "B", "text": "Wallenberg Syndrome", "correct": true}, {"label": "C", "text": "Foville Syndrome", "correct": false}, {"label": "D", "text": "Medial Medullary Syndrome", "correct": false}], "correct_answer": "B. Wallenberg Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medial <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">Medullary</span> Syndrome </strong></p>\n<p style=\"text-align: center;\"><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lateral <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">Medullary</span> Syndrome (Wallenberg Syndrome)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>On side of lesion</u></strong></p>\n<ul>\n<li>Paralysis with <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of one-half half the tongue: <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> twelfth nerve</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>On side of lesion</u></strong></p>\n<ul>\n<li>Pain, numbness, impaired sensation over one-half the face: <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> fifth nerve</li>\n<li>Ataxia of limbs, falling to side of lesion: <span class=\"customMeta\" data-dictid=\"33c210f1a81692777197a38b4d0a96\">Restiform</span> body, cerebellar hemisphere, cerebellar fibers, <span class=\"customMeta\" data-dictid=\"1b023a99c41692777199f0afcc23f6\">spinocerebellar</span> tract</li>\n<li>Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting: <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> nucleus</li>\n<li>Horner’s syndrome (miosis, ptosis, decreased sweating): <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> tract</li>\n<li>Dysphagia, hoarseness, <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of palate, <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of vocal cord, diminished <span class=\"customMeta\" data-dictid=\"9859613acd1692777187a2aaacae71\">gag</span> reflex: Issuing fibers ninth and tenth nerves</li>\n<li>Loss of taste: <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">Nucleus</span> and <span class=\"customMeta\" data-dictid=\"65decc8b65169277720160605b350f\">tractus</span> solitarius</li>\n<li>Numbness of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> arm, trunk, or leg: <span class=\"customMeta\" data-dictid=\"a36a9cd509169277718558c816914c\">Cuneate</span> and <span class=\"customMeta\" data-dictid=\"776c5be31e1692777188c8916fba20\">gracile</span> nuclei</li>\n<li>Weakness of lower face: Genuflected upper <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> fibers to <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nucleus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>On side opposite lesion</u></strong></p>\n<ul>\n<li>Paralysis of arm and leg, sparing face; impaired <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> and <span class=\"customMeta\" data-dictid=\"cd38f5515716927771969b9fb17e95\">proprioceptive</span> sense over one-half the body: <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">pyramidal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> lemniscus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>On side opposite lesion</u></strong></p>\n<ul>\n<li>Impaired pain and <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> sense over half the body, sometimes face: <span class=\"customMeta\" data-dictid=\"3d8e2766f01692777199d05e5ab2d4\">Spinothalamic</span> tract</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old man is brought to the emergency department after he collapsed at his home, and the neurologist suspects a medullary stroke after a thorough evaluation. Which of the following is NOT a feature of a medullary stroke?", "options": [{"label": "A", "text": "Irregular breathing patterns", "correct": false}, {"label": "B", "text": "Dysphagia and hoarseness", "correct": false}, {"label": "C", "text": "Contralateral muscle weakness", "correct": true}, {"label": "D", "text": "Ipsilateral facial pain and loss of temperature sensation", "correct": false}], "correct_answer": "C. Contralateral muscle weakness", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old man is admitted to the hospital after suddenly collapsing at home. Upon examination, he is fully conscious and aware of his surroundings but is unable to move any limbs or speak. He shows no signs of respiratory distress but struggles with swallowing and cannot perform any voluntary movements, except for blinking and vertical eye movements. What condition is this patient most likely experiencing?", "options": [{"label": "A", "text": "Parinaud Syndrome", "correct": false}, {"label": "B", "text": "Claude Syndrome", "correct": false}, {"label": "C", "text": "Raymond Syndrome", "correct": false}, {"label": "D", "text": "Locked-in Syndrome", "correct": true}], "correct_answer": "D. Locked-in Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 64-year-old man is brought to the emergency department after experiencing sudden weakness on the left side of his body. On examination, he exhibits right-sided facial droop and difficulty moving his right eye laterally. He has also lost the ability to feel pain and temperature on the right side of his body. What type of stroke is this patient most likely experiencing?", "options": [{"label": "A", "text": "Foville Syndrome", "correct": false}, {"label": "B", "text": "Millard-Gubler Syndrome", "correct": true}, {"label": "C", "text": "Dysarthria-Clumsy Hand Syndrome", "correct": false}, {"label": "D", "text": "Raymond Syndrome", "correct": false}], "correct_answer": "B. Millard-Gubler Syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pontine Stroke Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventro-caudal <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">Pontine</span> Infarction</strong></p>\n\t\t\t \n\n\t\t\t<p>-Paramedian perforating arteries arising from the <span class=\"customMeta\" data-dictid=\"cf3585c06f1692777182cba3cb4c97\">basilar</span> artery.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Contralateral <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> (corticospinal tract).</li>\n<li>Ipsilateral <span class=\"customMeta\" data-dictid=\"493415137f1692777180adce8b5447\">abducens</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (abducens nerve).</li>\n<li>Ipsilateral <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (facial nerve).</li>\n<li>Contralateral loss of pain and temperature sensation (lateral <span class=\"customMeta\" data-dictid=\"3d8e2766f01692777199d05e5ab2d4\">spinothalamic</span> tract).</li>\n<li><strong>Millard-Gubler Syndrome</strong>: <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> hemiparesis, <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> abducens, and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve palsy.</li>\n<li><strong>Foville Syndrome</strong>: Same as Millard-Gubler with additional <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">conjugate</span> gaze palsy. <strong>(Option A ruled out)</strong></li>\n<li><strong>Raymond Syndrome</strong>: <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> with <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"493415137f1692777180adce8b5447\">abducens</span> palsy, no <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve involvement. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mid-pontine Base Infarction</strong></p>\n\t\t\t \n\n\t\t\t<p>-Paramedian arteries or short <span class=\"customMeta\" data-dictid=\"57793361701692777184c3bc13c91d\">circumferential</span> arteries, both arising from the <span class=\"customMeta\" data-dictid=\"cf3585c06f1692777182cba3cb4c97\">basilar</span> artery.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ipsilateral <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> (pontine nuclei).</li>\n<li>Ipsilateral <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"068d6642471692777198d89a1be687\">sensorimotor</span> weakness (trigeminal nerve).</li>\n<li>Contralateral <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> (corticospinal tract).</li>\n<li><strong>Pure Motor Hemiparesis</strong>: Isolated <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> motor weakness due to <span class=\"customMeta\" data-dictid=\"a218fdbabf1692777185a2d48a9e1c\">corticospinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infarct.</li>\n<li><strong>Ataxic Hemiparesis</strong>: <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> with <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> motor weakness.</li>\n<li><strong>Dysarthria-Clumsy Hand Syndrome</strong>: Dysarthria, dysphagia, impaired hand dexterity, and weakness. <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tegmental <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">Pontine</span> Syndrome</strong></p>\n\t\t\t \n\n\t\t\t<p>-Rostral <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">Pontine</span> Syndrome: <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> cerebellar <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or superior cerebellar artery.</p>\n<p>-Caudal <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">Pontine</span> Syndrome: <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> cerebellar <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or short <span class=\"customMeta\" data-dictid=\"57793361701692777184c3bc13c91d\">circumferential</span> arteries.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ipsilateral <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> (trigeminal nucleus).</li>\n<li>Ipsilateral masticator <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> (trigeminal motor nucleus).</li>\n<li>Impaired blinking (tectospinal tract).</li>\n<li>Contralateral hemisensory loss (medial <span class=\"customMeta\" data-dictid=\"62a3d7acd416927771913ad82a2607\">lemniscus</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"3d8e2766f01692777199d05e5ab2d4\">spinothalamic</span> tract).</li>\n<li>Ipsilateral <span class=\"customMeta\" data-dictid=\"b71eeb17261692777188c444f1c9c4\">hemiataxia</span> (superior cerebellar peduncle).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presents with severe burning pain on the left side of his body three months after having a stroke. He describes the pain as constant and stabbing, with episodes of intense shooting pain lasting several minutes. Physical examination reveals hyperalgesia and allodynia in the affected areas, with abnormal temperature sensation. MRI shows a lesion in the ventroposterolateral thalamus. Which of the following best describes this condition?", "options": [{"label": "A", "text": "Complex regional pain syndrome with peripheral nerve involvement", "correct": false}, {"label": "B", "text": "Dejerine Roussy syndrome with central thalamic pain", "correct": true}, {"label": "C", "text": "Trigeminal neuralgia with facial pain", "correct": false}, {"label": "D", "text": "Post-herpetic neuralgia with dermatomal distribution", "correct": false}], "correct_answer": "B. Dejerine Roussy syndrome with central thalamic pain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dejerine Roussy Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spontaneous constant pain (burning, aching, freezing)</li>\n<li>Spontaneous <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> pain (shooting, lancinating)</li>\n<li>Evoked pain (hyperalgesia, allodynia)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sharp, burning, stabbing quality</li>\n<li>Affects areas corresponding to stroke</li>\n<li>May be immediate or delayed up to several months</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abnormal pain/temperature sensation (90% cases)</li>\n<li>Hyperalgesia</li>\n<li>Allodynia</li>\n<li>Variable touch/vibration changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Primarily: </strong>Ventroposterolateral thalamus</li>\n<li>Can occur with lesions anywhere along <span class=\"customMeta\" data-dictid=\"3d8e2766f01692777199d05e5ab2d4\">spinothalamic</span> tract</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old boy presents with progressive difficulty looking upward and complains of double vision. On examination, he demonstrates impaired upward gaze, jerky convergence movements of both eyes on attempted upward gaze, and pupils that constrict poorly to light but constrict well with near vision. He has adopted a chin-up position to compensate. MRI reveals a mass in the pineal region. Which of the following best characterizes this condition and its classic triad?", "options": [{"label": "A", "text": "Paralysis of downward gaze, convergence weakness, and pineal mass", "correct": false}, {"label": "B", "text": "Paralysis of upward gaze, convergence-retraction nystagmus, and pupillary light-near dissociation", "correct": true}, {"label": "C", "text": "Paralysis of lateral gaze, retraction nystagmus, and normal pupils", "correct": false}, {"label": "D", "text": "Complete ophthalmoplegia, dilated pupils, and pineal calcification", "correct": false}], "correct_answer": "B. Paralysis of upward gaze, convergence-retraction nystagmus, and pupillary light-near dissociation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parinaud Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classic Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Impaired upward gaze (upgaze palsy)</p>\n<p>2. Convergence-retraction nystagmus</p>\n<p>3. Pupillary light-near dissociation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Difficulty looking up</p>\n<p>- <span class=\"customMeta\" data-dictid=\"1458c330411692777186cd49bb6a30\">Diplopia</span> (65% of patients)</p>\n<p>- Blurred near vision</p>\n<p>- Oscillopsia</p>\n<p>- <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">Compensatory</span> chin-up position</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Collier's sign (lid retraction) in 40%</p>\n<p>- \"Setting sun\" sign</p>\n<p>- Loss of <span class=\"customMeta\" data-dictid=\"f7bc6be47c1692777185caa5f693ce\">convergence</span> (&lt;25% of patients)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"8d0ddb3b3c1692777195823fa13daa\">Pineal</span> tumors (most common in young)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"d26464df7216927771923483619265\">Midbrain</span> infarction</p>\n<p>- Hydrocephalus</p>\n<p>- Multiple sclerosis</p>\n<p>- Hemorrhage</p>\n<p>- Infections (toxoplasmosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal midbrain/pretectal area at level of superior colliculus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old man presents with a sudden onset of left-sided drooping eyelid and difficulty coordinating movements of his right arm and leg. On examination, he has left-sided ptosis, dilated left pupil, and the left eye is \"down and out.\" He demonstrates significant right-sided ataxia but has normal strength in all extremities. Which of the following conditions represent the suspected diagnosis?", "options": [{"label": "A", "text": "Weber syndrome", "correct": false}, {"label": "B", "text": "Claude syndrome", "correct": true}, {"label": "C", "text": "Benedikt syndrome", "correct": false}, {"label": "D", "text": "Nothnagel syndrome", "correct": false}], "correct_answer": "B. Claude syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Claude Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Midbrain (Red <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">Nucleus</span> Region)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"ae7e8fa7d31692777194e3d4325f6b\">Oculomotor</span> nerve (CN III)</p>\n<p>- Red nucleus</p>\n<p>- <span class=\"customMeta\" data-dictid=\"31f7d278591692777185650ccccc3d\">Dentatothalamic</span> tract</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ipsilateral Findings (CN III)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Ptosis</p>\n<p>- Dilated pupil</p>\n<p>- \"Down and out\" eye position</p>\n<p>- Diplopia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contralateral Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Cerebellar ataxia</p>\n<p>- Limb incoordination</p>\n<p>- No <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> (key distinguishing feature)</p>\n<p>- Intention tremor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Distinguishing Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- No <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> (unlike Weber)</p>\n<p>- No <span class=\"customMeta\" data-dictid=\"2676c83ab91692777184b545be8b1b\">choreiform</span> movements (unlike Benedikt)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> (unlike Nothnagel)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paramedian branches of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cerebral artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Stroke (most common)</p>\n<p>- Hemorrhage</p>\n<p>- Tumor</p>\n<p>- Multiple sclerosis</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weber Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral CN III <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (ptosis, pupillary dilation) + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> (corticospinal tract).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benedikt Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral CN III <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> and <span class=\"customMeta\" data-dictid=\"bb6d2476421692777200c2af1ac0c8\">tremor</span> (red <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> involvement).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wallenberg Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral Horner syndrome, ataxia, dysphagia, and <span class=\"customMeta\" data-dictid=\"4da1fe73a71692777189ec55b7ed8c\">hoarseness</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> loss of pain/temperature.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locked-In Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quadriplegia and <span class=\"customMeta\" data-dictid=\"405ccbd7d51692777181002e865b2f\">anarthria</span> with preserved consciousness and vertical eye movements.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Millard-Gubler Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral CN VI and VII <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> hemiparesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Raymond Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral CN VI <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> hemiparesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Foville Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral CN VI <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> + gaze palsy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dejerine Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral CN XII <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> and impaired proprioception/vibration.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with double vision and difficulty maintaining balance while walking. On examination, she has drooping of the right eyelid, a dilated right pupil, and significant unsteadiness with right-sided limb ataxia. Unlike other midbrain syndromes, she has no weakness in her extremities. Which of the following are the structures affected?", "options": [{"label": "A", "text": "Superior cerebellar peduncle and CN III", "correct": true}, {"label": "B", "text": "Cerebral peduncle and CN III", "correct": false}, {"label": "C", "text": "Red nucleus", "correct": false}, {"label": "D", "text": "Red nucleus and CN III", "correct": false}], "correct_answer": "A. Superior cerebellar peduncle and CN III", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nothnagel Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"d26464df7216927771923483619265\">Midbrain</span> (Quadrigeminal Plate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"ae7e8fa7d31692777194e3d4325f6b\">Oculomotor</span> nerve (CN III)</p>\n<p>- Superior cerebellar peduncle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ipsilateral Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- CN III <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (ptosis, dilated pupil, eye deviation)</p>\n<p>- Cerebellar ataxia</p>\n<p>- Limb incoordination</p>\n<p>- <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">Gait</span> disturbance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Distinguishing Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- No <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> (unlike Weber)</p>\n<p>- No tremors (unlike Benedikt)</p>\n<p>- Often bilateral</p>\n<p>- Commonly associated with tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"8d0ddb3b3c1692777195823fa13daa\">Pineal</span> region tumors</p>\n<p>- <span class=\"customMeta\" data-dictid=\"c7e960d24d169277719637a4da2a3e\">Quadrigeminal</span> plate tumors</p>\n<p>- <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> lesions</p>\n<p>- Multiple sclerosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Often presents as neuro-ophthalmological emergency</p>\n<p>- May be first sign of <span class=\"customMeta\" data-dictid=\"8d0ddb3b3c1692777195823fa13daa\">pineal</span> region tumor</p>\n<p>- Usually requires <span class=\"customMeta\" data-dictid=\"5e6f0865531692777193a6f20577b3\">neuroimaging</span> for diagnosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old man presents with a sudden onset of right-sided weakness and left-sided drooping of the eyelid. On examination, he has left-sided ptosis, a dilated left pupil that doesn't react to light, and the left eye is \"down and out.\" He also has right-sided hemiparesis affecting his face, arm, and leg. Which of the following best describes this syndrome and its anatomical location?", "options": [{"label": "A", "text": "Claude syndrome - Red nucleus and CN III", "correct": false}, {"label": "B", "text": "Weber syndrome - Cerebral peduncle and CN III", "correct": true}, {"label": "C", "text": "Benedict syndrome - Red nucleus and superior cerebellar peduncle", "correct": false}, {"label": "D", "text": "Millard-Gubler syndrome - Ventral pons affecting CN VI and VII", "correct": false}], "correct_answer": "B. Weber syndrome - Cerebral peduncle and CN III", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ventral <span class=\"customMeta\" data-dictid=\"d26464df7216927771923483619265\">Midbrain</span> (Cerebral Peduncle)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"ae7e8fa7d31692777194e3d4325f6b\">Oculomotor</span> nerve (CN III)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"7155184fc3169277718493ae922d7e\">Cerebral peduncle</span> (corticospinal tract)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ipsilateral Findings (CN III)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"e18c2053271692777194e62a208e01\">Ptosis</span> (drooping eyelid)</p>\n<p>- Dilated <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> (parasympathetic)</p>\n<p>- \"Down and out\" eye position</p>\n<p>- Impaired medial, upward, and downward gaze</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contralateral Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Hemiparesis/hemiplegia (face, arm, leg)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"1ce806f0111692777198eedf1b5824\">Spastic</span> paralysis</p>\n<p>- Hyperreflexia</p>\n<p>- Babinski sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paramedian branches of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cerebral artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Stroke (most common)</p>\n<p>- Tumor</p>\n<p>- Hemorrhage</p>\n<p>- Multiple sclerosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old male presents with a sudden onset of double vision, left-sided weakness, and difficulty moving his right eye. On examination, the patient has a right-sided ptosis, a dilated pupil that does not react to light, and an outward deviation of the right eye. The left side of his body shows weakness with hyperreflexia. MRI reveals an ischemic lesion in the midbrain. Which of the following structures is most likely involved in this patient’s condition?", "options": [{"label": "A", "text": "Trochlear nerve nucleus and Crus cerebri", "correct": false}, {"label": "B", "text": "Oculomotor nerve nucleus and Crus cerebri", "correct": true}, {"label": "C", "text": "Substantia nigra and Crus cerebri", "correct": false}, {"label": "D", "text": "Crus cerebri only", "correct": false}], "correct_answer": "B. Oculomotor nerve nucleus and Crus cerebri", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with sudden onset right-sided weakness, inability to speak, and unawareness of his surroundings. On examination, he has complete right-sided hemiplegia, and global aphasia, and is neglecting the right side of his visual field. Non-contrast CT of the brain shows a hypodense area involving the left middle cerebral artery territory. What is the most likely type of stroke?", "options": [{"label": "A", "text": "Lacunar Stroke", "correct": false}, {"label": "B", "text": "Posterior Circulation Stroke", "correct": false}, {"label": "C", "text": "Partial Anterior Circulation Stroke", "correct": false}, {"label": "D", "text": "Total Anterior Circulation Stroke", "correct": true}], "correct_answer": "D. Total Anterior Circulation Stroke", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man presents with a sudden onset of right-sided weakness and aphasia. CT angiography reveals an occlusion in one of the arteries. Which of the following best describes the location of this occlusion?", "options": [{"label": "A", "text": "B- M1 Segment of MCA", "correct": false}, {"label": "B", "text": "D- Segment of ACA", "correct": false}, {"label": "C", "text": "C- M2 Segment of MCA", "correct": false}, {"label": "D", "text": "F- PCA", "correct": false}], "correct_answer": "Unknown", "question_images": ["https://image.prepladder.com/notes/brvKFSsNxaOkIoypZszd1744368424.png"], "explanation_images": ["https://image.prepladder.com/notes/Rz8Bn46jmyT9IIG7lqIK1744368449.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:713px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vessel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location/Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Areas Supplied</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features When Occluded</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (ICA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ascends through neck, enters skull via <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> canal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gives rise to <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> and ACA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large territory infarcts affecting both <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> and <span class=\"customMeta\" data-dictid=\"f17a889c2e1692777180307821c3f9\">ACA</span> distributions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (ACA) (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Courses anteriorly and curves around <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> callosum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial surface of cerebral hemisphere, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 3/4 of <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> callosum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contralateral leg weakness, behavioral changes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCA - <span class=\"customMeta\" data-dictid=\"c1188e015016927771924969504f45\">M1 Segment</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Horizontal course from ICA <span class=\"customMeta\" data-dictid=\"6c076ff67d1692777183dff2a71da1\">bifurcation</span> to <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> bifurcation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lenticulostriate arteries to <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contralateral hemiparesis, <span class=\"customMeta\" data-dictid=\"9b5386bf6216927771812526afb5e6\">aphasia</span> (if dominant hemisphere)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCA - <span class=\"customMeta\" data-dictid=\"cf00656b8616927771929602fcf8c1\">M2 Segment</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insular segment in <span class=\"customMeta\" data-dictid=\"c76557c9e1169277719955ac4ecac7\">Sylvian</span> fissure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insular <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> and operculum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More restricted deficits than M1 occlusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCA - M3 Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Opercular segment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"70cc36bc1a1692777185d6cfa6e6b9\">convexity</span> of hemisphere</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specific <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> deficits based on location</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCA - M4 Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortical branches over <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specific <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> regions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focal deficits based on affected region</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male presents with sudden onset right-sided weakness, slurred speech, and difficulty comprehending language. A CT scan reveals an ischemic stroke. The stroke likely involves which of the following vessels?", "options": [{"label": "A", "text": "Anterior cerebral artery (ACA)", "correct": false}, {"label": "B", "text": "Middle cerebral artery (MCA)", "correct": true}, {"label": "C", "text": "Posterior cerebral artery (PCA)", "correct": false}, {"label": "D", "text": "Basilar artery", "correct": false}], "correct_answer": "B. Middle cerebral artery (MCA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/sotolMPEOXipRxo0MfHA1744368781.png", "https://image.prepladder.com/notes/uTA7siFyyQmonEnUFoFx1744368895.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old man with a history of hypertension and hyperlipidemia is brought to the emergency department after suddenly losing vision in the left visual field of both eyes. He denies any headache, weakness, or sensory deficits. On examination, his visual acuity is intact, but he has left homonymous hemianopia. There is no evidence of motor or sensory loss. Where is the most likely site of the stroke?", "options": [{"label": "A", "text": "Right Occipital Lobe", "correct": true}, {"label": "B", "text": "Left Occipital Lobe", "correct": false}, {"label": "C", "text": "Right Parietal Lobe", "correct": false}, {"label": "D", "text": "Left Parietal Lobe", "correct": false}], "correct_answer": "A. Right Occipital Lobe", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old woman is brought to the emergency department after her family noticed significant changes in her behavior and difficulty speaking. Upon examination, she displays weakness on the right side of her body and struggles to form coherent sentences, often speaking in short, fragmented phrases. The family also reports that she has become more irritable and has difficulty managing her daily tasks. What type of stroke is this patient most likely experiencing?", "options": [{"label": "A", "text": "Right Temporal Lobe Stroke", "correct": false}, {"label": "B", "text": "Frontal Lobe Stroke", "correct": true}, {"label": "C", "text": "Occipital Lobe Stroke", "correct": false}, {"label": "D", "text": "Left Parietal Lobe Stroke", "correct": false}], "correct_answer": "B. Frontal Lobe Stroke", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old right-handed man presents to the emergency department after his partner noticed he has been struggling to communicate effectively. He speaks in long sentences but often uses nonsensical words and seems unaware of his errors. Additionally, he has difficulty remembering recent conversations and frequently confuses familiar faces. What type of stroke is this patient most likely experiencing?", "options": [{"label": "A", "text": "Right Temporal Lobe Stroke", "correct": false}, {"label": "B", "text": "Left Temporal Lobe Stroke", "correct": true}, {"label": "C", "text": "Right Parietal Lobe Stroke", "correct": false}, {"label": "D", "text": "Frontal Lobe Stroke", "correct": false}], "correct_answer": "B. Left Temporal Lobe Stroke", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:708px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features of Left <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">Lobe</span> Stroke</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features of Right <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">Lobe</span> Stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Impaired language and memory: </strong>Difficulty with spoken language and remembering verbal information.</li>\n<li><strong>Fluent (Wernicke’s) aphasia: </strong>Fluent speech with incorrect words, affecting language comprehension.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Poor <span class=\"customMeta\" data-dictid=\"2e00fbba5016927772022f51502629\">visual memory</span> and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> awareness: </strong>Difficulty recognizing visual patterns and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> information.</li>\n<li><strong>Prosopagnosia</strong>: Inability to recognize faces, including familiar ones. <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General Features of <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">Lobe</span> Stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Poor memory: </strong>Difficulty recalling past memories and learning new information.</li>\n<li><strong>Prosopagnosia: </strong>Trouble recognizing faces and objects.</li>\n<li><strong>Fluent aphasia: </strong>Specifically in left-sided strokes, affecting speech fluency but with incorrect word use.</li>\n<li><strong>Visual perception difficulties: </strong>Challenges with interpreting the <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> and surroundings.</li>\n<li><strong>Trouble processing sound:</strong> Inability to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> or process sounds correctly.</li>\n<li><strong>Emotional and behavioral changes:</strong> Varying behaviors due to damage to the amygdala, such as aggression, passiveness, or difficulty interpreting <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> cues.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old right-handed woman is brought to the hospital after her husband noticed she was having trouble writing and appeared confused about her left and right sides. Upon examination, she struggles to recognize familiar objects and is unable to perform simple calculations. Her speech is intact, but she has difficulty repeating phrases. What type of stroke is this patient most likely experiencing?", "options": [{"label": "A", "text": "Right Temporal Lobe Stroke", "correct": false}, {"label": "B", "text": "Left Temporal Lobe Stroke", "correct": false}, {"label": "C", "text": "Left Parietal Lobe Stroke", "correct": true}, {"label": "D", "text": "Right Parietal Lobe Stroke", "correct": false}], "correct_answer": "C. Left Parietal Lobe Stroke", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features of Left <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">Parietal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">Lobe</span> Stroke</strong></p>\n<p><strong>(Dominant)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features of Right <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">Parietal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">Lobe</span> Stroke</strong></p>\n<p><strong>(Non-Dominant)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Agnosia</strong>: Difficulty recognizing objects, people, or sounds.</li>\n<li><strong>Right-left confusion</strong>: Poor <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> between right and left sides.</li>\n<li><strong>Agraphia</strong>: Difficulty with writing due to motor or memory issues.</li>\n<li><strong>Acalculia</strong>: Inability to process numbers and perform simple math.</li>\n<li><strong>Aphasia</strong>: Difficulty with speech, often <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> <span class=\"customMeta\" data-dictid=\"9b5386bf6216927771812526afb5e6\">aphasia</span> (speech repetition issues).</li>\n<li><strong>Gerstmann’s Syndrome</strong>:\n\t\t\t\t<ul>\n<li>Involves <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">Angular</span> <span class=\"customMeta\" data-dictid=\"231fafb8e116927771888a0efe57f1\">gyrus</span> - Brodmann area 39</li>\n<li>Triad of <strong>agnosia, agraphia, and acalculia.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hemineglect</strong>: Decreased awareness of the left side of the body or surroundings. <strong>(Option D ruled out)</strong></li>\n<li><strong>Poor <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> awareness</strong>: Difficulty navigating due to <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> perception issues.</li>\n<li><strong>Impaired sense of direction and visual memory</strong>: Difficulty navigating environments.</li>\n<li><strong>Anosognosia</strong>: Inability to perceive or acknowledge stroke-related deficits.</li>\n<li><strong>Proprioception dysfunction</strong>: Difficulty sensing body parts in space, affecting balance and coordination.</li>\n<li>Both lobes can also be affected, leading to further memory changes or <strong>Balint’s Syndrome</strong> (visual processing and gaze issues).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 67-year-old male presents to the emergency department with sudden right-sided weakness and difficulty coordinating his movements. He also reports an altered sensation on the right side. His medical history includes hypertension and diabetes. Upon examination, he shows reduced strength in his right arm and leg. What type of stroke is this patient most likely experiencing?", "options": [{"label": "A", "text": "Frontal Lobe Stroke", "correct": false}, {"label": "B", "text": "Temporal Lobe Stroke", "correct": false}, {"label": "C", "text": "Occipital Lobe Stroke", "correct": false}, {"label": "D", "text": "Lacunar Stroke", "correct": true}], "correct_answer": "D. Lacunar Stroke", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old male presents to the emergency department with sudden-onset right-sided weakness and difficulty speaking which started 2 hours ago. His medical history includes hypertension, hyperlipidemia, and a prior TIA. His BP is 180/110 mm Hg. A CT scan of the head rules out hemorrhagic stroke. Which of the following is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Administer intravenous Alteplase immediately.", "correct": true}, {"label": "B", "text": "Start intravenous heparin for anticoagulation therapy.", "correct": false}, {"label": "C", "text": "Initiate blood pressure management to lower the BP to &amp;lt;160/90 mmHg before considering thrombolytic therapy.", "correct": false}, {"label": "D", "text": "Begin treatment with antipyretics and surface cooling to manage fever.", "correct": false}], "correct_answer": "A. Administer intravenous Alteplase immediately.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/uVmTn0do4ALGLVqu21PB1744368669.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old diabetic male presents to the emergency department with a sudden onset of right-sided weakness and slurred speech that resolved completely within 2 hours. His blood pressure is 160/90 mmHg. Based on his ABCD2 score of 6, what is the most appropriate immediate management?", "options": [{"label": "A", "text": "Start oral aspirin 81 mg daily alone", "correct": false}, {"label": "B", "text": "Combination of clopidogrel plus aspirin", "correct": true}, {"label": "C", "text": "Start warfarin with target INR 2-3", "correct": false}, {"label": "D", "text": "Start ticagrelor alone", "correct": false}], "correct_answer": "B. Combination of clopidogrel plus aspirin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with sudden onset right-sided facial weakness and slurred speech that completely resolved within 45 minutes. Which of the following statements about this transient ischemic attack (TIA) is incorrect?", "options": [{"label": "A", "text": "If neurological symptoms begin improving within 1 hour, it indicates TIA", "correct": false}, {"label": "B", "text": "Treatment window period from symptom onset is 4.5 hours", "correct": false}, {"label": "C", "text": "Patient has highest risk of developing stroke after 72 hours", "correct": true}, {"label": "D", "text": "Symptoms must completely resolve within 24 hours to be classified as TIA", "correct": false}], "correct_answer": "C. Patient has highest risk of developing stroke after 72 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male presents with acute left-sided weakness. MRI imaging is performed showing: Which of the following best describes the significance of the diffusion-perfusion mismatch in this patient?", "options": [{"label": "A", "text": "It represents chronic ischemic changes and is not clinically relevant", "correct": false}, {"label": "B", "text": "It indicates the ischemic penumbra and potentially salvageable tissue", "correct": true}, {"label": "C", "text": "It is a marker of hemorrhagic transformation risk", "correct": false}, {"label": "D", "text": "It represents a completed infarction that cannot be salvaged", "correct": false}], "correct_answer": "B. It indicates the ischemic penumbra and potentially salvageable tissue", "question_images": ["https://image.prepladder.com/notes/gTSdo1a9AdlSw26FaDvE1744368553.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old male presents to the emergency department with sudden onset of left-sided hemiplegia and aphasia. His last known normal time was 5 hours ago. CT angiography reveals a right middle cerebral artery (MCA) occlusion. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Intravenous thrombolysis with tPA", "correct": false}, {"label": "B", "text": "Mechanical thrombectomy", "correct": true}, {"label": "C", "text": "Antiplatelet therapy only", "correct": false}, {"label": "D", "text": "Supportive care and observation", "correct": false}], "correct_answer": "B. Mechanical thrombectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with sudden onset of vertigo, dysphagia, hoarseness, and left-sided facial numbness. On examination, he has left-sided Horner's syndrome, right-sided loss of pain and temperature sensation in the body, and left-sided cerebellar signs. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Parinaud syndrome", "correct": false}, {"label": "B", "text": "Dejerine syndrome", "correct": false}, {"label": "C", "text": "Wallenberg syndrome", "correct": true}, {"label": "D", "text": "Weber syndrome", "correct": false}], "correct_answer": "C. Wallenberg syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/xvGVhx2kqkZ1VSfdl6V31744368510.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with a history of hypertension presents with a sudden onset of right-sided weakness affecting his face, arm, and leg without any speech disturbance. CT scan shows a small infarct in the posterior limb of the internal capsule. Which of the following vessels is most likely involved in this pathology?", "options": [{"label": "A", "text": "M1 segment", "correct": false}, {"label": "B", "text": "M2 segment", "correct": false}, {"label": "C", "text": "Lenticulostriate arteries", "correct": true}, {"label": "D", "text": "M3 segment", "correct": false}], "correct_answer": "C. Lenticulostriate arteries", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:724px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lacunar Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location of Infarct</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supplying Vessel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pure Motor Hemiparesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior limb of internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> or basis pontis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lenticulostriate arteries or <span class=\"customMeta\" data-dictid=\"6c178c36f616927771948cdea0dfae\">paramedian</span> <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Face, arm, and leg weakness on one side without sensory, visual, or cognitive deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pure <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> Stroke</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ventral <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> of thalamus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thalamogeniculate arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemisensory loss affecting face, arm, and leg without motor weakness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ataxic Hemiparesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior limb of internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> or basis pontis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lenticulostriate arteries or <span class=\"customMeta\" data-dictid=\"6c178c36f616927771948cdea0dfae\">paramedian</span> <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> with <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">pyramidal</span> signs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dysarthria-Clumsy Hand</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pons or internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> (genu)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Penetrating branches of <span class=\"customMeta\" data-dictid=\"cf3585c06f1692777182cba3cb4c97\">basilar</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or <span class=\"customMeta\" data-dictid=\"cba0c766911692777191b4bcb68f08\">lenticulostriate</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysarthria and <span class=\"customMeta\" data-dictid=\"f48ec32987169277718628dd3340d7\">dyspraxia</span> of hand without significant weakness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 38 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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She often feels fatigued and has mood changes before the headaches begin. According to the International Headache Society's criteria, which features are essential for diagnosing her condition as migraine?", "options": [{"label": "A", "text": "Bilateral pricking pain with nausea", "correct": false}, {"label": "B", "text": "Unilateral pain with photophobia without nausea", "correct": false}, {"label": "C", "text": "Unilateral throbbing pain with phonophobia", "correct": true}, {"label": "D", "text": "Bilateral pain with photophobia and nausea", "correct": false}], "correct_answer": "C. Unilateral throbbing pain with phonophobia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features of Migraine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Premonitory (Prodromal) Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neck discomfort</li>\n<li>Cognitive <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> (brain “fog”)</li>\n<li>Mood changes</li>\n<li>Fatigue</li>\n<li>Yawning/sleepiness</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> and thirst</li>\n<li>Food cravings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aura</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurologic disturbances (e.g., visual disturbances like scintillating scotoma)</li>\n<li>Due to Cerebral vasoconstriction. Therefore prevention is by Vasodilators.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Headache Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Nausea/vomiting</li>\n<li>Sensory sensitivities:\n\t\t\t\t<ul>\n<li>Photophobia (sensitivity to light)</li>\n<li>Phonophobia (sensitivity to sound)</li>\n<li>Osmophobia (sensitivity to smells)</li>\n<li>Allodynia (pain from non-painful stimuli)</li>\n<li>Vertigo</li>\n</ul>\n</li>\n<li>Due to cerebral vasodilation. So treatment is Vasoconstrictors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postdrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tiredness</li>\n<li>Weariness</li>\n<li>Impaired concentration</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:583px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Simplified <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Criteria for <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">Migraine</span> by International Headache Society </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Repeated attacks of headache lasting 4–72h in patients with a normal physical examination, no other reasonable cause for the headache, and:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>At least 2 of the following features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Plus at least 1 of the following features:</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Unilateral pain</li>\n<li>Throbbing pain</li>\n<li>Aggravation by movement</li>\n<li>Moderate or severe intensity</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Nausea/vomiting</li>\n<li>Photophobia and phonophobia</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with a 9-month history of frequent headaches occurring at least 3 times per week. She describes the pain as a dull, bilateral ache that feels like a tight band around her head. The headaches are often accompanied by neck tension, stress, and fatigue. She reports difficulty concentrating due to the pain, and her sleep has been disrupted. The patient is looking for a long-term solution to manage her condition. Which of the following is the most appropriate first-line treatment for this patient's condition?", "options": [{"label": "A", "text": "Amitriptyline, starting at 20 mg daily, with gradual increases as needed.", "correct": true}, {"label": "B", "text": "Combination of Ibuprofen 400 mg plus acetaminophen 1000 mg.", "correct": false}, {"label": "C", "text": "Aspirin and Botulinum toxin type A", "correct": false}, {"label": "D", "text": "Combination of massage therapy and acupuncture", "correct": false}], "correct_answer": "A. Amitriptyline, starting at 20 mg daily, with gradual increases as needed.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old woman presents with recurrent, sharp, electric shock-like pain on the right side of her face, affecting her jaw and cheek. The pain is triggered by light touch, such as brushing her teeth or shaving. She reports these episodes happening multiple times a day and lasting only a few seconds. Which of the following statements is TRUE regarding her condition?", "options": [{"label": "A", "text": "The most likely diagnosis is glossopharyngeal neuralgia, as the pain is localized to the jaw and oral cavity and is triggered by chewing.", "correct": false}, {"label": "B", "text": "Most commonly caused by vascular compression of the trigeminal nerve, often by the superior cerebellar artery.", "correct": true}, {"label": "C", "text": "The primary treatment is surgical decompression of the glossopharyngeal nerve.", "correct": false}, {"label": "D", "text": "This patient's condition is most likely to involve the ophthalmic branch (V1) of the trigeminal nerve.", "correct": false}], "correct_answer": "B. Most commonly caused by vascular compression of the trigeminal nerve, often by the superior cerebellar artery.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Trigeminal Neuralgia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Glossopharyngeal Neuralgia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also known as \"tic douloureux,\" is a chronic neurological condition marked by recurrent, brief episodes of electric shock-like <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> pain.</li>\n<li>Usually affects one side of the face and commonly involves the maxillary (V2) and mandibular (V3) branches of the <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve.</li>\n<li>Pain episodes are <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by <span class=\"customMeta\" data-dictid=\"7d7e9fdf401692777199f2038941b6\">stimuli</span> like touch, chewing, or exposure to cold air.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A rare pain syndrome affecting the <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> distribution of the <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> nerve (CN IX).</li>\n<li>Characterized by brief, sharp, <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> pain in areas like the jaw angle, ear, <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> fossa, and base of the tongue.</li>\n<li>Pain episodes are <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by coughing, talking, or swallowing. <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused mainly by <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve root, ofte,pn by the superior cerebellar artery.</li>\n<li>Other causes include space-occupying lesions (e.g., tumors), multiple sclerosis, or other <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> abnormalities.</li>\n<li>Compression leads to <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> of the nerve, resulting in <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> transmission of impulses, causing pain.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic (unknown cause) or secondary to specific conditions:</li>\n<li>Vascular compression, especially near the nerve root.</li>\n<li>Demyelinating diseases (e.g., multiple sclerosis), infections, and <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> conditions (e.g., Sjögren's disease).</li>\n<li>Intracranial tumors (medullary tumors, CP angle tumors).</li>\n<li>Anatomical anomalies (Eagle syndrome).</li>\n<li>Rarely <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> with <span class=\"customMeta\" data-dictid=\"b1a011ab5416927771949dde193e3a\">oropharyngeal</span> cancers (e.g., tongue carcinoma).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain is typically unilateral, sharp, and brief, often described as<strong> \"electric shock-like.\"</strong></li>\n<li>Triggers include light touch to specific <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> areas <strong>(\"trigger zones\")</strong> and routine activities like brushing <span class=\"customMeta\" data-dictid=\"17dfb015d2169277720023db8fe9e5\">teeth</span> or shaving.</li>\n<li>Pain episodes can occur multiple times per day, sometimes with a <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> period following each episode.</li>\n<li>V1 involvement (rare) may present with <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> symptoms like tearing and rhinorrhea. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intense, episodic, sharp pain lasting seconds to minutes.</li>\n<li>Pain is unilateral, often affecting the ear, tongue base, and <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> fossa.</li>\n<li>Relapsing-remitting pain pattern, may lead to weight loss due to difficulty eating.</li>\n<li>Occasionally, pain is associated with bradycardia, asystole, or syncope.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is often clinical, supported by <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> or <span class=\"customMeta\" data-dictid=\"84657f511f1692777193ee21d9a5e4\">MRA</span> to rule out secondary causes or <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> compression.</li>\n<li>High-resolution <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> (e.g., FIESTA sequencing) helps <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> nerve compression.</li>\n<li>Diagnosis based on the International <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Headache Disorders criteria includes <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> pain lasting seconds to minutes, <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by <span class=\"customMeta\" data-dictid=\"f4cf2eb2351692777190992f264326\">innocuous</span> stimuli, and of severe intensity.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical diagnosis with history and exam.</li>\n<li>Imaging:</li>\n<li><strong>MRI</strong>: Preferred to identify nerve <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> by blood vessels or tumors.</li>\n<li><strong>MRA</strong>: To detect <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> compression.</li>\n<li><strong>CT</strong> and <strong>X-ray</strong>: Useful for detecting an elongated or calcified <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process in Eagle syndrome.</li>\n<li>Cardiac evaluation for syncopal cases: <span class=\"customMeta\" data-dictid=\"36376dc3a81692777186a5d60f88cd\">Echocardiogram</span> and Holter monitoring.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pharmacologic Therapy</strong>:\n\t\t\t\t<ul>\n<li><strong>First-line</strong>: <span class=\"customMeta\" data-dictid=\"83136ce53c1692777183ab554f66a5\">Carbamazepine</span> (FDA-approved) or oxcarbazepine; both may cause dizziness, hyponatremia, and other side effects. <strong>(Option C ruled out)</strong></li>\n<li><strong>Second-line</strong>: Gabapentin, clonazepam, lamotrigine, and baclofen; used if first-line agents are ineffective.</li>\n</ul>\n</li>\n<li><strong>Surgical Therapy</strong>:\n\t\t\t\t<ul>\n<li><strong>Microvascular decompression</strong>: Effective in &gt;90% of cases; involves <span class=\"customMeta\" data-dictid=\"cecf1b86e61692777185f281991f2d\">craniotomy</span> and vessel decompression.</li>\n<li><strong>Rhizotomy</strong>: Ablative procedures like <span class=\"customMeta\" data-dictid=\"690286e9ce1692777200fa2951e55e\">thermocoagulation</span> or chemical <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> of the <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve for pain relief.</li>\n<li><strong>Peripheral neurectomy</strong>: Performed on <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> branches in remote areas; moderate success with some recurrence.</li>\n</ul>\n</li>\n<li><strong>Other Therapies</strong>:\n\t\t\t\t<ul>\n<li><strong>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections</strong>: Provides relief in cases <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> to medications.</li>\n<li><strong>Deep brain stimulation</strong>: Used as a last-resort option in <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases, with limited evidence of effectiveness.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medications</strong>: <span class=\"customMeta\" data-dictid=\"83136ce53c1692777183ab554f66a5\">Carbamazepine</span> or <span class=\"customMeta\" data-dictid=\"e18bce379b1692777194eec32b5879\">oxcarbazepine</span> are first-line; other options include gabapentin, duloxetine, and pregabalin.</li>\n<li><strong>Nerve Blocks</strong>: <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">Glossopharyngeal</span> nerve block with anesthetics or <span class=\"customMeta\" data-dictid=\"07f73f8986169277719716f3a62e1b\">radiofrequency</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> for persistent pain.</li>\n<li><strong>Surgery</strong>: <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">Microvascular</span> <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> is the main surgery for <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> compression; other procedures include <span class=\"customMeta\" data-dictid=\"eb26a27b721692777197f12de14ea3\">rhizotomy</span> or stylectomy for Eagle syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: 1. Naratriptan a) 5-HT1F Agonist 2. Lasmiditan b) Dopamine Receptor Antagonist 3. Rimegepant c) 5-HT1B/1D Agonist 4. Prochlorperazine d) CGRP Receptor Antagonist", "options": [{"label": "A", "text": "1-d, 2-c, 3-b, 4-a", "correct": false}, {"label": "B", "text": "1-a, 2-c, 3-b, 4-d", "correct": false}, {"label": "C", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}, {"label": "D", "text": "1-b, 2-d, 3-c, 4-a", "correct": false}], "correct_answer": "C. 1-c, 2-a, 3-d, 4-b", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old male presents to the emergency department following a severe head injury. On examination, he shows signs of increasing intracranial pressure, including altered consciousness and anisocoria (unequal pupil size). His CT scan reveals significant brain swelling and herniation. The medical team suspects a specific type of brain herniation. Which of the following types of brain herniation is most likely responsible for the patient’s altered pupillary response?", "options": [{"label": "A", "text": "Subfalcine Herniation", "correct": false}, {"label": "B", "text": "Transsphenoidal Herniation", "correct": false}, {"label": "C", "text": "Transtentorial Uncal Herniation", "correct": true}, {"label": "D", "text": "Cerebellar Tonsillar Herniation", "correct": false}], "correct_answer": "C. Transtentorial Uncal Herniation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of Brain Herniation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subfalcine Herniation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The cingulate <span class=\"customMeta\" data-dictid=\"231fafb8e116927771888a0efe57f1\">gyrus</span> moves beneath the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> falx.</li>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> territory.</li>\n<li>Causes <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> weakness due to <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> of motor areas and <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of vessels.<strong> (Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transalar/ <span class=\"customMeta\" data-dictid=\"84f3008c6c16927772009846fc41f6\">Transsphenoidal</span> Herniation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Descending: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> of the middle cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> by the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> ridge causes infarction.</li>\n<li>Ascending: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> of the internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> causes <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and middle cerebral arteries. <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transtentorial <span class=\"customMeta\" data-dictid=\"5bedae139e1692777201cb6313fd56\">Uncal</span> Herniation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Compression of the 3rd nerve causes <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> changes (constriction followed by dilation).</li>\n<li>Can lead to hydrocephalus, temporal/occipital <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> infarction, and <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> motor deficits (<strong>Kernohan’s notch</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">Herniation</span> (Descending and Ascending)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Descending: <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">Brainstem</span> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> causes <span class=\"customMeta\" data-dictid=\"f9d2c6e1171692777186e744baf748\">Duret hemorrhages</span> and <span class=\"customMeta\" data-dictid=\"c6dae10ff4169277718565b592878d\">Cushing triad</span> (hypertension, bradycardia, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> respirations).</li>\n<li>Ascending: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cerebral or superior cerebellar arteries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cerebellar <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">Tonsillar</span> Herniation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cerebellar tonsils move through the <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> magnum.</li>\n<li>Compresses the <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> and upper <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cord, leading to life-threatening conditions.</li>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> of brainstem, tonsils, and lower cerebellum. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transcalvarial Herniation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs due to calvarial defects (e.g., after hemicraniectomy).</li>\n<li>Brain tissue herniates through the skull defect, potentially causing hemorrhagic infarction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with a history of recurrent headaches. After a thorough evaluation, he is diagnosed with a headache that has a stinging character and characterized by the following features: Duration: 5-240 seconds Attacks: 3-200 attacks per day. Which of the following treatments is most appropriate for this condition?", "options": [{"label": "A", "text": "High-flow oxygen", "correct": false}, {"label": "B", "text": "Sumatriptan", "correct": false}, {"label": "C", "text": "IV Lidocaine", "correct": true}, {"label": "D", "text": "Verapamil", "correct": false}], "correct_answer": "C. IV Lidocaine", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cluster Headache</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>SUNCT</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration of Attacks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-180 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-240 seconds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency of Attacks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-8 attacks per day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-200 attacks per day</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain Quality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe, unilateral, often described as stabbing or boring</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sharp, unilateral, often described as stinging</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lacrimation, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> congestion, ptosis, miosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjunctival injection, tearing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Circadian Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often occurs at the same time daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No specific <span class=\"customMeta\" data-dictid=\"6d2d14b32a1692777184597558c86a\">circadian</span> pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in males, typically age &gt; 30</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur in both genders, usually age &gt; 40</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triggers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alcohol, certain foods, changes in sleep patterns</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stress, physical exertion, not well-defined triggers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-line Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-flow oxygen, <span class=\"customMeta\" data-dictid=\"9b35eee3b816927772000b391ab2ba\">triptans</span> (e.g., Sumatriptan)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV Lidocaine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old female presents with a 3-month history of new-onset headaches, scalp tenderness, and jaw claudication. She also reports significant fatigue and unintentional weight loss. Laboratory studies reveal an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). What is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Start high-dose corticosteroids", "correct": true}, {"label": "B", "text": "Perform temporal artery biopsy", "correct": false}, {"label": "C", "text": "Initiate aspirin therapy", "correct": false}, {"label": "D", "text": "Refer for imaging studies of the carotid arteries", "correct": false}], "correct_answer": "A. Start high-dose corticosteroids", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the variants of Migraine in Column A with their characteristic clinical features in Column B: Column A Column B 1. Ophthalmoplegic Migraine A. Associated with blindness and scintillating scotomas 2. Cluster Headaches B. Retro-orbital pain in males 3. Retinal Migraine C. Associated with occulomotor palsy 4. Familial Hemiplegic Migraine D. Presents with hemiplegia and can be confused with stroke E. Diagnosis often involves neuroimaging to rule out cerebrovascular accidents", "options": [{"label": "A", "text": "1-C, 2-E, 3-A, 4-B", "correct": false}, {"label": "B", "text": "1-C, 2-B, 3-A, 4-D", "correct": true}, {"label": "C", "text": "1-B, 2-E, 3-C, 4-D", "correct": false}, {"label": "D", "text": "1-B, 2-E, 3-A, 4-B", "correct": false}], "correct_answer": "B. 1-C, 2-B, 3-A, 4-D", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ophthalmoplegic Migraine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Ophthalmoplegic <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> can present with neurological deficits, such as <strong>third nerve palsy,</strong> which may include symptoms like <strong>ptosis and squinting.</strong></li>\n<li>It typically causes severe pain that can lead to vision impairment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cluster Headaches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Cluster headaches are known for their unilateral, severe pain typically located around the eye, often described as <strong>retro-orbital pain.</strong></li>\n<li>They are more common in <strong>males</strong> and can be associated with other symptoms such as <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and watering of the eyes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Retinal Migraine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> vision loss or <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">blindness</span> due to <span class=\"customMeta\" data-dictid=\"88758385011692777201c7fff08b99\">vasospasm</span> of the <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> arteries.</li>\n<li>Symptoms such as scintillating scotomas are also present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Familial Hemiplegic Migraine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Rare type of <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> that includes <strong>hemiplegia </strong>(temporary <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> on one side of the body) as a symptom.</li>\n<li>Because of this, it can easily be confused with a stroke.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man with a history of chronic migraines visits his physician to discuss treatment options. He is interested in triptans but has some health concerns that he wants to clarify. Which of the following is NOT a contraindication for triptans based on the provided information?", "options": [{"label": "A", "text": "History of coronary artery disease", "correct": false}, {"label": "B", "text": "History of seasonal allergies", "correct": true}, {"label": "C", "text": "Wolff-Parkinson-White syndrome", "correct": false}, {"label": "D", "text": "Concurrent use with MAO inhibitors", "correct": false}], "correct_answer": "B. History of seasonal allergies", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman completes the MIDAS questionnaire during her follow-up for chronic migraines. Her headaches have significantly impacted her work and social life. What is the primary purpose of the MIDAS assessment?", "options": [{"label": "A", "text": "To determine the specific medication needed for treatment.", "correct": false}, {"label": "B", "text": "To assess the frequency of headache attacks.", "correct": false}, {"label": "C", "text": "To evaluate headache-related disability and its impact on daily activities.", "correct": true}, {"label": "D", "text": "To classify the type of headache.", "correct": false}], "correct_answer": "C. To evaluate headache-related disability and its impact on daily activities.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MIDAS Questionnaire</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Instructions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Please answer the following questions about all the headaches you have had over the last 3 months.</p>\n<p>Select your answer in the box next to each question. Select <span class=\"customMeta\" data-dictid=\"116e588c7b1692777202c7f3040428\">zero</span> if you did not have the activity in the last 3 months. Please take the complete <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> to your healthcare professional.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Questions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>On how many days in the last 3 months did you miss work or school because of your headaches?</li>\n<li>How many days in the last 3 months was your productivity at work or school <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by half or more because of your headaches (do not include days you counted in question 1 where you missed work or school)?</li>\n<li>How many days in the last 3 months have you not done household work because of your headaches?</li>\n<li>How many days in the last 3 months was your productivity in household work <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by half or more because of your headaches (do not include days you counted in question 3 where you did not do household work)?</li>\n<li>On how many days in the last 3 months did you miss family, social, or leisure activities because of your headaches?</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>What your Physician will need to know about your headaches:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>How many days in the last 3 months did you have a headache? (If a headache lasted more than one day, count each day.)</li>\n<li>On a scale of 0–10, on average how painful were these headaches? (Where 0 = no pain at all, and 10 = pain as bad as it can be.)</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grading</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Total MIDAS scores categorize migraine-related disability into four grades:</p>\n<ul>\n<li>Grade I: Little or no disability (0–5)</li>\n<li>Grade II: Mild disability (6–10)</li>\n<li>Grade III: Moderate disability (11–20)</li>\n<li>Grade IV: Severe disability (≥ 21)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents to her doctor with a history of frequent migraines. She reports experiencing about five migraine attacks per month, which have not responded well to over-the-counter pain relievers. The attacks last between 24 and 48 hours and are accompanied by nausea and sensitivity to light and sound. Her doctor discusses the possibility of preventive treatment options. Based on her symptoms and frequency of attacks, which of the following preventive treatments is most appropriate for this patient?", "options": [{"label": "A", "text": "Acetaminophen", "correct": false}, {"label": "B", "text": "Propranolol", "correct": true}, {"label": "C", "text": "Sumatriptan", "correct": false}, {"label": "D", "text": "Rimegepant", "correct": false}], "correct_answer": "B. Propranolol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Migraine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prevention of Migraine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pharmacologic Options:</strong>\n<ul>\n<li>Simple Analgesics: Acetaminophen, aspirin, caffeine. <strong>(Option A ruled out)</strong></li>\n<li>NSAIDs: Naproxen, ibuprofen, tolfenamic acid, diclofenac.</li>\n<li>Triptans (5-HT1B/1D Agonists): Sumatriptan, rizatriptan, naratriptan, eletriptan, frovatriptan, zolmitriptan. <strong>(Option C ruled out)</strong></li>\n<li>Gepants (CGRP <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Antagonists): Rimegepant, ubrogepant. <strong>(Option D ruled out)</strong></li>\n<li>Ditans (5-HT1F Agonists): Lasmiditan.</li>\n<li>Dopamine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Antagonists: Metoclopramide, prochlorperazine.</li>\n<li>Other Options: Combination medications (e.g., acetaminophen, dichloralphenazone, isometheptene), opioids (limited use).</li>\n</ul>\n</li>\n<li><strong>Non-Pharmacologic Management:</strong>\n<ul>\n<li>Identify and avoid triggers.</li>\n<li>Regulated lifestyle: Healthy diet, regular exercise, consistent sleep, stress management (e.g., yoga, meditation).</li>\n<li>Neuromodulation techniques: sTMS, nVNS.</li>\n</ul>\n</li>\n<li><strong>Key Recommendations:</strong>\n<ul>\n<li>Use medications early in an attack.</li>\n<li>If symptoms persist after 60 minutes, consider increasing the initial dose or switching drug classes.</li>\n<li>Individualize treatment based on attack severity and patient response.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Indications for <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">Preventive</span> Treatment:</strong>\n<ul>\n<li>Consider for patients with four or more <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> attacks per month or those unresponsive to <span class=\"customMeta\" data-dictid=\"3acd96d3c91692777180bd966dec76\">abortive</span> treatments.</li>\n</ul>\n</li>\n<li><strong>Pharmacologic Options:</strong>\n<ul>\n<li>Beta Blockers: Propranolol, metoprolol.</li>\n<li>Antidepressants: Amitriptyline, nortriptyline, venlafaxine.</li>\n<li>Anticonvulsants: Topiramate, valproate.</li>\n<li>CGRP Antagonists: Eptinezumab, erenumab, fremanezumab, galcanezumab.</li>\n<li>Other Medications: <strong>Flunarizine</strong>, candesartan, melatonin.</li>\n</ul>\n</li>\n<li><strong>Considerations:</strong>\n<ul>\n<li>Preventive treatments often take<strong> 2–12 weeks</strong> to show effect.</li>\n<li>Side effects vary; some medications require careful monitoring (e.g., weight gain with certain antidepressants).</li>\n<li>Neuromodulation (sTMS) is also FDA-approved for prevention.</li>\n</ul>\n</li>\n<li><strong>Patient Management:</strong>\n<ul>\n<li>Start with low doses and gradually increase.</li>\n<li>Monitor effectiveness and side effects.</li>\n<li>After stabilization, taper off medication after approximately six months to assess ongoing need.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old male presents with sudden onset headache and right-sided weakness. He has a history of cocaine use. Which of the most likely mechanism caused his intracerebral hemorrhage?", "options": [{"label": "A", "text": "Direct vessel wall damage", "correct": false}, {"label": "B", "text": "Acute hypertensive surge", "correct": true}, {"label": "C", "text": "Vasculitis", "correct": false}, {"label": "D", "text": "Amyloid deposition", "correct": false}], "correct_answer": "B. Acute hypertensive surge", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman presents with a headache that has become increasingly frequent over the past month. She mentions that she often takes over-the-counter pain relievers to alleviate her discomfort. During the visit, she described her headaches as dull and pressing, primarily located around her forehead, and she rarely experiences nausea or light sensitivity. Which of the following types of headaches is NOT classified as a primary headache?", "options": [{"label": "A", "text": "Tension-type headache", "correct": false}, {"label": "B", "text": "Medication overuse headache", "correct": true}, {"label": "C", "text": "Migraine", "correct": false}, {"label": "D", "text": "Cluster headache", "correct": false}], "correct_answer": "B. Medication overuse headache", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Primary Headaches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Secondary Headaches</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"9\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Migraine (with or without aura) <strong>(Option C ruled out)</strong></li>\n<li>Tension-type headache- <strong>Most common </strong><strong>(Option A ruled out)</strong></li>\n<li>Trigeminal <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> <span class=\"customMeta\" data-dictid=\"bad7c9a1b71692777184f549bff914\">cephalalgia</span> (cluster) <strong>(Option D ruled out)</strong></li>\n<li>Primary stabbing headache</li>\n<li>Primary coughing headache</li>\n<li>Primary exertional headache</li>\n<li>Sex-related headache</li>\n<li>Thunderclap headache</li>\n<li>New daily persistent headache syndrome</li>\n</ul>\n</td>\n<td rowspan=\"9\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Medication overuse headache (chronic daily headache)</li>\n<li>Intracranial <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (subdural haematoma, <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> or <span class=\"customMeta\" data-dictid=\"c7f167b8df1692777190bcd90fe428\">intracerebral</span> haemorrhage)</li>\n<li>Raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure (brain tumour, <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hypertension)</li>\n<li>Infection (meningitis, encephalitis, brain abscess)</li>\n<li>Inflammatory disease (temporal arteritis, other vasculitis, arthritis)</li>\n<li>Referred pain from other structures (orbit, <span class=\"customMeta\" data-dictid=\"66f9c028981692777200c9ce0cd63f\">temporomandibular</span> joint, neck)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn delivered by forceps has a high-pitched cry and bulging anterior fontanelle. The mother notes that the baby seems unusually irritable. Which of the following is the most appropriate initial diagnostic step and management?", "options": [{"label": "A", "text": "CT head and surgical evacuation", "correct": false}, {"label": "B", "text": "USG skull and phenobarbitone", "correct": true}, {"label": "C", "text": "MRI brain and mannitol", "correct": false}, {"label": "D", "text": "X-ray skull and acetaminophen", "correct": false}], "correct_answer": "B. USG skull and phenobarbitone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intraventricular <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">Hemorrhage</span> in Neonates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"5eae3427c21692777196b11dc4b693\">Prematurity</span> (≤32 weeks)</p>\n<p>- Low birth weight (&lt;1500g)</p>\n<p>- No <span class=\"customMeta\" data-dictid=\"42bfa0b99f16927771817ed9a23b27\">antenatal</span> steroids</p>\n<p>- <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> delivery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Bulging fontanelle</p>\n<p>- Apnea/lethargy</p>\n<p>- Seizures</p>\n<p>- Often asymptomatic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Head USG (primary tool)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> for complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Minimal handling</p>\n<p>- Maintain stable BP</p>\n<p>- Monitor for hydrocephalus</p>\n<p>- <span class=\"customMeta\" data-dictid=\"0e1abbb47d169277719507b78b56e6\">Phenobarbital</span> for <span class=\"customMeta\" data-dictid=\"8395d9e54e1692777185e6be24d252\">convulsion</span> prevention</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man with atrial fibrillation on warfarin presents with progressive confusion and unsteady gait over the past month. His wife reports he had a minor fall 6 weeks ago. On examination, he is confused, has mild left-sided weakness, and his gait is shuffling. CT brain of the patient is given below. Which of the following best describes the pathophysiological mechanism of this condition?", "options": [{"label": "A", "text": "Direct arterial bleeding with rapid expansion", "correct": false}, {"label": "B", "text": "Recurrent microbleeds with inflammatory response and osmotic fluid accumulation", "correct": true}, {"label": "C", "text": "Subarachnoid space hemorrhage with CSF mixing", "correct": false}, {"label": "D", "text": "Primary brain parenchymal bleeding with edema", "correct": false}], "correct_answer": "B. Recurrent microbleeds with inflammatory response and osmotic fluid accumulation", "question_images": ["https://image.prepladder.com/content/JAPWRBtlEzLLoCC4zx3M1740464350.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute SDH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic SDH</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-72 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;3 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Rapid deterioration</p>\n<p>- Loss of consciousness</p>\n<p>- <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> deficits</p>\n<p>- High mortality</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Gradual onset</p>\n<p>- Confusion</p>\n<p>- Headache</p>\n<p>- <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">Gait</span> disturbance</p>\n<p>- Better prognosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Severe trauma</p>\n<p>- Young adults</p>\n<p>- Coagulopathy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Elderly</p>\n<p>- Brain atrophy</p>\n<p>- Anticoagulation</p>\n<p>- Minor trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"1dfb6906b91692777189e0acce4f86\">Hyperdense</span> crescent</p>\n<p>- Immediate mass effect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Hypodense/mixed density</p>\n<p>- <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> in 20-30%</p>\n<p>- Gradual mass effect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Emergency craniotomy</p>\n<p>- Reverse coagulopathy</p>\n<p>- <span class=\"customMeta\" data-dictid=\"dcf52bc6051692777189bc6d95b5e5\">ICU</span> care</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"424dfa19a216927771833dc4f65079\">Burr</span> hole drainage</p>\n<p>- Hold anticoagulation</p>\n<p>- May observe small ones</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old man presents to the emergency department after being struck in the temporal region during a hockey game. Initially conscious at the scene, he now presents with decreasing consciousness, right-sided pupillary dilation, and left hemiparesis. CT head shows a lentiform hyperdense lesion in the right temporal region with 12mm midline shift. What is the most appropriate immediate management?", "options": [{"label": "A", "text": "Observe and monitor neurological status", "correct": false}, {"label": "B", "text": "Start mannitol and hyperventilate", "correct": false}, {"label": "C", "text": "Emergency burr hole followed by craniotomy", "correct": true}, {"label": "D", "text": "Conservative management with anticonvulsants", "correct": false}], "correct_answer": "C. Emergency burr hole followed by craniotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man on warfarin (INR 2.5) falls and hits his head. He is initially alert and oriented, but after 2 hours, becomes progressively drowsy and confused. His CT scan is given below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Epidural hematoma", "correct": true}, {"label": "B", "text": "Subdural hematoma", "correct": false}, {"label": "C", "text": "Intraparenchymal hemorrhage", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "A. Epidural hematoma", "question_images": ["https://image.prepladder.com/notes/9EmRGe1bwKeYNWfoDytO1744370789.png"], "explanation_images": ["https://image.prepladder.com/notes/QB5iJoFT87eLzGsw9p9A1744370815.png", "https://image.prepladder.com/notes/nhRRZlde6oRgGxx4BSD21744370851.png", "https://image.prepladder.com/notes/TQZAUmebOvKn909Gy7JU1744370884.png", "https://image.prepladder.com/notes/Z3z3WHaMBEHsoXE7B3vn1744370923.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lucid Interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidural Hematoma</strong></p>\n<figure class=\"caption_element\"><img alt=\"Epidural hematoma\" data-author=\"James Heilman, MD\" data-hash=\"9366\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:EpiduralHematoma.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/QB5iJoFT87eLzGsw9p9A1744370815.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>++</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Biconvex/lentiform shape</p>\n<p>- Does not cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</p>\n<p>- Cross <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> sinuses</p>\n<p>- Hyperdense</p>\n<p>- Usually unilateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-Typically meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury (especially middle meningeal)</p>\n<p>-<strong>High <span class=\"customMeta\" data-dictid=\"12c4510e191692777201c23ec126a3\">velocity</span> trauma</strong></p>\n<p>-Young patient</p>\n<p>-Always traumatic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subdural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (Option B)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Subdural Hematoma\" data-author=\"James Heilman, MD\" data-hash=\"9367\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Subduralandherniation.PNG\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/nhRRZlde6oRgGxx4BSD21744370851.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+/-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Crescent-shaped</p>\n<p>- Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</p>\n<p>- Can be bilateral</p>\n<p>- Don't cross <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> sinuses</p>\n<p>- Follows brain surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">Bridging</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> tears</p>\n<p>- Can be <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">Traumatic</span> or <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> traumatic</p>\n<p>- Elderly patients</p>\n<p>- Extent of brain injury more in SDH than EDH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (Option C)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Intraparenchymal Hematoma\" data-author=\"Mark Rodrigues\" data-hash=\"9368\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/lobar-intracerebral-haemorrhage-3#image-36209781\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/TQZAUmebOvKn909Gy7JU1744370884.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">Irregular</span> shape within brain tissue</p>\n<p>- May have surrounding edema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct tissue damage or coagulopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subarachnoid Haemorrhage (Option D)</strong></p>\n<figure class=\"caption_element\"><img alt=\"Subarachnoid Haemorrhage\" data-author=\"James Heilman, MD\" data-hash=\"9369\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:SubarachnoidP.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Z3z3WHaMBEHsoXE7B3vn1744370923.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Blood in sulci/cisterns</p>\n<p>- Follows <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> spaces</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma or <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> rupture</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old man on warfarin for atrial fibrillation presents to the emergency department with sudden onset headache, right-sided weakness, and altered mental status. His INR is 4.8. CT Brain of the patient is given below. Which of the following represents the most appropriate immediate management strategy?", "options": [{"label": "A", "text": "Vitamin K 10mg IV only", "correct": false}, {"label": "B", "text": "Fresh frozen plasma (FFP) only", "correct": false}, {"label": "C", "text": "Hold warfarin and observe", "correct": false}, {"label": "D", "text": "4-factor Prothrombin Complex Concentrate (PCC), Vitamin K 10mg IV, and consider tranexamic acid", "correct": true}], "correct_answer": "D. 4-factor Prothrombin Complex Concentrate (PCC), Vitamin K 10mg IV, and consider tranexamic acid", "question_images": ["https://image.prepladder.com/notes/TXsvjRT9uqKkRkHO9csR1744370755.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Warfarin associated <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">Intracranial</span> Hemorrhage- Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-line Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-factor PCC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Rapid INR reversal</p>\n<p>- Contains factors II, VII, IX, X</p>\n<p>- Faster than FFP</p>\n<p>- Lower volume load</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin K 10mg IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Sustains reversal</p>\n<p>- Prevents <span class=\"customMeta\" data-dictid=\"a4812dcf9b169277719756aaf48b7c\">rebound</span> coagulopathy</p>\n<p>- Takes hours for full effect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tranexamic acid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Antifibrinolytic</p>\n<p>- May help stabilize hemorrhage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative if <span class=\"customMeta\" data-dictid=\"7ceec0cc8e16927771949e935d2576\">PCC</span> unavailable</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FFP (15-30 mL/kg)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Restores <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors to 30-50%</p>\n<p>- Requires larger volumes</p>\n<p>- Slower to administer</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old hypertensive man suddenly develops left facial droop and right arm weakness during a meeting. His BP is 220/130 mmHg. CT shows putaminal hemorrhage. What is the MOST appropriate immediate management?", "options": [{"label": "A", "text": "IV Mannitol", "correct": false}, {"label": "B", "text": "Immediate surgical evacuation", "correct": false}, {"label": "C", "text": "IV Nicardipine", "correct": true}, {"label": "D", "text": "Oral antihypertensives", "correct": false}], "correct_answer": "C. IV Nicardipine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old hypertensive male presents with sudden onset weakness of right face and arm, along with difficulty speaking. He is unable to form words properly but appears to understand commands. Brain imaging shows an acute infarct. Which division of the MCA is most likely involved?", "options": [{"label": "A", "text": "Superior division of left MCA", "correct": true}, {"label": "B", "text": "Inferior division of left MCA", "correct": false}, {"label": "C", "text": "Main trunk of left MCA", "correct": false}, {"label": "D", "text": "Lenticulostriate branches of left MCA", "correct": false}], "correct_answer": "A. Superior division of left MCA", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/zyBJV4XFt1wALE8rHWRO1744370700.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 82-year-old normotensive, non-diabetic man presents with sudden onset confusion and headache. MRI shows multiple lobar hemorrhages. Which is the MOST likely diagnosis?", "options": [{"label": "A", "text": "Cerebral amyloid angiopathy", "correct": true}, {"label": "B", "text": "Berry aneurysm rupture", "correct": false}, {"label": "C", "text": "Hypertensive crisis", "correct": false}, {"label": "D", "text": "Venous sinus thrombosis", "correct": false}], "correct_answer": "A. Cerebral amyloid angiopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Cerebral <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">Amyloid</span> <span class=\"customMeta\" data-dictid=\"6d7e26ca0216927771818c9c03bf9f\">Angiopathy</span> (CAA) (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Berry <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">Aneurysm</span> Rupture </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Hypertensive Crisis </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Venous <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">Thrombosis</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Elderly (&gt;60 years)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Younger</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Older, with chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Younger, hypercoagulable states</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hemorrhage Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> hemorrhages</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Subarachnoid, single event</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Deep (e.g., putamen, thalamus)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hemorrhagic infarction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hemorrhage Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Cortical-subcortical regions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Subarachnoid space</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Deep brain structures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Venous infarction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lobar hemorrhages, microbleeds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Single, <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> bleed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Deep hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Venous <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Acute neurological symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Thunderclap headache</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Often no symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Seizures, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Acute neurological presentation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sudden, thunderclap headache</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Acute, with chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Acute, gradual progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spares deep structures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Focal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Deep brain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Venous infarction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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The parents report that the child has been experiencing these seizures since early childhood. Which of the following syndromes is NOT associated with myoclonic seizures?", "options": [{"label": "A", "text": "JANZ Syndrome", "correct": false}, {"label": "B", "text": "Lennox-Gastaut Syndrome", "correct": false}, {"label": "C", "text": "Progressive Myoclonic Epilepsies", "correct": false}, {"label": "D", "text": "None of the above", "correct": true}], "correct_answer": "D. None of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match each drug with its preferred use for the corresponding type of seizure. 1. Partial seizures a. Lorazepam 2. Generalized tonic-clonic seizures b. Diazepam 3. Febrile seizures c. Valproate 4. Status epilepticus d. Carbamazepine", "options": [{"label": "A", "text": "1-d, 2-c, 3-b, 4-a", "correct": true}, {"label": "B", "text": "1-c, 2-d, 3-b, 4-a", "correct": false}, {"label": "C", "text": "1-b, 2-d, 3-a, 4-c", "correct": false}, {"label": "D", "text": "1-d, 2-b, 3-a, 4-c", "correct": false}], "correct_answer": "A. 1-d, 2-c, 3-b, 4-a", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0zaen1aUjDAfHhN3drXs1744332327.png", "https://image.prepladder.com/notes/smhiEdju9eeDJIWFe0JW1744332368.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Seizure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anti-Epileptic Drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial or <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lamotrigine</li>\n<li>Oxcarbazepine</li>\n<li>Eslicarbazepine</li>\n<li>Carbamazepine</li>\n<li>Phenytoin</li>\n<li>Levetiracetam</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Generalized <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> <span class=\"customMeta\" data-dictid=\"bf5818a5e41692777184b67521723b\">clonic seizure</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Valproate</li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absence <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ethosuximide</li>\n<li>Valproate</li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Febrile <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diazepam (rectal) (drug of choice)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Status epilepticus </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lorazepam (drug of choice)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Juvenile myoclonic <span class=\"customMeta\" data-dictid=\"7546d26cea1692777187c257d4e14c\">epilepsy</span> (Janz syndrome) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug of choice: Valproate &gt; <span class=\"customMeta\" data-dictid=\"51e60386c21692777191ddf08160e9\">Lamotrigine</span> &gt; Topiramate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lennox Gestaut syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Valproate (first line drug)</strong></p>\n<p><img alt=\"LGS\" data-author=\"\" data-hash=\"9026\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/0zaen1aUjDAfHhN3drXs1744332327.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dravet's syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Valproate (drug of choice)</strong></p>\n<p><img alt=\"DRAVET SYNDROME\" data-author=\"\" data-hash=\"9027\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/smhiEdju9eeDJIWFe0JW1744332368.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infantile <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> ( also known as <span class=\"customMeta\" data-dictid=\"3fa45fe9451692777202810d42087f\">West syndrome</span> or Hypsarrhythmia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Occasional episodes: </strong></p>\n<ul>\n<li><strong>Drug of choice: <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> hormone +/- glucocorticoids</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Associated with <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> (lifelong seizures):</strong></p>\n<ul>\n<li><strong>Drug of choice: Vigabatrin</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Levetiracetam (safest in pregnancy)</strong></li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old woman with a history of seizures and poor medication adherence presents to the ER after a 6-minute seizure followed by another, with impaired consciousness between episodes. She is unresponsive and has labored breathing. What is the preferred drug of choice for her treatment?", "options": [{"label": "A", "text": "Valproate", "correct": false}, {"label": "B", "text": "Levetiracetam", "correct": false}, {"label": "C", "text": "Lorazepam", "correct": true}, {"label": "D", "text": "Diazepam", "correct": false}], "correct_answer": "C. Lorazepam", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9QA58gzrW4lT3Hr3XWXv1744332163.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4 y/o girl presents to the pediatric clinic with a port-wine stain on her forehead and upper eyelid. Her mother reports that she has been experiencing frequent seizures and has some difficulty in school. O/E, the child exhibits unilateral weakness of the left arm. CT imaging reveals tram-track calcifications in the brain. Which condition is most consistent with this presentation?", "options": [{"label": "A", "text": "Neurofibromatosis Type 1", "correct": false}, {"label": "B", "text": "Sturge-Weber Syndrome", "correct": true}, {"label": "C", "text": "Tuberous Sclerosis", "correct": false}, {"label": "D", "text": "Hypoparathyroidism", "correct": false}], "correct_answer": "B. Sturge-Weber Syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/LX7HuvFRvJlg5ra4ZTRv1744332014.png", "https://image.prepladder.com/notes/OV7aJNDjjzrnAhTIvGAf1744331330.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7 y/o boy is brought to the pediatric clinic due to developmental delays and frequent seizures. Upon examination, the following findings were observed. MRI shows subependymal giant cell astrocytomas. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Neurofibromatosis Type 1", "correct": false}, {"label": "B", "text": "Tuberous Sclerosis", "correct": true}, {"label": "C", "text": "Sturge-Weber Syndrome", "correct": false}, {"label": "D", "text": "Wunderlich Syndrome", "correct": false}], "correct_answer": "B. Tuberous Sclerosis", "question_images": ["https://image.prepladder.com/notes/S90ozs6fmoAQNZ1eqF7S1744331792.png", "https://image.prepladder.com/notes/G2hxLizPuCpw6oo05Ibq1744331589.png", "https://image.prepladder.com/notes/DWb2oD30dhK0ofb664dw1744331726.png"], "explanation_images": ["https://image.prepladder.com/notes/S90ozs6fmoAQNZ1eqF7S1744331792.png", "https://image.prepladder.com/notes/G2hxLizPuCpw6oo05Ibq1744331589.png", "https://image.prepladder.com/notes/DWb2oD30dhK0ofb664dw1744331726.png", "https://image.prepladder.com/notes/ScI6RVPg1YuXNszV0ovz1744331656.png", "https://image.prepladder.com/notes/G2hxLizPuCpw6oo05Ibq1744331589.png", "https://image.prepladder.com/notes/eJuag0hIH44D3l3bQ5fd1744331534.png", "https://image.prepladder.com/notes/fNQiwaveQwPgUuOhn36o1744331473.png", "https://image.prepladder.com/notes/3DWjFLrtXQyxwPXQzyI11744331431.png", "https://image.prepladder.com/notes/5KFZwxXVwrWPjmtlb71W1744331373.png", "https://image.prepladder.com/notes/OV7aJNDjjzrnAhTIvGAf1744331330.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12 y/o boy presents to the clinic with a history of behavioural changes and progressive seizures following a measles infection at age 2. The neurologist suspects subacute sclerosing panencephalitis (SSPE). Which combination of diagnostic findings would confirm the diagnosis according to SSPE diagnostic criteria?", "options": [{"label": "A", "text": "Typical clinical presentation, elevated CSF measles antibody titers, and normal EEG", "correct": false}, {"label": "B", "text": "Brain biopsy with characteristic histopathological findings and elevated CSF globulin levels.", "correct": false}, {"label": "C", "text": "Characteristic EEG findings, elevated CSF globulin levels, and elevated CSF measles antibody titers", "correct": true}, {"label": "D", "text": "Increased T2 signal on MRI, acellular CSF, and elevated serum measles-specific IgG", "correct": false}], "correct_answer": "C. Characteristic EEG findings, elevated CSF globulin levels, and elevated CSF measles antibody titers", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10 y/o boy presents to the clinic with a year-long history of cognitive decline. His parents report increased irritability, social withdrawal, and difficulty in school. He had measles at age 2. On examination, he shows signs of myoclonus and motor difficulties. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Subacute sclerosing panencephalitis", "correct": true}, {"label": "B", "text": "Dravet syndrome", "correct": false}, {"label": "C", "text": "Landau-Kleffner syndrome", "correct": false}, {"label": "D", "text": "Juvenile myoclonic epilepsy", "correct": false}], "correct_answer": "A. Subacute sclerosing panencephalitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subacute <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> <span class=\"customMeta\" data-dictid=\"871ad2a8051692777194a3f7cd0309\">Panencephalitis</span> (SSPE)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>SSPE is a rare, severe <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of the <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> virus.</li>\n<li>It typically presents in early <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> and has a progressive course with high mortality.</li>\n<li>Vaccination has <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> cases, but <span class=\"customMeta\" data-dictid=\"e9337bf1ae1692777199ce67095de2\">SSPE</span> remains a concern due to <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> re-emergence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by the <strong>measles virus</strong>, which is highly <span class=\"customMeta\" data-dictid=\"adc58f95b216927771853032f276b9\">contagious</span> and transmitted via aerosols.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"d3874506171692777191570df32b65\">latency</span> period ranges from <strong>6-8 years post-infection</strong>, with shorter periods in younger children.</li>\n<li>The virus targets<strong> lymphocytes and epithelial cells</strong>, causing significant immunosuppression.</li>\n<li>SSPE is associated with a poor <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> and persistent <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> presence in the CNS.</li>\n<li>Neuronal entry and infection mechanisms are not fully understood; mutations in the virus may facilitate <span class=\"customMeta\" data-dictid=\"d1751616631692777187e01fbeb22d\">evasion</span> of the immune response.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms typically arise 6-8 years after <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> infection, starting with cognitive decline.</li>\n<li>Early signs include personality changes, poor school performance, and lethargy.</li>\n<li><strong>Stage I</strong>: <strong>Personality and behavioural changes, including irritability, dementia, lethargy, social withdrawal, and speech regression.</strong></li>\n<li><strong>Stage II</strong>:<strong> Progressive decline in motor function characterized by myoclonus, dyskinesia, and dystonia.</strong></li>\n<li><strong>Stage III</strong>: <strong>Development of <span class=\"customMeta\" data-dictid=\"e2952dfc311692777187fa773bcc9f\">extrapyramidal</span> symptoms, posturing, and spasticity.</strong></li>\n<li><strong>Stage IV</strong>: Akinetic mutism, <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> failure, or transition to a <span class=\"customMeta\" data-dictid=\"5be6ed908e16927772017095bae56c\">vegetative</span> state.</li>\n<li>Progressive motor function decline occurs, with<strong> <span class=\"customMeta\" data-dictid=\"e0f942b41616927771934975b589ae\">myoclonus</span> and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> paralysis.</strong></li>\n<li>Patients may develop <strong>seizures</strong>, leading to <strong>vegetative states or akinetic mutism.</strong></li>\n<li>Visual symptoms may precede other signs, including<strong> <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> lesions and vision loss.</strong></li>\n<li>Atypical presentations can involve <strong>psychiatric symptoms </strong>and rapid decline, especially in younger patients.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following conditions with their respective EEGs. 1) Focal seizure a) 2) Absence seizure b) 3) Hypsarrythmia c) 4) Periodic sharp wave complexes d)", "options": [{"label": "A", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}, {"label": "B", "text": "1-b, 2-d, 3-c, 4-a", "correct": false}, {"label": "C", "text": "1-d, 2-c, 3-b, 4-a", "correct": false}, {"label": "D", "text": "1-d, 2-b, 3-c, 4-a", "correct": false}], "correct_answer": "A. 1-c, 2-a, 3-d, 4-b", "question_images": ["https://image.prepladder.com/notes/vKoVKGI5WbddivQTPdUo1744330712.png", "https://image.prepladder.com/notes/f9IRG9xyYL3qCFeASqOJ1744330083.png", "https://image.prepladder.com/notes/JwNAssGxWWAqTYhbi5yp1744330660.png", "https://image.prepladder.com/notes/AG0wY0qrKztu9atPcIeQ1744330552.png"], "explanation_images": ["https://image.prepladder.com/notes/JwNAssGxWWAqTYhbi5yp1744330660.png", "https://image.prepladder.com/notes/vKoVKGI5WbddivQTPdUo1744330712.png", "https://image.prepladder.com/notes/AG0wY0qrKztu9atPcIeQ1744330552.png", "https://image.prepladder.com/notes/f9IRG9xyYL3qCFeASqOJ1744330083.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focal seizure</strong></p>\n<p>-EEG shows <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> spikes or sharp waves in the region of the brain corresponding to the <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> onset.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"FOCAL SEIZURE\" data-author=\"\" data-hash=\"9012\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/JwNAssGxWWAqTYhbi5yp1744330660.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absence seizure</strong></p>\n<p>-EEG exhibits 3 Hz spike-and-slow wave discharges, typically generalized and symmetric.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Absence seizures\" data-author=\"\" data-hash=\"9013\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/vKoVKGI5WbddivQTPdUo1744330712.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypsarrythmia</strong></p>\n<p>-EEG presents chaotic, bursts of <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> asynchronous high-amplitude slow waves interspersed with spikes followed by generalized <span class=\"customMeta\" data-dictid=\"25ad895a231692777202f568bc6bfc\">voltage</span> attenuation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Hypsarrythmia\" data-author=\"\" data-hash=\"9011\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/AG0wY0qrKztu9atPcIeQ1744330552.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Periodic sharp wave complexes</strong></p>\n<p>-EEG reveals generalized synchronized high-voltage sharp waves occurring at 1–2 Hz.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"PSWC\" data-author=\"\" data-hash=\"9007\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/f9IRG9xyYL3qCFeASqOJ1744330083.png\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62 y/o man presents with rapid cognitive decline, visual disturbances, and myoclonus. An EEG shows localized frontal intermittent rhythmical delta activity (FIRDA) that evolves to periodic sharp wave complexes (PSWC) after a few weeks. Based on this presentation and EEG findings, which of the following conditions is most likely associated with his symptoms?", "options": [{"label": "A", "text": "Hepatic encephalopathy", "correct": false}, {"label": "B", "text": "Creutzfeldt-Jakob disease", "correct": true}, {"label": "C", "text": "Renal encephalopathy", "correct": false}, {"label": "D", "text": "Alzheimer’s disease", "correct": false}], "correct_answer": "B. Creutzfeldt-Jakob disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/f9IRG9xyYL3qCFeASqOJ1744330083.png", "https://image.prepladder.com/notes/IiOpCUzkArcMoU4xURX41744330252.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-day-old infant born at 39 weeks gestation is being evaluated for seizures, and there is a family history of seizures. What is the most common type of seizure seen in newborns?", "options": [{"label": "A", "text": "Benign Rolandic epilepsy", "correct": false}, {"label": "B", "text": "Subtle seizure", "correct": true}, {"label": "C", "text": "Febrile seizures", "correct": false}, {"label": "D", "text": "Myoclonic seizures", "correct": false}], "correct_answer": "B. Subtle seizure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 y/o woman with a history of catamenial epilepsy reports an increase in seizure frequency just before her menstrual period. She is currently taking carbamazepine and is newly started on OCPs for contraception. What is the most appropriate advice for her regarding her current situation?", "options": [{"label": "A", "text": "Continue carbamazepine without changes.", "correct": false}, {"label": "B", "text": "Switch to phenytoin for better control.", "correct": false}, {"label": "C", "text": "Consider alternative contraception methods due to carbamazepine's effect on oral contraceptives.", "correct": true}, {"label": "D", "text": "Stop all antiseizure medications while trying to conceive.", "correct": false}], "correct_answer": "C. Consider alternative contraception methods due to carbamazepine's effect on oral contraceptives.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Catamenial Epilepsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> frequency around <span class=\"customMeta\" data-dictid=\"8bcfb5bdd31692777192c63fc31702\">menses</span> due to estrogen/progesterone effects or antiseizure drug level changes.</li>\n<li>Some women may require<strong> increased antiseizure drug dosages during menses.</strong></li>\n<li><strong>Natural progestins or <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> medroxyprogesterone </strong>may benefit certain women.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>~50% of women experience unchanged <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> frequency; ~30% may increase, and ~20% decrease.</li>\n<li>Monitoring of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> antiseizure drug levels is essential during pregnancy.</li>\n<li><strong>Lamotrigine and <span class=\"customMeta\" data-dictid=\"32ecf2ca0316927771912f101e25b0\">levetiracetam</span> </strong>are recommended as first-line <strong>monotherapy </strong>for generalized and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> onset seizures.</li>\n<li>The higher <span class=\"customMeta\" data-dictid=\"8e016cf2891692777200f428d4b4db\">teratogenic</span> risk with multiple antiseizure drugs is noted.</li>\n<li>Valproic acid is strongly associated with adverse <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> outcomes and is thus contraindicated in pregnancy.</li>\n<li><strong>Folate supplementation (1–4 mg/d)</strong> is recommended due to <span class=\"customMeta\" data-dictid=\"c60081b87a169277718164196e89e4\">antifolate</span> effects of anticonvulsants.</li>\n<li>Enzyme-inducing drugs (phenytoin, carbamazepine, oxcarbazepine, topiramate, phenobarbital, primidone) may cause <span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\">vitamin K</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> in newborns. Hence<strong> mothers should take oral vitamin K, and infants should receive <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> <span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\">vitamin K</span> at birth.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraception</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Certain antiseizure medications <strong>(carbamazepine, phenytoin, phenobarbital, topiramate) reduce oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> efficacy</strong> via <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> induction.</li>\n<li>Alternative <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> methods (IUDs, long-acting <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> contraceptives) should be considered.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breast-Feeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antiseizure medications are excreted in breast milk at varying levels (5% for <span class=\"customMeta\" data-dictid=\"fb9f66eee716927772015cf6e28839\">valproic acid</span> to 300% for levetiracetam).</li>\n<li>Encouraged to breastfeed unless infant shows signs of drug effects (e.g., lethargy, poor feeding).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10 y/o boy presents to the clinic with a history of seizures characterised by stiffness and rhythmic jerking of the entire body that occur multiple times a week. He has tried several medications but continues to experience seizures. Which of the following would be the most appropriate first-line treatment for this patient?", "options": [{"label": "A", "text": "Ethosuximide", "correct": false}, {"label": "B", "text": "Lamotrigine", "correct": true}, {"label": "C", "text": "Carbamazepine", "correct": false}, {"label": "D", "text": "Topiramate", "correct": false}], "correct_answer": "B. Lamotrigine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:535px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Type of Seizure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>First-Line Treatments</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Generalized-Onset Tonic-Clonic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lamotrigine <strong>(Option B)</strong></li>\n<li>Valproic acid</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Focal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lamotrigine</li>\n<li>Carbamazepine <strong>(Option C ruled out)</strong></li>\n<li>Oxcarbazepine</li>\n<li>Eslicarbazepine</li>\n<li>Phenytoin</li>\n<li>Levetiracetam</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Typical Absence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Valproic acid</li>\n<li>Ethosuximide <strong>(Option A ruled out)</strong></li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Atypical Absence, Myoclonic, Atonic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Valproic acid</li>\n<li>Lamotrigine</li>\n<li>Topiramate <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement about Mesial Temporal Lobe Epilepsy Syndrome is FALSE?", "options": [{"label": "A", "text": "EEG may show unilateral or bilateral anterior temporal spikes.", "correct": false}, {"label": "B", "text": "MRI typically reveals an enlarged hippocampus with trilaminar architecture.", "correct": true}, {"label": "C", "text": "It is often refractory to anticonvulsants but may respond well to surgical intervention.", "correct": false}, {"label": "D", "text": "Auras, postictal disorientation and memory loss can occur.", "correct": false}], "correct_answer": "B. MRI typically reveals an enlarged hippocampus with trilaminar architecture.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ul73DriNwRIEIT8mQrKS1744329388.png", "https://image.prepladder.com/notes/ul73DriNwRIEIT8mQrKS1744329388.png", "https://image.prepladder.com/notes/MQgTYwXvcVevc2ELRDqk1744329615.png", "https://image.prepladder.com/notes/xBZOZET9StJCxjl5RxgC1744329723.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Mesial <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"7546d26cea1692777187c257d4e14c\">Epilepsy</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Often associated with a history of <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> seizures</li>\n<li>Rarely involves generalised seizures</li>\n<li>A family history of <span class=\"customMeta\" data-dictid=\"7546d26cea1692777187c257d4e14c\">epilepsy</span> may be present</li>\n<li>Seizures can remit but may reoccur</li>\n<li>Typically has an early onset</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Observations(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Auras are commonly experienced.</li>\n<li>Postictal disorientation.</li>\n<li>Behavioural arrest or staring episodes.</li>\n<li>Memory loss can occur.</li>\n<li>Presence of complex automatisms.</li>\n<li>Dysphasia may occur if the focus is in the dominant hemisphere.</li>\n<li>Unilateral <span class=\"customMeta\" data-dictid=\"3bb2ac8bfb1692777196679581acb3\">posturing</span> is observed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Laboratory Studies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>EEG may show <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> spikes. <strong>(Option A ruled out)</strong></li>\n<li>Interictal PET scans reveal hypometabolism.</li>\n<li>Ictal <span class=\"customMeta\" data-dictid=\"96ab1953781692777198453f9ed9cd\">SPECT</span> scans demonstrate hyperperfusion.</li>\n<li>Intracranial <span class=\"customMeta\" data-dictid=\"41485ab11b16927771819f08c3a54c\">amobarbital</span> (Wada) test may indicate material-specific memory deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>MRI Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"7ce110705616927771896c58ac81b5\">hippocampus</span> appears smaller with increased signal on T2-weighted sequences.</li>\n<li>Loss of the <span class=\"customMeta\" data-dictid=\"89aa3a27df1692777200ccbbf73236\">trilaminar</span> architecture of the hippocampus. <strong>(Option B)</strong></li>\n<li>Reduced size of the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> lobe</li>\n<li>Enlargement of the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> horn.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"MTLA\" data-author=\"Gaillard F, Walizai T, Sharma R\" data-hash=\"9002\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/mesial-temporal-sclerosis\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ul73DriNwRIEIT8mQrKS1744329388.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathologic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Characterized by a selective loss of specific cell populations within the <span class=\"customMeta\" data-dictid=\"7ce110705616927771896c58ac81b5\">hippocampus</span> in most cases</li>\n<li>Dispersion of the <span class=\"customMeta\" data-dictid=\"fd69fc99d41692777188cc051aafa5\">granule</span> cell layer and <span class=\"customMeta\" data-dictid=\"e985987c6d16927771882fad2f33bc\">gliosis</span> are noted.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Refractory to anticonvulsants.</li>\n<li>Responds well to <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention. <strong>(Option C ruled out)</strong>\n<figure class=\"caption_element\"><img alt=\"MESIAL TEMPORAL\" data-author=\"Gaillard F, Walizai T, Sharma R\" data-hash=\"9003\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/mesial-temporal-sclerosis\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/MQgTYwXvcVevc2ELRDqk1744329615.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<strong></strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 y/o man is brought to the neurology clinic for evaluation after a brief period of unconsciousness. He is awake and alert during the examination. An EEG is performed while his eyes are closed. What is the frequency range recorded in the patient’s EEG?", "options": [{"label": "A", "text": "8-13 Hz", "correct": true}, {"label": "B", "text": "&amp;gt;13 Hz", "correct": false}, {"label": "C", "text": "&amp;lt;4 Hz", "correct": false}, {"label": "D", "text": "4-8 Hz", "correct": false}], "correct_answer": "A. 8-13 Hz", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/lXrOlhwHOI9rmXNHtzDz1744327605.png", "https://image.prepladder.com/notes/JlAWkKXLUj02csXJxekJ1744327664.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Normal Brain Electrical Activity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Situation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alpha</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Awake with eyes closed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>8–13 Hz</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most frequently seen. Enhanced in drowsiness and <span class=\"customMeta\" data-dictid=\"dd4bbf3a1a16927771988e61c3d5e9\">sedative</span> drugs like benzodiazepines.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;13 Hz</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Theta</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>When sleeping. Drifting to sleep.</p>\n<p>NREM Stage 1 sleep</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4–8 Hz</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Also called as <span class=\"customMeta\" data-dictid=\"9e5f0b77751692777198ff32ae6295\">sleep spindles</span> (associated with K complexes)</p>\n<p>Deeper sleep</p>\n<p>NREM Stage 2 sleep</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12–14 Hz</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delta</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NREM Stage 3 sleep</p>\n<p>Deepest sleep</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;4 Hz</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7 y/o girl presents to the pediatric neurology clinic with a history of multiple seizure types. Her parents report that she has experienced GTCS, atonic seizures where she suddenly drops to the ground, and atypical absence seizures. The child has also shown signs of cognitive impairment. Which of the following statements is TRUE regarding her condition?", "options": [{"label": "A", "text": "Characterized by bilateral myoclonic jerks that are most frequent in the morning.", "correct": false}, {"label": "B", "text": "The EEG findings show diffuse, symmetric, bilateral 4 to 6 Hz polyspike and wave discharges.", "correct": false}, {"label": "C", "text": "Valproate and Topiramate are used in treatment.", "correct": true}, {"label": "D", "text": "The condition typically presents in early adolescence.", "correct": false}], "correct_answer": "C. Valproate and Topiramate are used in treatment.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:701px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Lennox-Gastaut Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Juvenile Myoclonic <span class=\"customMeta\" data-dictid=\"7546d26cea1692777187c257d4e14c\">Epilepsy</span> (JME/ JANZ Syndrome)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Occurs in children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Early <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Associated with various <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> causes (e.g., <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> novo mutations, developmental abnormalities, <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> hypoxia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Unknown cause; <span class=\"customMeta\" data-dictid=\"5be6ff563616927771963d8ac13f91\">polygenic</span> factors suggested</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Seizure Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> types, including generalized tonic-clonic, atonic, and <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> absence seizures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Primarily <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> myoclonic jerks; may also have generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> and absence seizures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Myoclonic Seizures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not a primary feature</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Most frequent in the morning after awakening; can be provoked by sleep deprivation. </strong><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Consciousness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Impaired cognitive function in most cases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Preserved unless <span class=\"customMeta\" data-dictid=\"e0f942b41616927771934975b589ae\">myoclonus</span> is severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>EEG Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Shows slow (&lt;3 Hz) spike-and-wave discharges.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Shows diffuse, symmetric, <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> 4 to 6 Hz <span class=\"customMeta\" data-dictid=\"61083cca2c1692777196e6b32f8d1f\">polyspike</span> and wave discharges,</strong> predominantly in the fronto-central region. <strong>(Option B ruled out)</strong></p>\n<p>Ictal <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> recordings reveal 10-16 Hz <span class=\"customMeta\" data-dictid=\"61083cca2c1692777196e6b32f8d1f\">polyspike</span> discharges that correlate with myoclonic jerks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Valproate, lamotrigine, and topiramate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Valproic acid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 y/o man is brought to the ED after experiencing a generalized tonic-clonic seizure. An EEG is performed after the seizure. Which of the following statements is TRUE regarding the EEG findings associated with his seizure?", "options": [{"label": "A", "text": "The interictal EEG is often normal in patients.", "correct": false}, {"label": "B", "text": "During the tonic phase, the EEG typically shows a progressive increase in generalized low-voltage fast activity.", "correct": true}, {"label": "C", "text": "The postictal EEG usually reveals localized spikes corresponding to the seizure focus.", "correct": false}, {"label": "D", "text": "The EEG during the clonic phase shows continuous high-amplitude activity without interruption.", "correct": false}], "correct_answer": "B. During the tonic phase, the EEG typically shows a progressive increase in generalized low-voltage fast activity.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/wkHX44MEhZsSMCco6yy51744328842.png", "https://image.prepladder.com/notes/5PBoMMKbZFJggmq72KgO1744328873.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Focal Seizure- EEG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>GTCS- EEG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The routine <span class=\"customMeta\" data-dictid=\"e0305a6ec61692777190b68aa2f229\">interictal</span> <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> in patients with <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> seizures is often normal. <strong>(Option A ruled out)</strong></li>\n<li>It may show<strong> brief discharges, such as <span class=\"customMeta\" data-dictid=\"03eeb9d42b16927771870ca6bb7119\">epileptiform</span> spikes or sharp waves.</strong></li>\n<li>Focal seizures can arise from areas like the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> or <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> lobe, which may be distant from the scalp.</li>\n<li>As a result, the <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> recorded during the <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> may be nonlocalizing.</li>\n<li>The region of <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> onset can be identified using surgically placed <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> electrodes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>During the<strong> <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> phase</strong>, the <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> shows a progressive increase in generalized low-voltage fast activity. <strong>(Option B)</strong></li>\n<li>This is followed by generalized high-amplitude <span class=\"customMeta\" data-dictid=\"61083cca2c1692777196e6b32f8d1f\">polyspike</span> discharges.</li>\n<li>In the <strong>clonic phase</strong>, high-amplitude activity is typically <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">interrupted</span> by slow waves, creating a spike-and-slow-wave pattern. <strong>(Option D ruled out)</strong></li>\n<li>Generalized seizures tend to terminate synchronously across widespread brain regions.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"b20624b08216927771961a650a498e\">postictal</span> <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> displays <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> of all cerebral activity, followed by slowing that gradually recovers as the patient awakens. <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"FOCAL SEIZURE\" data-author=\"Andrew Pan, Ajay Gupta, Elaine Wyllie, Hans Lüders, William Bingaman\" data-hash=\"9000\" data-license=\"Open access\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1111/j.0013-9580.2004.38003.x\" data-tags=\"April2025\" height=\"751\" src=\"https://image.prepladder.com/notes/wkHX44MEhZsSMCco6yy51744328842.png\" width=\"997\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"GTCS\" data-author=\"Der Lange\" data-hash=\"9001\" data-license=\"CC BY SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Spike-waves.png#/media/File:Spike-waves.png\" data-tags=\"April2025\" height=\"751\" src=\"https://image.prepladder.com/notes/5PBoMMKbZFJggmq72KgO1744328873.png\" width=\"719\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 y/o patient faints while standing in a crowded, hot room. Before fainting, he felt dizzy, sweaty, and nauseous. He regains consciousness quickly without any prolonged confusion or disorientation afterwards. What is the most likely diagnosis for this patient's fainting episode?", "options": [{"label": "A", "text": "Generalized Tonic-Clonic Seizure (GTCS)", "correct": false}, {"label": "B", "text": "Vasovagal Syncope", "correct": true}, {"label": "C", "text": "Cardiac Arrhythmia", "correct": false}, {"label": "D", "text": "Hypoglycemia", "correct": false}], "correct_answer": "B. Vasovagal Syncope", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:708px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align:center\"><strong>Vasovagal <span class=\"customMeta\" data-dictid=\"9f04fb3f2f1692777199272e3daf84\">Syncope</span> (Neurally Mediated Syncope)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align:center\"><strong>Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">Tonic-Clonic</span> Seizures (GTCS)</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It results from a <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> that alters <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> outflow, leading to bradycardia, vasodilation, and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output. This lowers <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> and causes cerebral hypoperfusion, leading to syncope.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GTCS are caused by widespread <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> in the brain, leading to both <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> (stiffening) and clonic (jerking) muscle contractions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triggers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Emotional stress, pain, standing upright for long periods, warm environments, dehydration, blood loss, and sight of blood.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GTCS can occur without clear triggers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> outflow (vagal activation) and <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> outflow result in <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> and hypotension. Cerebral <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> falls below <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">compensatory</span> limits, causing loss of consciousness.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seizures begin abruptly, often without warning. The <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> phase involves sustained muscle contraction, leading to symptoms like the \"ictal cry\" due to vocal cord contraction. The clonic phase features rhythmic jerking as muscles relax intermittently.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Premonitory</strong>: Dizziness, lightheadedness, nausea, yawning, sweating, pallor, and palpitations.</li>\n<li><strong>During the event</strong>: <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">Transient</span> loss of consciousness, uprolling of the eyes, dilated pupils, possible muscle jerks (myoclonus), and rarely, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> or faecal incontinence.</li>\n<li><strong>EEG pattern</strong>: \"Slow-flat-slow\" pattern with high-amplitude slow waves, followed by <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> flattening.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Premonitory</strong>: Some patients have vague <span class=\"customMeta\" data-dictid=\"a3fcc80f4716927771960596ddff36\">premonitory</span> symptoms, but stereotypical auras are rare.</li>\n<li><strong>During the event</strong>: <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">Tonic</span> <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> followed by clonic jerking. The patient may experience cyanosis, tongue biting, loss of bladder/bowel control, and increased heart rate and blood pressure.</li>\n<li><strong>Postictal</strong>: Period of confusion lasting minutes to hours, fatigue, headache, muscle soreness, and incontinence. <span class=\"customMeta\" data-dictid=\"b20624b08216927771961a650a498e\">Postictal</span> confusion is a prominent feature.</li>\n<li><strong>EEG pattern</strong>: Low-voltage fast activity during the <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> phase, followed by a spike-and-slow-wave pattern during the clonic phase. <span class=\"customMeta\" data-dictid=\"b20624b08216927771961a650a498e\">Postictal</span> <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> of brain activity is observed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recovery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quick recovery of consciousness without prolonged confusion. <span class=\"customMeta\" data-dictid=\"b20624b08216927771961a650a498e\">Postictal</span> confusion and hallucinations are rare.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GTCS has a prolonged <span class=\"customMeta\" data-dictid=\"b20624b08216927771961a650a498e\">postictal</span> phase with confusion and fatigue.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-month-old infant presents with brief episodes of sudden flexion of the trunk and limbs, lasting a few seconds. EEG shows hypsarrhythmia, and during the episodes, there's marked background suppression on the EEG. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Absence seizures", "correct": false}, {"label": "B", "text": "Myoclonic seizures", "correct": false}, {"label": "C", "text": "Epileptic spasms", "correct": true}, {"label": "D", "text": "Lennox-Gastaut syndrome", "correct": false}], "correct_answer": "C. Epileptic spasms", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23 y/o patient presents with sudden, brief muscle jerks involving both arms. EEG shows bilaterally synchronous spike-and-slow-wave discharges. The patient has a history of consuming poor-quality beef. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Epileptic spasms", "correct": false}, {"label": "B", "text": "Juvenile Myoclonic Epilepsy", "correct": false}, {"label": "C", "text": "Variant Creutzfeldt-Jakob Disease (vCJD)", "correct": true}, {"label": "D", "text": "Anoxic brain injury", "correct": false}], "correct_answer": "C. Variant Creutzfeldt-Jakob Disease (vCJD)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7 y/o child is brought to the clinic due to frequent episodes of \"daydreaming\" during school, which last for a few seconds and are accompanied by subtle eyelid blinking. The episodes occur several times a day, and the child has no recollection of these events. An EEG shows 3-Hz generalized spike-and-slow-wave discharges. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Typical absence seizures", "correct": true}, {"label": "B", "text": "Atypical absence seizures", "correct": false}, {"label": "C", "text": "Focal seizures with impaired awareness", "correct": false}, {"label": "D", "text": "Generalized tonic-clonic seizures", "correct": false}], "correct_answer": "A. Typical absence seizures", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Typical Absence Seizures (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Atypical Absence Seizures (Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Characteristics:</strong> Sudden, brief lapses of consciousness without postural control loss, lasting seconds.</li>\n<li><strong>Motor Signs:</strong> Subtle, <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> motor signs such as <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> blinking, chewing, or small clonic hand movements.</li>\n<li><strong>Onset:</strong> Common in children (ages 4–10) or early adolescence, occurring hundreds of times a day.</li>\n<li><strong>Clinical Presentation:</strong> May appear as \"daydreaming\" and poor school performance, often misdiagnosed as attention deficit disorder.</li>\n<li><strong>EEG Findings:</strong> Generalized 3-Hz spike-and-slow-wave discharges.</li>\n<li><strong>Provoked By: <span class=\"customMeta\" data-dictid=\"e07ff4a5ce1692777189b9e95326f3\">Hyperventilation</span> may induce seizures and <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> discharges.</strong></li>\n<li><strong>Treatment:</strong> <strong>Valproate (drug of choice)</strong>\n<ul>\n<li>Valproate-associated <span class=\"customMeta\" data-dictid=\"104c254ce81692777203458937f730\">fulminant</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure (younger the age, higher the risk)</li>\n<li><strong>Ethosuximide is used</strong> (especially in &lt;2 years).</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Characteristics:</strong> Longer, less abrupt lapses of consciousness with more noticeable motor signs.</li>\n<li><strong>EEG Findings:</strong> Slower (&lt;2.5 Hz) generalized spike-and-slow-wave discharges, plus other abnormalities.</li>\n<li><strong>Association:</strong> <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">Linked</span> to structural brain abnormalities and often co-occurs with <span class=\"customMeta\" data-dictid=\"85208af1af16927771929490bc4d4b\">mental retardation</span> or neurologic dysfunction.</li>\n<li><strong>Treatment Response:</strong> Less responsive to anticonvulsants compared to typical absence seizures.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o woman experiences sudden unresponsiveness during conversations, followed by repetitive hand movements and lip-smacking. Afterwards, she seems confused and does not remember the event. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Absence Seizure", "correct": false}, {"label": "B", "text": "Panic Attack", "correct": false}, {"label": "C", "text": "Focal Seizure with Impaired Awareness", "correct": true}, {"label": "D", "text": "Focal Seizure with Intact Awareness", "correct": false}], "correct_answer": "C. Focal Seizure with Impaired Awareness", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Tiw8Or6fkOJjFnPgN2731744328413.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 y/o woman experiences involuntary movements that begin in her right hand and progressively spread to her right arm and face. She remains fully aware throughout the episode. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Absence seizure", "correct": false}, {"label": "B", "text": "Todd’s paralysis", "correct": false}, {"label": "C", "text": "Epilepsia partialis continua", "correct": false}, {"label": "D", "text": "Jacksonian march", "correct": true}], "correct_answer": "D. Jacksonian march", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/S7HmHKx204HOggJo1kIV1744328033.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40 y/o man collapses suddenly while walking and experiences a brief period of unconsciousness. His family notes that his body became completely limp before he fell. When he regains consciousness, he is confused and has a headache. What type of seizure does he most likely have?", "options": [{"label": "A", "text": "Clonic seizure", "correct": false}, {"label": "B", "text": "Tonic-clonic seizure", "correct": false}, {"label": "C", "text": "Atonic seizure", "correct": true}, {"label": "D", "text": "Myoclonic seizure", "correct": false}], "correct_answer": "C. Atonic seizure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification of Generalised Seizures</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalised seizures are characterised by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> that rapidly spreads across both hemispheres of the brain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tonic-Clonic Seizures (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These can occur alone or in combination with other <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> types. Involves muscle stiffening (tonic phase), followed by rhythmic jerking (clonic phase).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absence Seizures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Typical:</strong> Brief lapses in consciousness, without loss of postural control. Common in children. May be mistaken for daydreaming and attention deficit disorder.</p>\n<p><strong>Atypical:</strong> Longer episodes, slower onset/offset, may involve other motor symptoms.</p>\n<p><strong>With Special Features:</strong> Specific characteristics like <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> or additional movements.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myoclonic Seizures (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden jerking movements of muscles.</p>\n<p><strong>Myoclonic-Atonic: </strong>Jerks followed by loss of muscle tone.</p>\n<p><strong>Myoclonic-Tonic:</strong> Jerks accompanied by muscle stiffening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atonic Seizures (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sudden loss of muscle tone, leading to falls</strong>. These seizures are brief but pose a high risk of injury due to the sudden nature of the fall.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clonic Seizures (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rhythmic jerking without the initial <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> phase.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tonic Seizures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased muscle tone with impaired awareness. Usually seen as a part of <span class=\"customMeta\" data-dictid=\"7546d26cea1692777187c257d4e14c\">epilepsy</span> syndrome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epileptic spasm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They typically occur in infants and are marked by sudden, forceful contractions of the muscles, particularly those of the trunk. The spasms often occur in clusters(5-50), especially upon waking, and are associated with widespread brain abnormalities.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o man experiences sudden visual disturbances, seeing flashing lights and coloured shapes, but remains fully awake during the episode. After a few seconds, the sensations subside. Which type of seizure is most likely?", "options": [{"label": "A", "text": "Focal seizure with retained awareness", "correct": true}, {"label": "B", "text": "Focal seizure with impaired awareness", "correct": false}, {"label": "C", "text": "Absence seizure", "correct": false}, {"label": "D", "text": "Generalised tonic-clonic seizure", "correct": false}], "correct_answer": "A. Focal seizure with retained awareness", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/S7HmHKx204HOggJo1kIV1744328033.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Classification of <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> Seizures</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focal seizures originate from a specific area in one <span class=\"customMeta\" data-dictid=\"d702dfe10816927771881b37be4e4a\">hemisphere</span> of the brain.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Classification by Awareness</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focal Seizures with Retained Awareness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No loss of awareness during the seizure,</strong> symptoms depend on the brain area affected like<strong> visual disturbances, motor jerking, and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> changes. (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focal Seizures with Impaired Awareness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Awareness is <strong>impaired</strong>, often starting with a blank stare and involving automatisms like lip-smacking, picking, chewing and other repetitive movements. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Motor vs <span class=\"customMeta\" data-dictid=\"df3d075c29169277719316e22e7cbd\">Nonmotor</span> Onset (In <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> Seizures with Retained Awareness)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observable movements like tonic, clonic, or myoclonic jerking.</p>\n<p><strong>Special Features</strong></p>\n<ul>\n<li><strong>Jacksonian March: </strong>Progressive motor involvement starting in a specific body part.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"jacksonian march\" data-author=\"NA\" data-hash=\"8998\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/S7HmHKx204HOggJo1kIV1744328033.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Todd’s Paralysis: </strong>Temporary weakness after a <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> seizure.</li>\n<li><strong>Epilepsia Partialis Continua:</strong> Continuous <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> seizures resistant to medication.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nonmotor Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensory, autonomic, or emotional changes without visible movement.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Evolution </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focal Seizures Evolving into generalised Seizures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Start focally but spread to both hemispheres, often leading to generalised <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28 y/o woman is witnessed having a seizure. After a brief period of muscle stiffening, she begins to have jerking movements. The episode lasts about one minute, and she becomes unresponsive with flaccid muscles afterwards. She later regains consciousness but is confused. Which phase of the seizure involves alternating muscle contraction and relaxation?", "options": [{"label": "A", "text": "Tonic phase", "correct": false}, {"label": "B", "text": "Clonic phase", "correct": true}, {"label": "C", "text": "Post-ictal period", "correct": false}, {"label": "D", "text": "Aura", "correct": false}], "correct_answer": "B. Clonic phase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Generalised <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">Tonic-Clonic</span> <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">Seizure</span> - Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tonic phase (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clonic phase (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Post-ictal period (Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> throughout the body.</li>\n<li>Ictal cry: Loud sound from laryngeal contraction.</li>\n<li>Cyanosis: Due to <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> compromise.</li>\n<li>Tongue biting and <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> activity (increased heart rate, blood pressure).</li>\n<li>Lasts about 10-20 seconds</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Alternating muscle <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> and relaxation.</strong></li>\n<li>Relaxation periods gradually increase until the <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> ends (usually lasts &lt;1 minute).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unresponsiveness and muscle flaccidity.</li>\n<li>Excessive <span class=\"customMeta\" data-dictid=\"f3c45b71f616927771983a1da80a25\">salivation</span> and laboured breathing.</li>\n<li>Incontinence may occur.</li>\n<li>Gradual return of consciousness, with confusion, headache, fatigue, and muscle pain.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 35 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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He reports having had a mild gastrointestinal illness a few weeks prior. On examination, he exhibits areflexia and difficulty with eye movements. Electrophysiological studies indicate demyelination. Which of the following variants of Guillain-Barré Syndrome is most likely associated with this patient's presentation?", "options": [{"label": "A", "text": "Acute inflammatory demyelinating polyneuropathy (AIDP)", "correct": true}, {"label": "B", "text": "Axonal variant", "correct": false}, {"label": "C", "text": "Miller Fisher Syndrome", "correct": false}, {"label": "D", "text": "Chronic inflammatory demyelinating polyneuropathy (CIDP)", "correct": false}], "correct_answer": "A. Acute inflammatory demyelinating polyneuropathy (AIDP)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A group of immune-mediated conditions causing <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> paralysis, with the most common <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> being <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"25cf8215eb1692777186f0ab76dc34\">demyelinating polyneuropathy</span> (AIDP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1–2 cases per 100,000 individuals per year.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Preceding Infections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>About two-thirds of AIDP cases have a prior history of infection, often triggering an <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> response leading to demyelination.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> <span class=\"customMeta\" data-dictid=\"25cf8215eb1692777186f0ab76dc34\">Demyelinating Polyneuropathy</span> (AIDP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The most common <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> is in Europe &amp; North America.</li>\n<li>Patchy <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> nerves</li>\n<li><strong>Antibodies seen:</strong>\n<ul>\n<li>IgG <span class=\"customMeta\" data-dictid=\"4665fdd0a0169277718100f58eb0d5\">Anti</span> GM1</li>\n<li>IgG <span class=\"customMeta\" data-dictid=\"4665fdd0a0169277718100f58eb0d5\">Anti</span> GQ1b</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Axonal Variants</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More prevalent in China and Japan; account for 10% of <span class=\"customMeta\" data-dictid=\"aa23182e651692777188296980e246\">GBS</span> cases in Western countries; often associated with <span class=\"customMeta\" data-dictid=\"a61219530816927771837697e1555e\">Campylobacter</span> jejuni infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Miller Fisher Syndrome</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best-recognised variant.</p>\n<p>Associated with anti-GQ1b antibodies.</p>\n<p>Presents with internal and external ophthalmoplegia, ataxia, and areflexia.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A recent study on autoantibodies associated with Guillain-Barré syndrome (GBS) revealed important findings. Which of the following statements about the role of autoantibodies in GBS is TRUE?", "options": [{"label": "A", "text": "Anti-ganglioside antibodies are rarely found in GBS patients and have no prognostic significance.", "correct": false}, {"label": "B", "text": "The presence of anti-GM1 antibodies correlates with better clinical outcomes in GBS patients.", "correct": false}, {"label": "C", "text": "A diverse array of autoantibodies targeting nerve components suggests multiple immune mechanisms contribute to GBS pathology.", "correct": true}, {"label": "D", "text": "Specific autoantibodies are only directed against gangliosides, with no other targets identified in GBS pathology.", "correct": false}], "correct_answer": "C. A diverse array of autoantibodies targeting nerve components suggests multiple immune mechanisms contribute to GBS pathology.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diversity of Autoantibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GBS patients exhibit a wide range of autoantibodies <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> nerve cells and structures, indicating multiple immune mechanisms may contribute to <span class=\"customMeta\" data-dictid=\"aa23182e651692777188296980e246\">GBS</span> pathology.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prevalence of Anti-Ganglioside Antibodies</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-ganglioside antibodies</strong> are the <strong>most common</strong>, detected in up to 50% of <span class=\"customMeta\" data-dictid=\"aa23182e651692777188296980e246\">GBS</span> patients, often arising from <span class=\"customMeta\" data-dictid=\"04f4b6dbf71692777192ca0c4f70fa\">microbial</span> molecular mimicry.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prognostic Implications</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Specific autoantibodies, especially <strong>anti-GM1</strong>, are associated with poorer clinical outcomes.</li>\n<li>Presence correlates with variants like pure motor variants and Miller-Fisher syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Target Antigens</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>While gangliosides are primary targets, other potential targets include nodal and paranodal proteins (e.g., neurofascin), suggesting a broader spectrum of <span class=\"customMeta\" data-dictid=\"06e07ce7821692777182e8ffd9676f\">autoantibody</span> involvement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical-Immunological Correlations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Research aims to establish correlations between <span class=\"customMeta\" data-dictid=\"aa23182e651692777188296980e246\">GBS</span> clinical presentations and specific autoantibodies, enhancing understanding of immune responses in relation to patient outcomes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect regarding the types of Guillain-Barré syndrome?", "options": [{"label": "A", "text": "AIDP is the most common form in adults.", "correct": false}, {"label": "B", "text": "AMSAN has a better prognosis than AMAN.", "correct": true}, {"label": "C", "text": "AMAN involves axonal degeneration in children and young adults", "correct": false}, {"label": "D", "text": "Miller-Fisher syndrome is associated with anti-GQ1b antibodies", "correct": false}], "correct_answer": "B. AMSAN has a better prognosis than AMAN.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:676px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Neural Target</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Electrodiagnostic Study</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>AIDP (Acute <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> Demyelinating Polyneuropathy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Most common in adults <strong> (Option A)</strong></li>\n<li>Rapid recovery</li>\n<li>IgG Anti-GM1 a/b</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Schwann cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Demyelination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>AMAN (Acute Motor Axonal Neuropathy) </strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Seen in children and young adults <strong>(Option C)</strong></li>\n<li>Poor prognosis</li>\n<li>IgG Anti-GM1 a/b</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nodes of Ranvier</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Axonal degeneration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>AMSAN (Acute Motor <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> Axonal Neuropathy) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Uncommon</li>\n<li>Seen in adults</li>\n<li>Worst prognosis</li>\n<li>IgG Anti-GM1 a/b</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nodes of Ranvier</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Axonal degeneration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Miller <span class=\"customMeta\" data-dictid=\"427e4a7ec6169277720233b7958c69\">Fisher Syndrome</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Triad:</strong> Ophthalmoplegia, Areflexia, Ataxia</li>\n<li>Seen in 5% of cases</li>\n<li>Anti-GQ1b <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Identical to AIDP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Either <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> or axonal degeneration</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presents with a 2-day history of progressive weakness that started in his legs after returning from his international trip. He has difficulty climbing stairs, increasing fatigue with normal activities, and mild tingling in his feet. He has a recent history of mild flu-like symptoms, including fever and malaise. On examination, he shows weakness in both lower extremities with reduced muscle tone and absent deep tendon reflexes. Laboratory findings reveal that CSF analysis showed elevated protein with a normal cell count. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Guillain-Barré syndrome", "correct": true}, {"label": "B", "text": "Tick paralysis", "correct": false}, {"label": "C", "text": "Myasthenia gravis", "correct": false}, {"label": "D", "text": "Poliomyelitis", "correct": false}], "correct_answer": "A. Guillain-Barré syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Motor Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Progressive <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> paralysis</strong> <strong>(distal to proximal)</strong></li>\n<li>Areflexia</li>\n<li>Weakness in legs causing rubbery legs and <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> to stand</li>\n<li>Truncal paralysis, quadriplegia, neck floppiness</li>\n<li>Bilateral 7th nerve palsy</li>\n<li>Bulbar palsy\n\t\t\t\t<ul>\n<li>Difficulty in handling secretions leading to <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia</li>\n<li>A leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> involvement.</li>\n</ul>\n</li>\n<li>Diaphragmatic paralysis\n\t\t\t\t<ul>\n<li>Ventilatory support is required in 30% of cases.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"c32b3a9fac16927771831530888fdf\">carbon dioxide</span> levels.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sensory Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Glove-and-stocking distribution paresthesias</li>\n<li>Proprioception loss\n\t\t\t\t<ul>\n<li>Difficulty in climbing stairs</li>\n<li>Pain in the neck/arm/shoulder is similar to over-exercised muscle</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Sensory manifestations can occur before or along with motor manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autonomic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"3704fc52401692777186c42775c9fb\">dysregulation</span> (e.g., <span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\">orthostatic</span> hypotension, bladder/bowel sparing/transient involvement)</li>\n<li>Wide fluctuations of blood pressure, arrhythmias, postural hypotension</li>\n<li>Reduced heart rate and blood pressure, <span class=\"customMeta\" data-dictid=\"fec88fc386169277719326fdef547f\">neurogenic</span> shock.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with a 3-day history of progressive weakness, initially localized to his legs but now involving the arms. He reports increased difficulty with tasks such as buttoning his shirt and climbing stairs, along with episodes of fatigue during minimal exertion. He also describes a tingling sensation in his fingers and has experienced mild fever and generalized malaise over the past week. On examination, he demonstrates significant weakness in all four extremities, reduced muscle tone, and absent deep tendon reflexes. What is the next best step in the management of this patient?", "options": [{"label": "A", "text": "Lumbar puncture for cerebrospinal fluid analysis", "correct": true}, {"label": "B", "text": "Nerve conduction studies", "correct": false}, {"label": "C", "text": "Serum acetylcholine receptor antibodies test", "correct": false}, {"label": "D", "text": "Polymerase chain reaction for poliovirus", "correct": false}], "correct_answer": "A. Lumbar puncture for cerebrospinal fluid analysis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lumbar Puncture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>CSF protein: 100-1000 mg/dL</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> protein but normal <span class=\"customMeta\" data-dictid=\"09be7d1f11169277720210bf5b0280\">WBC</span> count (albuminocytologic dissociation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CSF Study Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Normal <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> findings (&lt;48 hours)</li>\n<li>Maximum rise of protein seen by 7 days</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Electrodiagnostic Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Prolonged F-wave latencies\n\t\t\t\t<ul>\n<li>Earliest finding in AIDP (Acute <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> Demyelinating Polyneuropathy)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Flaccid <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> Weakness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Weakness of limbs (flaccid).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Areflexia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Areflexia is present in areas of weakness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CytoAlbuminologic dissociation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> protein with normal <span class=\"customMeta\" data-dictid=\"09be7d1f11169277720210bf5b0280\">WBC</span> count.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Monophasic Illness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Symptoms develop over 12 hours to 28 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Electrodiagnostic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Electrodiagnostic findings are consistent with demyelination.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presents with generalized weakness and inability to walk due to loss of balance after a recent viral illness. He reports double vision, and examination reveals bilateral ptosis and global areflexia. He has a history of alcohol use but is non-diabetic and non-hypertensive. What is the most appropriate treatment?", "options": [{"label": "A", "text": "Intravenous immunoglobulin", "correct": true}, {"label": "B", "text": "Corticosteroids", "correct": false}, {"label": "C", "text": "Thiamine", "correct": false}, {"label": "D", "text": "Pyridostigmine", "correct": false}], "correct_answer": "A. Intravenous immunoglobulin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IVIG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Treatment of choice (TOC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Plasmapheresis (Plex)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Equally effective as IVIG; use either</li>\n<li>Functional improvement may occur &gt;1 week after treatment or show delayed response<strong> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Not useful in this condition<strong> (Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Frequent assessment of <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> negative inspiratory force (NIF) and vital capacity</li>\n</ul>\n<ul>\n<li>Determines need for <span class=\"customMeta\" data-dictid=\"dcf52bc6051692777189bc6d95b5e5\">ICU</span> admission due to impending <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Aggressive physical rehabilitation is imperative</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old female presents with acute dysphagia, particularly for liquids, and nasal regurgitation, following a recent dengue fever. Examination reveals bilateral facial weakness and areflexia in the upper limbs. Brain and cervical spine MRI is normal, while cerebrospinal fluid analysis shows elevated protein with normal glucose. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute pharyngeal cervicobrachial neuropathy", "correct": true}, {"label": "B", "text": "Miller-Fisher syndrome", "correct": false}, {"label": "C", "text": "Multiple sclerosis", "correct": false}, {"label": "D", "text": "Botulism", "correct": false}], "correct_answer": "A. Acute pharyngeal cervicobrachial neuropathy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man presents with progressive memory loss, difficulty in performing daily activities, and mood changes. His family notes that he often repeats the same questions and becomes easily confused. Neurological examination reveals no focal deficits, but cognitive testing indicates significant impairment in memory and language skills. What is the possible neurotransmitter status for this condition?", "options": [{"label": "A", "text": "Increased Acetylcholine, decreased Norepinephrine, decreased Serotonin", "correct": false}, {"label": "B", "text": "Decreased Acetylcholine, decreased Norepinephrine, decreased Serotonin", "correct": true}, {"label": "C", "text": "Normal Acetylcholine, increased Norepinephrine, normal Serotonin", "correct": false}, {"label": "D", "text": "Increased Acetylcholine, increased Norepinephrine, decreased Serotonin", "correct": false}], "correct_answer": "B. Decreased Acetylcholine, decreased Norepinephrine, decreased Serotonin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:535px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Neurotransmitter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Location of Synthesis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Decreased ACh</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nucleus <span class=\"customMeta\" data-dictid=\"849623f7a71692777182fb29760194\">basalis</span> of Meynert (forebrain)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Decreased Norepinephrine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Locus <span class=\"customMeta\" data-dictid=\"7ab09b1b141692777184616deb49e2\">coeruleus</span> (pons)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Decreased Serotonin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"127f1d277616927771975f15621776\">raphe</span> (brainstem)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man with Down syndrome is being monitored for cognitive decline due to his increased risk for Alzheimer's disease. Why is this patient at a higher risk for developing Alzheimer's disease?", "options": [{"label": "A", "text": "Presenilin 1 gene mutation", "correct": false}, {"label": "B", "text": "Overexpression of the APP gene", "correct": true}, {"label": "C", "text": "Mutation in the ApoE4 gene", "correct": false}, {"label": "D", "text": "Release of pro-inflammatory cytokines and promoting insulin resistance", "correct": false}], "correct_answer": "B. Overexpression of the APP gene", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromosome 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presenilin 2 gene defective</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromosome 14</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presenilin 1 gene defective<strong> (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromosome 19</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ApoE gene</p>\n<p>ApoE4 allele: Higher risk of developing <span class=\"customMeta\" data-dictid=\"a325d0c14e16927771992fe8a96758\">sporadic</span> Alzheimer's disease <strong> (Option C ruled out)</strong></p>\n<p>ApoE2 allele: Low risk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromosome 21</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> protein (APP) gene</p>\n<p>Alzheimer's Disease in <span class=\"customMeta\" data-dictid=\"e8be57a3f316927771864f46a8ea54\">Down syndrome</span> (extra copy of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 21 leads to overexpression of the <span class=\"customMeta\" data-dictid=\"351e627bcf1692777181d406512336\">APP</span> gene) <strong>(Option B)</strong></p>\n<p>Early-age-of-onset <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> AD</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following neurodegenerative disorders is not classified as a tauopathy?", "options": [{"label": "A", "text": "Alzheimer’s disease", "correct": false}, {"label": "B", "text": "Punch-drunk syndrome", "correct": false}, {"label": "C", "text": "Parkinson’s disease", "correct": true}, {"label": "D", "text": "Pantothenate kinase-associated neurodegeneration (PKAN)", "correct": false}], "correct_answer": "C. Parkinson’s disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman has been diagnosed with early-stage Alzheimer's disease. Her husband reports that she frequently struggles to remember recent events and has begun to repeat herself in conversations. Additionally, she has difficulty managing her finances and has gotten lost while driving to familiar places. Despite these issues, she insists that she is “just fine” and is not concerned about her memory. Which term best describes the unawareness of her cognitive decline?", "options": [{"label": "A", "text": "Subjective cognitive decline", "correct": false}, {"label": "B", "text": "Anosognosia", "correct": true}, {"label": "C", "text": "Apraxia", "correct": false}, {"label": "D", "text": "Mild cognitive impairment (MCI)", "correct": false}], "correct_answer": "B. Anosognosia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 74-year-old woman is brought to a memory clinic by her daughter, who reports increasing forgetfulness over the past year. The daughter notes that her mother often misplaces items, struggles to find the right words during conversations, and repeats questions she has just asked. Recently, she became lost while driving to her regular grocery store, which she has frequented for years. On examination, she has difficulty following a conversation, and signs of apraxia are present. There are no significant findings on routine laboratory tests, and an FDG-PET is ordered. Which finding in FDG-PET is most consistent with the diagnosis of this patient’s condition?", "options": [{"label": "A", "text": "Hypometabolism in the posterior temporal-parietal cortex", "correct": true}, {"label": "B", "text": "Cerebral atrophy", "correct": false}, {"label": "C", "text": "Widened third ventricle", "correct": false}, {"label": "D", "text": "Detection of amyloid depositions", "correct": false}], "correct_answer": "A. Hypometabolism in the posterior temporal-parietal cortex", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/qyXhAPnWbRmGbeuplgPm1744371697.png", "https://image.prepladder.com/notes/sL2hm9UMxLhkFKjdJDJZ1744372796.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:742px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alzheimer’s disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frontotemporal Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Creutzfeldt-</strong></p>\n<p><strong>Jakob disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lewy-body Dementia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular basis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aβ/tau</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tau,TDP-43,FET</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PrPSC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>α-Synuclein</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Step-wise cognitive decline, often following strokes or infarcts.</p>\n<p><strong>Memory impairment</strong> occurs later.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progressive memory loss, disorientation, and confusion. <strong>Aphasia</strong>, <strong>apraxia</strong>, and <strong>agnosia</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early changes in personality and behavior, or <span class=\"customMeta\" data-dictid=\"9b5386bf6216927771812526afb5e6\">aphasia</span> (primary progressive aphasia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapidly progressive <span class=\"customMeta\" data-dictid=\"41cc5ad93c169277718553c6b948a3\">dementia</span> with <strong>myoclonus</strong>, <strong>ataxia</strong>, and <strong>startle myoclonus</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visual hallucinations, fluctuating cognition, <span class=\"customMeta\" data-dictid=\"7bdd34850816927771973c86f95b79\">REM</span> sleep behavior disorder, parkinsonism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple infarcts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortical atrophy, especially in the <strong>hippocampus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontal/Temporal <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> atrophy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>cortical hyperintensity especially <strong>basal ganglia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortical atrophy, especially in <strong>occipital lobes</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old woman with moderate Alzheimer's disease has been on Donepezil for the past year. On routine follow-up, her cognitive abilities are declining further, and the physician decides to add another medication. Which treatment would be most appropriate to consider at this stage?", "options": [{"label": "A", "text": "Rivastigmine", "correct": false}, {"label": "B", "text": "Memantine", "correct": true}, {"label": "C", "text": "Aducanumab", "correct": false}, {"label": "D", "text": "Galantamine", "correct": false}], "correct_answer": "B. Memantine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT part of the clinical triad of Normal Pressure Hydrocephalus (NPH)?", "options": [{"label": "A", "text": "Ataxia", "correct": false}, {"label": "B", "text": "Urinary incontinence", "correct": false}, {"label": "C", "text": "Dementia", "correct": false}, {"label": "D", "text": "Visual disturbances", "correct": true}], "correct_answer": "D. Visual disturbances", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/uwvMcv8b4oUMHYMl01cz1744373232.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 23 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 12 y/o girl presents with headaches, vomiting, and altered mental status. MRI shows obstructive hydrocephalus caused by multiple cysts blocking cerebrospinal fluid (CSF) flow. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Viral encephalitis", "correct": false}, {"label": "B", "text": "Neurocysticercosis", "correct": true}, {"label": "C", "text": "Bacterial meningitis", "correct": false}, {"label": "D", "text": "Multiple sclerosi", "correct": false}], "correct_answer": "B. Neurocysticercosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neurocysticercosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stages of lesion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>Seizures: The most common symptom</strong>, typically new-onset partial seizures that may generalize.</li>\n<li style=\"text-align: center;\">Headaches</li>\n<li style=\"text-align: center;\"><strong>Hydrocephalus: Caused by cysts obstructing <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) flow, leading to increased pressure.</strong></li>\n<li style=\"text-align: center;\">Cognitive and Personality Changes</li>\n<li style=\"text-align: center;\">Focal Neurological Deficits (weakness or <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> disturbances)</li>\n<li style=\"text-align: center;\">Increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">Intracranial</span> Pressure (nausea, vomiting, ataxia, visual deficits, papilledema)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Vesicular: <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> lesions with scolex. The <span class=\"customMeta\" data-dictid=\"a59b97ce831692777194f6c0160f15\">parasite</span> is viable. <strong>(</strong><strong>Live stage)</strong></li>\n<li style=\"text-align: center;\">Colloidal: Cysts degenerate, causing surrounding oedema. <strong>(Degenerating stage)</strong></li>\n<li style=\"text-align: center;\">Granulonodular: Cysts with less oedema, more solidified. <strong>(Degenerating stage)</strong></li>\n<li style=\"text-align: center;\">Nodular-Calcified: <span class=\"customMeta\" data-dictid=\"a59b97ce831692777194f6c0160f15\">Parasite</span> is no longer viable. Cysts calcify, with no active inflammation. <strong>(Dead stage)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o man presents with fever, a headache, and focal neurological deficits on the right side. He had dental surgery two weeks ago. CT shows a ring-enhancing lesion with surrounding oedema in the left temporal lobe. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Low-grade glioma", "correct": false}, {"label": "B", "text": "Primary brain tumour", "correct": false}, {"label": "C", "text": "Metastatic brain tumour", "correct": false}, {"label": "D", "text": "Brain abscess", "correct": true}], "correct_answer": "D. Brain abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/eYkzhaA7ooagDGjGBWwD1744447154.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Brain Tumor and Brain Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Brain Tumour </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Brain Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Abnormal growth</strong> of cells in the brain or meninges.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Localised collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> due to <strong>infection.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Headaches, nausea, and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> due to <strong>raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure.</strong></p>\n<p style=\"text-align:center\">Seizures and gradual neurological deficits.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Headaches, <strong>fever </strong>(in about half of cases), <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> deficits, and sometimes seizures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">MRI and CT scan</p>\n<p style=\"text-align:center\">Biopsy confirms the type and grade</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">MRI is preferred, CT-guided <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> identifies the<strong> <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> agent.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Surgery, radiotherapy, chemotherapy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> antibiotics and <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> drainage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common brain tumour in childhood?", "options": [{"label": "A", "text": "Pilocytic astrocytoma", "correct": true}, {"label": "B", "text": "Medulloblastoma", "correct": false}, {"label": "C", "text": "Ependymoma", "correct": false}, {"label": "D", "text": "Metastasis", "correct": false}], "correct_answer": "A. Pilocytic astrocytoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following syndromes with their most commonly seen brain tumours respectively. 1. Von Hippel Landau a) Bilateral vestibular schwannomas 2. Tuberous sclerosis b) Glioma 3. Neurofibromatosis 2 c) Hemangioblastoma of the cerebellum 4. Li Fraumeni Syndrome d) Subependymal giant cell astrocytoma", "options": [{"label": "A", "text": "1-c, 2-d, 3-a, 4-b", "correct": true}, {"label": "B", "text": "1-b, 2-d, 3-c, 4-a", "correct": false}, {"label": "C", "text": "1-d, 2-a, 3-b, 4-c", "correct": false}, {"label": "D", "text": "1-b, 2-d, 3-a, 4-c", "correct": false}], "correct_answer": "A. 1-c, 2-d, 3-a, 4-b", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Associated Tumours</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cowden's syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dysplastic cerebellar <span class=\"customMeta\" data-dictid=\"96a06bc4d616927771886fc9efcb00\">gangliocytoma</span> (Lhermitte-Duclos disease), meningioma, astrocytoma, breast, endometrial, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer, trichilemmomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gardner's syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Medulloblastoma, glioblastoma, craniopharyngioma, <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> polyposis, multiple osteomas, skin and soft tissue tumours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Li-Fraumeni syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gliomas, medulloblastomas, sarcomas, breast cancer, leukaemia, and others</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lynch syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Glioblastomas and other gliomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> (Wermer's syndrome)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pituitary adenoma, <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"491e5b2e851692777198ba329e42ce\">schwannoma</span> and pancreatic <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> cell tumours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>NF1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Schwannomas, astrocytomas, <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve gliomas, meningiomas, neurofibromas, neurofibrosarcomas, and others</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>NF2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> schwannomas, astrocytomas, multiple meningiomas, ependymomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tuberous <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">Sclerosis</span> (Bourneville disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Subependymal giant cell astrocytoma, ependymomas, glioma, ganglioneuroma, hamartoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Turcot syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gliomas, medulloblastomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Von <span class=\"customMeta\" data-dictid=\"a5053b37c2169277718910a0dcc85a\">Hippel</span> Landau</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hemangioblastomas of the cerebellum, <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> angiomas, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell carcinoma, pheochromocytoma, pancreatic tumours and cysts, <span class=\"customMeta\" data-dictid=\"9840f5d4e2169277718767b259be57\">endolymphatic sac</span> tumours of the middle ear</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40 y/o man with a known brain tumour has recently undergone radiation therapy. During a follow-up visit, his doctor ordered imaging studies to evaluate the tumour. The physician wants to determine whether the changes observed on the imaging are due to tumour progression or necrosis resulting from treatment. Which imaging technique can help differentiate between the two?", "options": [{"label": "A", "text": "Computed Tomography (CT)", "correct": false}, {"label": "B", "text": "Gadolinium-enhanced Magnetic Resonance Imaging (MRI)", "correct": false}, {"label": "C", "text": "MR Spectroscopy", "correct": true}, {"label": "D", "text": "Functional MRI", "correct": false}], "correct_answer": "C. MR Spectroscopy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22 y/o man is suspected to have a brain tumour after presenting with several concerning symptoms. He also reports episodes of nausea and difficulty with balance. Which of the following features when present will you not suspect brain tumors?", "options": [{"label": "A", "text": "Persistent headaches", "correct": false}, {"label": "B", "text": "Seizures", "correct": false}, {"label": "C", "text": "Behaviour changes", "correct": false}, {"label": "D", "text": "Decreased skin sensitivity to temperature", "correct": true}], "correct_answer": "D. Decreased skin sensitivity to temperature", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the correct statements on CNS tumours. Calcifications are found in Meningioma and Oligodendroglioma. Rathke’s cyst and Craniopharyngioma are present as suprasellar masses. Meningioma and Glioblastoma multiforme never cross the midline. Giant cell Astrocytoma and Ependymoma occur as Intraventricular tumours. Schwannoma is an important Cerebello-pontine angle tumour. Metastatic lesions are never present in the suprasellar area.", "options": [{"label": "A", "text": "2,3,5,6", "correct": false}, {"label": "B", "text": "1,2,4,5", "correct": true}, {"label": "C", "text": "1,2,5,6", "correct": false}, {"label": "D", "text": "All the above", "correct": false}], "correct_answer": "B. 1,2,4,5", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Important Facts on <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> Tumours</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sellar/ <span class=\"customMeta\" data-dictid=\"baccb1fb501692777199a254595de0\">Suprasellar</span> Tumours</strong></p>\n<p style=\"text-align:center\"><strong>(</strong><strong>Statement 2</strong><strong> &amp; </strong><strong>Statement 6</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cerebello-Pontine Angle Tumors</strong></p>\n<p style=\"text-align:center\"><strong>(Statement 5)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pituitary Adenoma</li>\n<li>Craniopharyngioma</li>\n<li>Rathke’s cyst</li>\n<li>Meningioma (Presence of <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">Dural</span> tail)</li>\n<li>Schwannoma</li>\n<li>Dermoid</li>\n<li>Germinoma</li>\n<li>Metastasis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Schwannoma</li>\n<li>Meningioma</li>\n<li>Epidermoid</li>\n<li>Arachnoid cyst</li>\n<li>Paraganglioma</li>\n<li>Metastasis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Calcifications in <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> Tumours</strong></p>\n<p style=\"text-align:center\"><strong>(Statement 1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Midline Crossing <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> Tumours</strong></p>\n<p style=\"text-align:center\"><strong>(Statement 3)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Meningioma</li>\n<li>Craniopharyngioma</li>\n<li>Oligodendroglioma</li>\n<li>Chordoma</li>\n<li>Ependymoma</li>\n<li>Metastasis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glioblastoma multiforme</li>\n<li>Radiation necrosis</li>\n<li>Meningioma</li>\n<li>Lymphoma</li>\n<li>Epidermoid cysts</li>\n<li>Multiple Sclerosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tumour mimics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intraventricular Tumours</strong></p>\n<p style=\"text-align:center\"><strong>(Statement 4)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abscess</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> (Tumefactive)</li>\n<li>Aneurysm</li>\n<li>Infections- Eg. <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">Herpes</span> encephalitis, tuberculoma, neurocysticercosis</li>\n<li>Dural AV Fistula</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ependymoma</li>\n<li>Subependymoma</li>\n<li>Meningioma</li>\n<li>Choroid <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">Plexus</span> Papilloma</li>\n<li>Giant cell Astrocytoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common primary malignant brain tumour in adults?", "options": [{"label": "A", "text": "Meningioma", "correct": false}, {"label": "B", "text": "Glioma", "correct": true}, {"label": "C", "text": "Vestibular schwannoma", "correct": false}, {"label": "D", "text": "CNS Lymphoma", "correct": false}], "correct_answer": "B. Glioma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 y/o female presents to the ED with seizures and headaches. An MRI Contrast of the brain is given below. The neurologist is considering treatment options based on the imaging findings. Given the presence of multiple viable cystic lesions on the CT scan, which of the following treatment regimens is most appropriate?", "options": [{"label": "A", "text": "Albendazole only", "correct": false}, {"label": "B", "text": "Praziquantel only", "correct": false}, {"label": "C", "text": "Albendazole + Praziquantel", "correct": true}, {"label": "D", "text": "Prednisolone only", "correct": false}], "correct_answer": "C. Albendazole + Praziquantel", "question_images": ["https://image.prepladder.com/notes/VYvNBjQgqVUMVJfD57Pu1744446752.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 y/o male presents to the clinic with progressive headaches, fever, and weight loss over the past month. Neurological examination reveals focal deficits and a CT scan of the brain is given below. The patient also exhibits signs of meningitis. Based on the clinical presentation and CT findings, which of the following conditions is most likely diagnosed?", "options": [{"label": "A", "text": "Neurocysticercosis", "correct": false}, {"label": "B", "text": "Tuberculoma", "correct": true}, {"label": "C", "text": "Brain abscess", "correct": false}, {"label": "D", "text": "Metastasis", "correct": false}], "correct_answer": "B. Tuberculoma", "question_images": ["https://image.prepladder.com/notes/k5JYjsVbsJcepjpJ5pcI1744445982.png"], "explanation_images": ["https://image.prepladder.com/notes/udPMpU9p8wqamnSe2GKt1744446204.png", "https://image.prepladder.com/notes/QJHVTtFIzwF3hKTc4rKn1744446106.png", "https://image.prepladder.com/notes/NfOuJY13doJnZgePkIsv1744446331.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:591px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Neurocysticercosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Tuberculoma of the Brain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Smaller (&lt; 20 mm), single or multiple</p>\n<p style=\"text-align:center\"><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Larger (&gt; 20 mm), often multiple, conglomerated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Associated Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Junction of grey-white matter</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Common in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>MR Spectroscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Multiple <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid peaks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Lipid peaks</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Focal Neurological Deficits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Raised ICP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Transient</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Constitutional Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>CT images</strong></p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Neurocysticercosis\" data-author=\"Evans C, Garcia HH, Gilman RH and Friedland JS\" data-hash=\"9879\" data-license=\"OPEN ACCES\" data-source=\"https://en.wikipedia.org/wiki/Neurocysticercosis\" data-tags=\"April2025\" height=\"227\" src=\"https://image.prepladder.com/notes/udPMpU9p8wqamnSe2GKt1744446204.png\" width=\"105\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:middle\">\n<figure class=\"caption_element\"><img alt=\"Tuberculoma of the Brain\" data-author=\"Carlos David Perez-Malagon • Raul Barrera-Rodriguez • Miguel A. Lopez-Gonzalez • Luis F. Alva-Lopez\" data-hash=\"9877\" data-license=\"CC BY\" data-source=\"https://www.cureus.com/articles/78621-diagnostic-and-neurological-overview-of-brain-tuberculomas-a-review-of-literature#!/authors\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/QJHVTtFIzwF3hKTc4rKn1744446106.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28 y/o female presents to the neurology clinic with recurrent headaches and occasional seizures. An MRI of the brain is performed to evaluate her symptoms. The gadolinium-enhanced MRI shows cystic lesions as shown in the image below. Based on the MRI findings described, which stage of the clinical condition does this lesion represent?", "options": [{"label": "A", "text": "Vesicular Stage", "correct": true}, {"label": "B", "text": "Colloidal Stage", "correct": false}, {"label": "C", "text": "Granulonodular Stage", "correct": false}, {"label": "D", "text": "Calcified Stage", "correct": false}], "correct_answer": "A. Vesicular Stage", "question_images": ["https://image.prepladder.com/notes/d81cK9xO3D2yZ3KclGhg1744445493.png"], "explanation_images": ["https://image.prepladder.com/notes/IY1G4mcyt00fzX6HjhhX1744445825.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o male presents with new-onset seizures and persistent headaches. He gives a history of travel to China a month ago. A CT scan of the brain is performed, revealing several ill-defined lesions with surrounding oedema and ring enhancement. Based on these imaging findings, which of the following is the confirmatory test for the condition?", "options": [{"label": "A", "text": "Gadolinium-enhanced MRI", "correct": false}, {"label": "B", "text": "Western blot", "correct": true}, {"label": "C", "text": "Susceptibility-weighted imaging (SWI)", "correct": false}, {"label": "D", "text": "Fundoscopic Exam", "correct": false}], "correct_answer": "B. Western blot", "question_images": ["https://image.prepladder.com/notes/NUWV0XDBDvRrjViLSsbO1744445126.png"], "explanation_images": ["https://image.prepladder.com/notes/FBGe4XEdvutMMpYVDW2a1744445253.png", "https://image.prepladder.com/notes/NmQfPVP9rV9jebwQ3LvM1744445353.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52 y/o man with a history of hypertension suddenly collapses. Imaging confirms a large left-sided brain infarction. His ICP is elevated, and the neurosurgical team is concerned about herniation. What type of herniation is most commonly associated with increased ICP?", "options": [{"label": "A", "text": "Subfalcine herniation", "correct": false}, {"label": "B", "text": "Foraminal herniation", "correct": false}, {"label": "C", "text": "Transtentorial herniation", "correct": true}, {"label": "D", "text": "Cingulate herniation", "correct": false}], "correct_answer": "C. Transtentorial herniation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/isBUnQPWtInxfC8vUoUq1744443155.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 y/o man from a rural area presents with recurrent seizures. He recalls occasionally eating undercooked pork and living in a community with poor sanitation. A brain MRI shows multiple cystic lesions. What is the most likely cause of his condition?", "options": [{"label": "A", "text": "Infection by adult Taenia solium tapeworms in the intestines", "correct": false}, {"label": "B", "text": "Ingestion of T. solium eggs from contaminated food or hands", "correct": true}, {"label": "C", "text": "Eating undercooked pork containing adult tapeworms", "correct": false}, {"label": "D", "text": "Migration of larvae from the lungs to the brain", "correct": false}], "correct_answer": "B. Ingestion of T. solium eggs from contaminated food or hands", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/yFHuYe5oCB2QvkK96eMC1746519572.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is known to mimic coma but does not involve actual loss of consciousness?", "options": [{"label": "A", "text": "Hepatic encephalopathy", "correct": false}, {"label": "B", "text": "Uremic encephalopathy", "correct": false}, {"label": "C", "text": "Hypoglycemia-induced coma", "correct": false}, {"label": "D", "text": "Locked-in syndrome", "correct": true}], "correct_answer": "D. Locked-in syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Reversible Coma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes of <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment of <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Coma </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Metabolic Coma:</strong></p>\n<ul>\n<li>Results from lack of oxygen/glucose or disrupted neuronal excitability.</li>\n<li>Conditions include <strong>hypoglycemia, hyponatremia, hypercalcemia, and hepatic/renal failure. </strong> <strong>(Option C ruled out)</strong></li>\n<li><strong>Hepatic <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">encephalopathy</span> and <span class=\"customMeta\" data-dictid=\"7b92610b86169277720111ae27d1d8\">uremic</span> encephalopathy</strong> cause <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">coma</span> due to elevated <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> levels and elevated creatinine/ <span class=\"customMeta\" data-dictid=\"39ff852e18169277718881d95570cc\">guanidine</span> respectively. <strong>(Option A and B ruled out)</strong></li>\n</ul>\n<p style=\"text-align:center\"><strong>Drug/Toxin-Induced Coma:</strong></p>\n<ul>\n<li>It is caused by drugs or toxins that affect the brainstem's <strong>reticular activating system (RAS)</strong> and cerebral cortex.</li>\n<li>Some drugs, like barbiturates, may <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"f4360a0c6b16927771839d1262a586\">brain death</span> signs.</li>\n</ul>\n<p style=\"text-align:center\"><strong>Epileptic Coma:</strong></p>\n<ul>\n<li>Generalised seizures (nonconvulsive status epilepticus) can cause coma.</li>\n<li>EEG is essential for detecting treatable seizures in unexplained coma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immediate Interventions:</strong></p>\n<ul>\n<li>Prevent further brain damage.</li>\n<li>Correct hypotension, hypoglycemia, hypercalcemia, hypoxia, hypercapnia.</li>\n</ul>\n<p style=\"text-align:center\"><strong>Airway Management:</strong></p>\n<ul>\n<li>Oropharyngeal <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> for drowsy patients with normal breathing.</li>\n<li>Tracheal <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> for apnea, obstruction, or <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> risk.</li>\n</ul>\n<p style=\"text-align:center\"><strong>Medications:</strong></p>\n<ul>\n<li>Naloxone for <span class=\"customMeta\" data-dictid=\"e22dbf6c52169277719441ac94a69e\">opioid</span> overdose.</li>\n<li>Dextrose for hypoglycemia.</li>\n<li>Thiamine for malnourished patients (prevent Wernicke’s encephalopathy).</li>\n<li>Physostigmine for <span class=\"customMeta\" data-dictid=\"9b4dbbb3321692777181e6fe172b88\">anticholinergic</span> <span class=\"customMeta\" data-dictid=\"3f4eecb1c6169277719459c801fb19\">overdose</span> (with caution).</li>\n<li>Fomepizole for <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">ethylene</span> <span class=\"customMeta\" data-dictid=\"7451dcad4f1692777188609e12be1d\">glycol</span> poisoning.</li>\n</ul>\n<p style=\"text-align:center\"><strong>Additional Considerations:</strong></p>\n<ul>\n<li>Manage strokes with <span class=\"customMeta\" data-dictid=\"51021a109516927772009e1d66fee2\">tPA</span> or <span class=\"customMeta\" data-dictid=\"4f8aa8490916927771876a34458133\">embolectomy</span> after ruling out haemorrhage.</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"6c1412e72916927771893d06180642\">hypotonic</span> IV fluids in brain illness to prevent swelling.</li>\n<li>Treat <span class=\"customMeta\" data-dictid=\"4313afe6dc16927771823d43696a2d\">bacterial meningitis</span> promptly with antibiotics and dexamethasone.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50 y/o woman presents with persistent headaches, double vision, and vomiting and also experiences worsening morning headaches. Examination shows reactive pupils and limited right eye lateral movement. Which cranial nerve is most likely affected by increased intracranial pressure?", "options": [{"label": "A", "text": "Optic nerve (CN II)", "correct": false}, {"label": "B", "text": "Oculomotor nerve (CN III)", "correct": false}, {"label": "C", "text": "Trochlear nerve (CN IV)", "correct": false}, {"label": "D", "text": "Abducens nerve (CN VI)", "correct": true}], "correct_answer": "D. Abducens nerve (CN VI)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o male is declared brain dead after a severe head injury. His family consents to organ donation. Which of the following organs is most commonly transplanted from a brain-dead donor?", "options": [{"label": "A", "text": "Pancreas", "correct": false}, {"label": "B", "text": "Heart", "correct": false}, {"label": "C", "text": "Liver", "correct": false}, {"label": "D", "text": "Kidney", "correct": true}], "correct_answer": "D. Kidney", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organ <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">Transplantation</span> from the Brain-Dead</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Organ donation occurs after confirming brain death. <strong>Two doctors</strong> with specific qualifications must confirm <span class=\"customMeta\" data-dictid=\"f4360a0c6b16927771839d1262a586\">brain death</span> through tests separately. Although brain dead, the patient remains ventilated to keep organs <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> for transplantation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organ Transplantation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indication </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Kidney <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">Transplantation</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Most common transplantation</strong>. Performed for end-stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease (ESRD). Common causes are <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> nephropathy, hypertension, and glomerulonephritis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">Transplantation</span> </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Second most common</strong> transplantation. Done for Cirrhosis, liver cancers, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure and cholestatic diseases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Heart <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">Transplantation</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Refractory <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> due to cardiomyopathy, <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease, and <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> defects.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lung Transplantation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Performed for severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, e.g., <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis, emphysema, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> fibrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pancreas <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">Transplantation</span> </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Often combined with <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients with <span class=\"customMeta\" data-dictid=\"780a2697611692777187403cc06a32\">ESRD</span> to reverse diabetes and its complications.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38 y/o man with severe brain injury is undergoing tests to confirm brain death. The apnoea test is part of the evaluation. What is the purpose of the apnoea test in brain death diagnosis?", "options": [{"label": "A", "text": "To assess spontaneous respiratory effort", "correct": true}, {"label": "B", "text": "To evaluate cardiac function during hypoxia", "correct": false}, {"label": "C", "text": "To measure oxygenation levels during ventilation", "correct": false}, {"label": "D", "text": "To monitor brainstem motor reflexes", "correct": false}], "correct_answer": "A. To assess spontaneous respiratory effort", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Brain Death Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Brain death refers to the permanent cessation of all brain and <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> functions while <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity and other bodily functions are maintained artificially. It is legally and ethically equivalent to death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Preconditions for <span class=\"customMeta\" data-dictid=\"f4360a0c6b16927771839d1262a586\">Brain Death</span> Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">Deep <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">coma</span> with no influence of <span class=\"customMeta\" data-dictid=\"974aacc9c716927771867653a1dd71\">depressant</span> drugs.</li>\n<li style=\"text-align:center\">No <span class=\"customMeta\" data-dictid=\"9723be730516927771896878ec012a\">hypothermia</span> (body temperature &gt;35°C).</li>\n<li style=\"text-align:center\">Normal electrolyte, acid-base, and <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels, no <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> or <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> causes.</li>\n<li style=\"text-align:center\">No <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> <span class=\"customMeta\" data-dictid=\"aea081ceb416927771976e2c17be74\">respiration</span> due to <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> dependence.</li>\n<li style=\"text-align:center\">The underlying condition causing brain damage must be irremediable.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Tests to Confirm Brain Death</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong><u>Absence of <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> reflexes</u></strong>:</p>\n<ul>\n<li style=\"text-align:center\">Fixed, non-reactive pupils.</li>\n<li style=\"text-align:center\">Absent corneal and vestibulo-ocular reflexes.</li>\n<li style=\"text-align:center\">No motor response to <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve stimulation.</li>\n<li style=\"text-align:center\">Absent <span class=\"customMeta\" data-dictid=\"9859613acd1692777187a2aaacae71\">gag</span> <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> and no response to <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> suctioning.</li>\n</ul>\n<p style=\"text-align:center\"><strong><u>Apnoea Test</u></strong>:</p>\n<ul>\n<li style=\"text-align:center\">Checks for <strong>Spontaneous <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> effort.</strong> <strong>(Option A)</strong></li>\n<li style=\"text-align:center\">There is <strong>no <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> effort</strong> in <span class=\"customMeta\" data-dictid=\"f4360a0c6b16927771839d1262a586\">brain death</span> when disconnected from the ventilator, despite PaCO2 rising above 50 mmHg.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Additional Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">A four-vessel <span class=\"customMeta\" data-dictid=\"fa1da4abca1692777181b5898561f7\">angiogram</span> or <span class=\"customMeta\" data-dictid=\"7cb1c220051692777190be13e8c7cc\">isotope</span> brain scan is used to confirm the absence of cerebral blood flow, particularly in complex cases.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Testing Protocol</strong>: Must be performed by <strong>two experienced doctors</strong> and repeated after a short interval to confirm the diagnosis. Once <span class=\"customMeta\" data-dictid=\"f4360a0c6b16927771839d1262a586\">brain death</span> is confirmed, organ donation may be considered with appropriate consent.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o male presents to the ED after experiencing a severe headache, nausea, and confusion for the past few hours. O/E, the physician observes a slow heart rate, high blood pressure, and irregular respiratory patterns. What other clinical finding is most likely to be observed in this patient?", "options": [{"label": "A", "text": "Decreased body temperature", "correct": false}, {"label": "B", "text": "Increased pupil size on the affected side", "correct": true}, {"label": "C", "text": "Photophobia", "correct": false}, {"label": "D", "text": "Elevated blood glucose levels", "correct": false}], "correct_answer": "B. Increased pupil size on the affected side", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o male presents to the emergency department after a cardiac arrest. He was resuscitated and remains comatose. A CT scan reveals cerebral oedema and midline shift, indicating raised intracranial pressure (ICP). Which Tier 2 therapy would be most appropriate for managing his elevated ICP?", "options": [{"label": "A", "text": "Therapeutic hypothermia", "correct": true}, {"label": "B", "text": "Decompressive hemicraniectomy", "correct": false}, {"label": "C", "text": "Continuous sedation", "correct": false}, {"label": "D", "text": "Osmotic therapy", "correct": false}], "correct_answer": "A. Therapeutic hypothermia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/C02Sy7Jor3KBaIpYg8zy1744444002.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tier 2 Therapy</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Tier 2 therapy refers to advanced interventions for managing persistent elevated <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure (ICP) when initial treatments (Tier 1) are ineffective. Both <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> <span class=\"customMeta\" data-dictid=\"9723be730516927771896878ec012a\">hypothermia</span> and decompressive <span class=\"customMeta\" data-dictid=\"e3b6f640d316927771880233de1d2b\">hemicraniectomy</span> aim to minimise brain damage and enhance patient outcomes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Therapeutic <span class=\"customMeta\" data-dictid=\"9723be730516927771896878ec012a\">Hypothermia</span> (32-36°C)</strong></p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><u>Indication</u>: Primarily for <strong>hypoxic-ischemic <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">encephalopathy</span> (HIE) following <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</strong></li>\n<li style=\"text-align:center\"><u>Mechanism</u>: Slows <strong>neuronal injury processes</strong> by <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> body temperature, <strong>potentially reducing brain damage. </strong></li>\n<li style=\"text-align:center\"><u>Clinical Evidence</u>: Proven effective in improving outcomes for <span class=\"customMeta\" data-dictid=\"60dcb15b7616927771846fa5872355\">comatose</span> patients after resuscitation, with trials showing benefits at mild <span class=\"customMeta\" data-dictid=\"9723be730516927771896878ec012a\">hypothermia</span> (33°C).</li>\n<li style=\"text-align:center\"><u>Guidelines</u>: Recommended for 24 hours in unresponsive <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest patients, target temperature is typically 32-36°C.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Decompressive Hemicraniectomy</strong></p>\n<p style=\"text-align:center\"><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><u>Indication</u>: For <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> elevated <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> that persists despite other treatments.</li>\n<li style=\"text-align:center\"><u>Procedure</u>: Involves surgically removing a portion of the skull to relieve pressure on the swollen brain.</li>\n<li style=\"text-align:center\"><u>Clinical Evidence</u>: Shown to improve outcomes in select patients, especially in cases of <strong>severe <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> brain injury and significant brain swelling.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pentobarbital Coma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><u>Indication</u>: Considered for <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> ICP</li>\n<li style=\"text-align:center\"><u>Application</u>: It is not as commonly used as other therapies but may be applied in specific circumstances.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient in the ICU exhibits signs of severe brain dysfunction and demonstrates decerebrate posturing. What should the healthcare team consider regarding intracranial pressure (ICP) management?", "options": [{"label": "A", "text": "ICP monitoring is unnecessary and they should focus on other interventions", "correct": false}, {"label": "B", "text": "Immediate intervention is required for elevated ICP", "correct": true}, {"label": "C", "text": "The prognosis is good despite posturing", "correct": false}, {"label": "D", "text": "Avoid ventriculostomy as it may worsen the condition", "correct": false}], "correct_answer": "B. Immediate intervention is required for elevated ICP", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/NrBhKAtZaoiX6fPzuRsB1744443718.png", "https://image.prepladder.com/notes/Fxb89RQoEmYN5FFDHeXV1744443838.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Real-Time Monitoring : Facilitates immediate assessment of ICP, guiding treatment decisions.</li><li>↳ Pressure Relief : Reduces ICP through CSF drainage, potentially improving patient outcomes.</li><li>↳ Guides Treatment : Informs other therapies, such as osmotic therapy or sedation.</li><li>↳ Preference : Generally favoured over parenchymal ICP monitoring when CSF drainage is necessary.</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with fulminant hepatic failure is admitted to the intensive care unit (ICU). The patient is at risk of increased intracranial pressure due to cerebral oedema. What is the primary goal of management of ICP in this patient?", "options": [{"label": "A", "text": "Keep ICP below 20 mmHg", "correct": true}, {"label": "B", "text": "Keep ICP below 40 mmHg", "correct": false}, {"label": "C", "text": "Keep CPP below 20 mmHg", "correct": false}, {"label": "D", "text": "Liver transplantation without ICP monitoring", "correct": false}], "correct_answer": "A. Keep ICP below 20 mmHg", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>ICP Monitoring</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Critical for managing patients with severe brain injury. <span class=\"customMeta\" data-dictid=\"9ddd195e9a1692777197bb3f135c2e\">Real-time</span> <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> measurements enable timely interventions and treatment adjustments to prevent further brain injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indications for <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> Monitoring</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">Severe <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">Traumatic</span> Brain Injury (TBI): Especially when the Glasgow <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> Scale (GCS) score is 8 or lower.</li>\n<li style=\"text-align:center\">Major Brain Tissue Displacement\n\t\t\t\t<ul>\n<li>Large Ischemic or Hemorrhagic Strokes</li>\n<li>Hydrocephalus</li>\n</ul>\n</li>\n<li style=\"text-align:center\">Fulminant <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> Failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Methods of <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Ventriculostomy</strong>: Involves inserting a <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> into the brain’s <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> ventricles. Allows for direct measurement of <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) to lower pressure.</li>\n<li style=\"text-align:center\"><strong>Parenchymal Monitoring</strong>: Involves placing a sensor directly into brain tissue. Used when <span class=\"customMeta\" data-dictid=\"aee7075bc016927772016a35880cac\">ventriculostomy</span> is not suitable due to <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> oedema or coagulopathy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Goals of <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Maintain <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> below 20 mmHg</strong>: <strong>To prevent brain <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and herniation</strong>. <strong>(Option A) </strong> <strong> </strong><strong>(Option B ruled out)</strong></li>\n<li style=\"text-align:center\"><strong>Maintain <span class=\"customMeta\" data-dictid=\"e18e507fd11692777184e028672b90\">Cerebral <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> Pressure</span> (CPP) above 60 mmHg</strong>: Ensures adequate <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the brain despite elevated ICP. <strong>(Option C ruled out) </strong>\n<ul>\n<li>Cerebral <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> Pressure (CPP) is the pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> that drives <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the brain. Adequate <span class=\"customMeta\" data-dictid=\"940b4b015c1692777185ffed9cddfc\">CPP</span> is essential for delivering oxygen and nutrients to neuronal tissues while removing <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> waste products.</li>\n<li>It is calculated using the formula<strong>: <span class=\"customMeta\" data-dictid=\"940b4b015c1692777185ffed9cddfc\">CPP</span> = Mean <span class=\"customMeta\" data-dictid=\"9e831262a7169277718263c34e2dc1\">Arterial Pressure</span> (MAP) - <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">Intracranial</span> Pressure (ICP).</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o male is brought to the ED after a road traffic accident. He is unconscious with a GCS score of 6. His blood pressure is 160/100 mmHg, and he exhibits symptoms of bradycardia and irregular respiration. What is the first step in managing his raised intracranial pressure?", "options": [{"label": "A", "text": "Perform hyperventilation", "correct": false}, {"label": "B", "text": "Administer mannitol", "correct": false}, {"label": "C", "text": "Elevate head end", "correct": true}, {"label": "D", "text": "Administer 0.45% NaCl", "correct": false}], "correct_answer": "C. Elevate head end", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">Intracranial</span> Pressure (ICP) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Trauma, tumours, haemorrhage, or <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">hydrocephalus</span> can lead to increased ICP.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Headache, vomiting, altered consciousness, <span class=\"customMeta\" data-dictid=\"b16483f2be1692777194cac30b9764\">papilledema</span> (swelling of the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc), unequal pupils due to <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> compression</p>\n<p style=\"text-align:center\"><strong>Cushing's triad: Hypertension, bradycardia, and <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"aea081ceb416927771976e2c17be74\">respiration</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management of Raised <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> (when ICP&gt;20-25mmHg for &gt;5min)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Initial Measures</strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Head elevation</strong>: Raising the head to 30 degrees enhances <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> and reduces <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> by promoting <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> out of the brain.</li>\n<li style=\"text-align:center\"><strong>Sedation</strong>: Sedating the patient with agents like <span class=\"customMeta\" data-dictid=\"a2e652a5261692777192d6890d6cf4\">midazolam</span> reduces <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demands on the brain, helping control ICP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Medical Therapies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Osmotherapy (Mannitol or <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">Hypertonic</span> saline)</strong>: <strong>(Option B ruled out)</strong></p>\n<ul>\n<li style=\"text-align:center\">Mannitol acts as an osmotic diuretic, reducing cerebral oedema by drawing fluid from brain tissue.</li>\n<li style=\"text-align:center\">Hypertonic <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> works similarly by pulling water from brain cells into the bloodstream, <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> brain swelling.</li>\n<li style=\"text-align:center\">Contraindication: Active <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> bleeding</li>\n</ul>\n<p style=\"text-align:center\"><strong>Glucocorticoids</strong>: Effective in reducing <span class=\"customMeta\" data-dictid=\"c8013ecf46169277720128cab0a7b4\">vasogenic</span> oedema, particularly in cases involving tumours, but <strong>not used for trauma-induced ICP. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ventilation Strategies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hyperventilation:</strong> <strong>Temporarily reduces <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> by inducing cerebral vasoconstriction, leading to decreased blood flow.</strong> This is a short-term measure that requires careful monitoring to avoid ischemia. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CSF Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">In cases of <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">hydrocephalus</span> or <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> enlargement, <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) can be drained through a <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> to relieve pressure.</p>\n<p style=\"text-align:center\">Ventriculostomy is the procedure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pressor therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Common pressors like phenylephrine, dopamine, and <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> raise MAP to ensure cerebral <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and relieve <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> by promoting autoregulatory <span class=\"customMeta\" data-dictid=\"3f0b42b17016927772014c586d44b7\">vasoconstriction</span> and reducing <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> blood volume. <span class=\"customMeta\" data-dictid=\"5f297233411692777196aa627be21d\">Pressor</span> therapy is used only after other treatments fail.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Advanced Therapies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Decompressive craniectomy</strong>: A <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedure where part of the skull is removed to allow the brain to swell without causing further pressure buildup. This is considered when <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> remains uncontrolled by other measures.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 33 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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Born prematurely at 34 weeks with low birth weight, a lumbar puncture reveals cloudy cerebrospinal fluid (CSF) with high white blood cell count, decreased glucose, and elevated protein levels. Which is not a causative factor for this infant's condition?", "options": [{"label": "A", "text": "Group B Streptococcus", "correct": false}, {"label": "B", "text": "Escherichia coli", "correct": false}, {"label": "C", "text": "Streptococcus pneumoniae", "correct": true}, {"label": "D", "text": "Listeria monocytogenes", "correct": false}], "correct_answer": "C. Streptococcus pneumoniae", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bacterial <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> in neonates and children</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Common Causes by Age Group</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neonates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pre-school Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Older Children</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Escherichia <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> (gram-negative bacilli)</li>\n<li style=\"text-align: center;\">Group B streptococci</li>\n<li style=\"text-align: center;\">Listeria monocytogenes <strong>(Option A, B and D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Haemophilus influenzae type b</li>\n<li style=\"text-align: center;\">Neisseria meningitidis</li>\n<li style=\"text-align: center;\">Streptococcus pneumoniae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Neisseria meningitidis</li>\n<li style=\"text-align: center;\">Streptococcus pneumoniae</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Lethargy, fever, hypothermia, seizure, headache, stiff neck, irritability, drowsiness, and vomiting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Lumbar <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> (CSF analysis)</u>:</p>\n<ul>\n<li style=\"text-align: center;\"><strong>Cloudy <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> with high white <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">blood cell count</span> (neutrophils)</strong></li>\n<li style=\"text-align: center;\"><strong>Elevated protein, decreased glucose</strong></li>\n</ul>\n<p style=\"text-align: center;\">Gram <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> or culture reveals bacteria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Empirical antibiotics</u>: <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">Broad-spectrum</span> antibiotics started immediately</p>\n<p style=\"text-align: center;\"><u>Targeted antibiotics</u>: Based on <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> bacteria</p>\n<p style=\"text-align: center;\">Adjunctive <span class=\"customMeta\" data-dictid=\"6045a2ba311692777188aaeacafe4f\">glucocorticoid</span> therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Hearing loss (common with H. influenzae and S. pneumoniae), seizures, memory impairment, decreased intellectual function, hydrocephalus, sepsis, and risk of death</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Vaccination</u>: Against H. influenzae type b, N. meningitidis</p>\n<p style=\"text-align: center;\"><u>Chemoprophylaxis</u>: <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">Prophylactic</span> antibiotics for close contacts of meningococcal <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> cases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the emergency with fever, severe headache, neck stiffness, and confusion. A lumbar puncture is performed, revealing a high white blood cell count with a predominance of neutrophils and elevated protein levels. What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Administer oral antibiotics", "correct": false}, {"label": "B", "text": "Initiate intravenous broad-spectrum antibiotics", "correct": true}, {"label": "C", "text": "Start antitubercular therapy", "correct": false}, {"label": "D", "text": "Conduct a follow-up lumbar puncture", "correct": false}], "correct_answer": "B. Initiate intravenous broad-spectrum antibiotics", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LzJwCsIutcXiCoPqzvU61740605076.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bacterial <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">Meningitis</span> in Adults and Prevention</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Streptococcus pneumoniae and <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitides</strong> are the primary causes.<strong> <span class=\"customMeta\" data-dictid=\"0df89fd47716927771914ac591d3a9\">Listeria</span> monocytogenes</strong> is a significant risk in adults over 50, especially in those with diabetes, alcoholism, or weakened immune systems.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathophysiological Process</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"352\" src=\"https://image.prepladder.com/content/LzJwCsIutcXiCoPqzvU61740605076.png\" width=\"325\"/></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong><u>Immediate Management</u></strong><strong>: Start with <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> </strong>antibiotics to cover pathogens. Treatment is then changed based on the identified organism and its susceptibility. <strong>(Option B)</strong></li>\n<li style=\"text-align: center;\"><u>Adjunctive Therapy</u>: <strong>Dexamethasone</strong> may be given to reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and prevent complications, particularly if administered early.</li>\n<li style=\"text-align: center;\"><u>Supportive Care</u>: Manage complications like raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure and seizures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Vaccines for H. influenzae type b, N. meningitidis, and S. pneumoniae. No vaccine currently exists for group B meningococcal infections.</li>\n<li style=\"text-align: center;\"><strong>Chemoprophylaxis</strong>: Close contacts of individuals with meningococcal <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> should receive <strong>prophylactic antibiotics </strong>like rifampicin, ciprofloxacin, <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">azithromycin</span> or ceftriaxone to reduce the risk of secondary infections.\n\t\t\t\t<ul>\n<li><strong>Rifampicin - 600 mg 12 hourly for 2 days</strong></li>\n<li><strong>Ciprofloxacin - 500 mg single dose</strong></li>\n<li><strong>Azithromycin 500 mg single dose</strong></li>\n<li><strong>Ceftriaxone - 250 mg <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">Intramuscular</span> single dose</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Predominant Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Polymorphonuclear Neutrophils (PMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fungal/Tubercular Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Straw-colored (TB meningitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Viral Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or</p>\n<p style=\"text-align: center;\">Turbid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following accurately describes the CSF findings in viral encephalitis caused by HSV-1?", "options": [{"label": "A", "text": "Predominance of neutrophils with low glucose levels", "correct": false}, {"label": "B", "text": "Lymphocytic pleocytosis with normal glucose levels", "correct": true}, {"label": "C", "text": "High protein levels and no change in white blood cells", "correct": false}, {"label": "D", "text": "Presence of eosinophils with normal glucose levels", "correct": false}], "correct_answer": "B. Lymphocytic pleocytosis with normal glucose levels", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JumMtg5Zd5MYbLjqIQ721740606404.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HSV <span class=\"customMeta\" data-dictid=\"9644652a1f16927771873765457fcc\">Encephalitis</span> Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PCR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuroimaging and <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shows lymphocytic <span class=\"customMeta\" data-dictid=\"83e27900ef1692777195384e008950\">pleocytosis</span> (increased lymphocytes).</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels.</li>\n<li>Slightly elevated protein concentration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF PCR</strong> for <span class=\"customMeta\" data-dictid=\"17df0c44e116927771897deca1bbf4\">HSV</span> is <strong>highly sensitive (96%) and specific </strong>(99%) for confirming diagnosis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MRI is preferred for early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of <span class=\"customMeta\" data-dictid=\"17df0c44e116927771897deca1bbf4\">HSV</span> encephalitis. <strong>Characteristic lesions appear on T2-weighted and diffusion-weighted MRI</strong>, affecting the orbitofrontal and <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> lobes.</li>\n<li>EEG may show <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">periodic</span> slow-wave activity in the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> lobes, indicative of <span class=\"customMeta\" data-dictid=\"17df0c44e116927771897deca1bbf4\">HSV</span> encephalitis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Predominant Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Polymorphonuclear Neutrophils (PMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fungal/Tubercular Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Straw-colored (TB meningitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Viral Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal or</p>\n<p style=\"text-align: center;\">Turbid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 y/o male is brought to the emergency after experiencing fever, seizures, and confusion. Neurological examination reveals hemiparesis on the left side. A preliminary diagnosis of HSV encephalitis is made after an MRI shows abnormalities in the right temporal lobe. Which complication is this patient at greatest risk for if the condition is not treated promptly?", "options": [{"label": "A", "text": "Cognitive impairment", "correct": true}, {"label": "B", "text": "Peripheral neuropathy", "correct": false}, {"label": "C", "text": "Sudden cardiac arrest", "correct": false}, {"label": "D", "text": "Respiratory failure", "correct": false}], "correct_answer": "A. Cognitive impairment", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o male with a history of HIV infection presents to the ED with headache, fever, photophobia, and neck stiffness. His CD4 count is 80 cells/mm³. Lumbar puncture reveals an elevated opening pressure, low glucose, and elevated protein levels. India ink staining of the cerebrospinal fluid showed the following picture. Which of the following is the most appropriate initial treatment regimen for this patient?", "options": [{"label": "A", "text": "Fluconazole monotherapy", "correct": false}, {"label": "B", "text": "Amphotericin B and Flucytosine", "correct": true}, {"label": "C", "text": "Voriconazole monotherapy", "correct": false}, {"label": "D", "text": "Caspofungin and Fluconazole", "correct": false}], "correct_answer": "B. Amphotericin B and Flucytosine", "question_images": ["https://image.prepladder.com/notes/EG3d6h90wA6fIoFc6UBk1744379234.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cryptococcus neoformans (most common)</li>\n<li>Candida</li>\n<li>Histoplasma</li>\n<li>Blastomyces</li>\n<li>Coccidioides</li>\n<li>Sporothrix</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunocompromised patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li>Altered mental status, lethargy</li>\n<li>Fever</li>\n<li>Neck stiffness</li>\n<li>Nausea and vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lumbar Puncture:</strong> Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and high protein levels. White cell count can be normal or higher than 20 microL and have a <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> predominance.</li>\n<li>India ink <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> shows <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells.</li>\n<li>CSF ELISA for CRAG (Cryptococcal Antigen).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n<p><strong>(Options A, C &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>LAMB</strong> (Liposomal Amphotericin-B) and <strong>5-Fluorocytosine</strong> (Flucytosine) for 2 weeks</li>\n<li><strong>Fluconazole </strong>is given subsequently for 8-10 weeks.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a lumbar puncture, the needle passes through several anatomical layers before reaching the subarachnoid space. Which of the following is the correct sequence of structures pierced during this procedure?", "options": [{"label": "A", "text": "Skin → Ligamentum flavum → Supraspinous ligament → Interspinous ligament → Dura → Arachnoid", "correct": false}, {"label": "B", "text": "Skin → Supraspinous ligament → Interspinous ligament → Ligamentum flavum → Arachnoid → Dura", "correct": false}, {"label": "C", "text": "Skin → Supraspinous ligament → Ligamentum flavum → Interspinous ligament → Dura → Arachnoid", "correct": false}, {"label": "D", "text": "Skin → Supraspinous ligament → Interspinous ligament → Ligamentum flavum → Dura → Arachnoid", "correct": true}], "correct_answer": "D. Skin → Supraspinous ligament → Interspinous ligament → Ligamentum flavum → Dura → Arachnoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/KTImNvyqAvXH0ZC8ChAI1744380015.png", "https://image.prepladder.com/notes/X2JUVgsEaH9yTRP36pwr1744382282.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient undergoes lumbar puncture for the evaluation of suspected meningitis. Two days later, he develops a severe headache that worsens when he sits or stands and improves when lying down. He has no fever, neck stiffness, or neurological deficits. His headache persists despite conservative measures such as bed rest and analgesics. What is the next appropriate treatment?", "options": [{"label": "A", "text": "Intravenous caffeine", "correct": false}, {"label": "B", "text": "Blood patch", "correct": true}, {"label": "C", "text": "Steroid therapy", "correct": false}, {"label": "D", "text": "Acetaminophen", "correct": false}], "correct_answer": "B. Blood patch", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38 y/o man presented to the ED with progressive weakness in his legs that started 4 days ago. He reports that the weakness began as difficulty climbing stairs and has now progressed to difficulty walking. He denies any trauma, fever, or sensory loss, although he has experienced some mild tingling in his fingertips. He reports no urinary or bowel problems. Which of the following best describes the CSF finding in this patient?", "options": [{"label": "A", "text": "High protein with high white blood cell count", "correct": false}, {"label": "B", "text": "Low protein with normal white blood cell count", "correct": false}, {"label": "C", "text": "High protein with normal white blood cell count", "correct": true}, {"label": "D", "text": "Normal protein with high white blood cell count", "correct": false}], "correct_answer": "C. High protein with normal white blood cell count", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/IS79yDlfHzeYbNWnu2FJ1744382503.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sugar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">50-250</p>\n<p style=\"text-align:center\">mm H2O</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">0-4</p>\n<p style=\"text-align:center\">Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">&gt;50-60% of blood level</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">&lt;0.45g/l</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Clear</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute bacterial</strong></p>\n<p style=\"text-align:center\"><strong>meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">&gt; 1000 PMN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↑↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Cloudy</p>\n<p style=\"text-align:center\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tuberculous</strong></p>\n<p style=\"text-align:center\"><strong>meningitis</strong></p>\n<ul>\n<li style=\"text-align:center\">A malnourished child with PEM- <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> 4</li>\n<li style=\"text-align:center\">BCG <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> is absent</li>\n<li style=\"text-align:center\">Contact with Koch's</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">&gt; 100-1000</p>\n<p style=\"text-align:center\">lymphocytes</p>\n<p style=\"text-align:center\">per cubic mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↑↑</p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Cobweb</strong></p>\n<p style=\"text-align:center\"><strong>coagulum</strong></p>\n<figure class=\"caption_element\"><img alt=\"TB cobweb coagulum\" data-author=\"Ghimire, Bardan &amp; Thapaliya, Ishwor &amp; Yadav, Jeshika &amp; Bhandari, Sujata &amp; Paudyal, Man B &amp; Mehta, Neha &amp; Bhandari, Sagar &amp; Raj Adhikari, Yagya &amp; Sapkota, Sanjaya &amp; Bhattarai, Madhur.\" data-hash=\"9458\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Gross-cerebrospinal-fluid-finding-showing-clear-light-yellow-fluid-with-cobweb-coagulum_fig2_376231495\" data-tags=\"\" height=\"138\" src=\"https://image.prepladder.com/notes/IS79yDlfHzeYbNWnu2FJ1744382503.png\" width=\"137\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Clear/cloudy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subarachnoid</strong></p>\n<p style=\"text-align:center\"><strong>haemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">RBC -</p>\n<p style=\"text-align:center\">predominantly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Normal/↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Bloody in the</p>\n<p style=\"text-align:center\">initial phase</p>\n<p style=\"text-align:center\">after 48 hours.</p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Xanthochromic</strong></p>\n<p style=\"text-align:center\"><strong>CSF </strong>(due to hemolysis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Viral meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">10-2000</p>\n<p style=\"text-align:center\">lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Normal/↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Clear</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>GBS</strong></p>\n<p style=\"text-align:center\">(Albumino</p>\n<p style=\"text-align:center\">cytological</p>\n<p style=\"text-align:center\">dissociation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Clear</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">CNS <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">leukemia</span> &amp; <span class=\"customMeta\" data-dictid=\"6bd3522c4516927771855962983e97\">Cryptococcal</span> meningitis: Sugar is <strong>low</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 36 y/o patient presents with a 3-week history of headache, low-grade fever, malaise, and confusion. The patient is HIV-negative. O/E, neck rigidity and cranial nerve palsy are affecting the ocular nerves. Lumbar puncture shows elevated WBCs (mainly lymphocytes), high protein, and low glucose levels in the CSF. MRI reveals the following. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Waiting for CSF culture results before initiating treatment", "correct": false}, {"label": "B", "text": "Initiating empirical anti-tuberculosis therapy immediately", "correct": true}, {"label": "C", "text": "Starting broad-spectrum antibiotics for bacterial meningitis", "correct": false}, {"label": "D", "text": "Performing a brain biopsy for a definitive diagnosis", "correct": false}], "correct_answer": "B. Initiating empirical anti-tuberculosis therapy immediately", "question_images": ["https://image.prepladder.com/notes/w9EeYPFkTCltyoFsEjvY1744382809.png"], "explanation_images": ["https://image.prepladder.com/notes/w9EeYPFkTCltyoFsEjvY1744382809.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong><u>Symptoms and Clinical Features:</u></strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Headache</strong>, slight <strong>mental changes</strong>, and <strong>low-grade fever</strong> can develop over weeks, often accompanied by <strong>malaise</strong>, <strong>anorexia</strong>, and <strong>irritability</strong>.</li>\n<li>More severe cases present with <strong>confusion</strong>, <strong>lethargy</strong>, <strong>neck rigidity</strong>, and <strong>altered sensorium</strong>.</li>\n<li>Disease progression: evolves over 1–2 weeks, longer than bacterial meningitis.</li>\n<li><strong>Cranial nerve palsies</strong>, especially <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> nerves, are common due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> at the base of the brain.</li>\n<li>May result in <strong>coma</strong>, <strong>hydrocephalus</strong>, and <strong>intracranial hypertension</strong> if untreated.</li>\n<li><strong>Cerebral ischemia</strong> can result from the involvement of cerebral arteries.</li>\n<li><strong>Tuberculoma</strong> (space-occupying lesion) may cause seizures and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological signs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong><u>CSF Findings:</u></strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Elevated <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count</strong> (up to 1000/μL, predominantly lymphocytes).</li>\n<li><strong>High protein content</strong> (1–8 g/L).</li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> concentration</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong><u>Investigation of Choice:</u></strong></h4>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Culture of CSF</strong> (gold standard, takes 4–8 weeks, positive in ~50%).</li>\n<li><strong>Smear for <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB)</strong> (low sensitivity, positive in 10–40%).</li>\n<li><strong>PCR</strong> for <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> DNA (variable sensitivity).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong><u>Imaging:</u></strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT/MRI</strong> may show <strong>hydrocephalus</strong> and <strong>abnormal enhancement</strong> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns or ependyma.</li>\n<li><strong>Tuberculomas</strong> appear as contrast-enhanced ring lesions on imaging.</li>\n</ul>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"TB meningitis\" data-author=\"Morteza Sanei Taheri, Mohammad Ali Karimi, Hamidreza Haghighatkhah, Ramin Pourghorban, Mohammad Samadian, Hosein Delavar Kasmaei\" data-hash=\"9461\" data-license=\"Open access\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2015/202806\" data-tags=\"\" height=\"321\" src=\"https://image.prepladder.com/notes/w9EeYPFkTCltyoFsEjvY1744382809.png\" width=\"282\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>MRI showing ring-enhanced lesions -tuberculoma</strong><strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong><u>Treatment:</u></strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Empirical therapy</strong> is often initiated based on suspicion.</li>\n<li><strong>Initial drug regimen</strong>: isoniazid, rifampin, pyrazinamide, ethambutol, and pyridoxine.</li>\n<li><strong>Duration</strong>: 6–12 months depending on response.</li>\n<li><strong>Dexamethasone</strong> (12–16 mg/day) for 3 weeks, tapered for 3 more weeks (recommended for HIV-negative patients).</li>\n<li><strong>Tuberculoma</strong> may require a <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for diagnosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68 y/o immunocompromised patient with a history of CKD presents to the ER with fever, headache, and neck stiffness. Blood cultures are pending, and a lumbar puncture reveals elevated CSF protein, decreased glucose, and neutrophilic pleocytosis. Given the patient's age and comorbidities, which of the following is the most appropriate empirical antibiotic regimen?", "options": [{"label": "A", "text": "Ceftriaxone and Vancomycin", "correct": false}, {"label": "B", "text": "Ceftriaxone and Dexamethasone", "correct": false}, {"label": "C", "text": "Ampicillin, Ceftriaxone, and Vancomycin", "correct": true}, {"label": "D", "text": "Ceftazidime and Vancomycin", "correct": false}], "correct_answer": "C. Ampicillin, Ceftriaxone, and Vancomycin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Empiric Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Children &lt;3 Months of Age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ampicillin</strong>: To cover <em>Listeria monocytogenes</em></li>\n<li><strong>Cefotaxime or Ceftriaxone</strong>: To cover <em>S. pneumoniae</em>, <em>Group B streptococci</em>, <em>H. influenzae</em>, and <em>N. meningitidis</em></li>\n<li><strong>Gentamicin</strong>: May be added in critically ill patients for <span class=\"customMeta\" data-dictid=\"8bea728e5a16927771990878566a63\">synergy</span> against <em>Listeria monocytogenes</em></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Children &gt;3 Months to Adults (up to 55 years):</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ceftriaxone or Cefotaxime</strong>: Covers <em>S. pneumoniae</em>, <em>N. meningitidis</em>, <em>H. influenzae</em></li>\n<li><strong>Vancomycin</strong>: To cover cephalosporin-resistant <em>S. pneumoniae</em></li>\n<li><strong>Dexamethasone</strong>: To reduce meningeal inflammation</li>\n<li><strong>Acyclovir</strong>: Added if <span class=\"customMeta\" data-dictid=\"17df0c44e116927771897deca1bbf4\">HSV</span> <span class=\"customMeta\" data-dictid=\"9644652a1f16927771873765457fcc\">encephalitis</span> is suspected</li>\n<li><strong>Doxycycline</strong>: Added during <span class=\"customMeta\" data-dictid=\"63b7807cc41692777200fab227369f\">tick</span> season to cover tick-borne bacterial infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults &gt;55 Years or <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">Immunocompromised</span> Patients (including pregnancy, chronic illness, organ transplantation, malignancy, or <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> therapy):</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ampicillin</strong>: Added for <em>Listeria monocytogenes</em> coverage</li>\n<li><strong>Ceftriaxone or Cefotaxime</strong>: To cover <em>S. pneumoniae</em>, <em>N. meningitidis</em></li>\n<li><strong>Vancomycin</strong>: To cover resistant <em>S. pneumoniae</em></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patients with <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa Infection:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ceftazidime or Meropenem</strong>: For <em>Pseudomonas aeruginosa</em></li>\n<li><strong>Vancomycin</strong>: Added in case of suspected <em>Staphylococcal</em> infections</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o patient presents with fever, headache, neck stiffness, and photophobia. On examination, the patient is lethargic and lumbar puncture reveals elevated CSF opening pressure, PMN leukocytosis, decreased glucose levels, and increased protein concentration. Which clinical sign is most likely to be present in this patient?", "options": [{"label": "A", "text": "Kernig's sign", "correct": true}, {"label": "B", "text": "Tinel's sign", "correct": false}, {"label": "C", "text": "Positive Babinski sign", "correct": false}, {"label": "D", "text": "Positive Romberg sign", "correct": false}], "correct_answer": "A. Kernig's sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KUyePxJC6ql1FcVpD6wq1740608465.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Consciousness:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased level of consciousness occurs in &gt;75% of cases, ranging from <span class=\"customMeta\" data-dictid=\"7f737d5d2f1692777191ac675cbf29\">lethargy</span> to coma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kernig's Sign:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive when <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> extension of the knee elicits pain; indicative of meningeal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brudzinski's Sign:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive when <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of the neck results in <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of the hips and knees; also indicative of meningeal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pupils:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May present as dilated and poorly <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> due to increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure (ICP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posturing:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible <span class=\"customMeta\" data-dictid=\"b992edcc081692777186b24fecb86f\">decerebrate posturing</span> as a sign of severe <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> dysfunction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs of Increased ICP:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> opening pressure (&gt;180 mmH2O), papilledema, and potential cerebral <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> (1–8% incidence).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Symptoms:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nausea, vomiting, photophobia; seizures in 15–40% (focal or generalized).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningococcemia Rash:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythematous <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> that quickly becomes petechial, commonly on the trunk and lower extremities.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male with untreated HIV presents with headache, fever, nausea, vomiting, and confusion. His CD4+ count is 45/μL. O/E, there is neck stiffness and altered mental status. Lumbar puncture shows elevated opening pressure, low glucose, and encapsulated yeast on India ink staining. What is the most appropriate initial treatment?", "options": [{"label": "A", "text": "High-dose oral fluconazole", "correct": false}, {"label": "B", "text": "IV acyclovir", "correct": false}, {"label": "C", "text": "IV amphotericin B plus flucytosine", "correct": true}, {"label": "D", "text": "Oral corticosteroids plus broad-spectrum antibiotics", "correct": false}], "correct_answer": "C. IV amphotericin B plus flucytosine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/kaWcmYSb9G4UGqTULNyP1744385025.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">The leading <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> cause of <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> in AIDS patients is primarily due to <em>Cryptococcus neoformans</em> (C. neoformans); <em>C. gattii</em> accounts for up to 12%.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">Symptoms include fever, nausea, vomiting, altered mental status, headache, and meningeal signs.</li>\n<li style=\"text-align:center\">Low <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of seizures and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CSF Profile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">It may be normal or show modest elevations in <span class=\"customMeta\" data-dictid=\"09be7d1f11169277720210bf5b0280\">WBC</span> and protein levels.</li>\n<li style=\"text-align:center\">Decreased <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels may be observed.</li>\n<li style=\"text-align:center\">Elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> opening pressure is typical.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">Identification of organisms via India ink examination of CSF.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Cryptococcus India Ink Stain\" data-author=\"Beardsley, Justin &amp; Lam, Thanh &amp; Day, Jeremy\" data-hash=\"9466\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/ndia-ink-staining-of-a-Vietnamese-clinical-isolates-of-Cryptococcus-neoformans-var_fig2_275226761\" data-tags=\"\" height=\"268\" src=\"https://image.prepladder.com/notes/kaWcmYSb9G4UGqTULNyP1744385025.png\" width=\"356\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n<ul>\n<li style=\"text-align:center\">Detection of <span class=\"customMeta\" data-dictid=\"6bd3522c4516927771855962983e97\">cryptococcal</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> in <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> or blood.</li>\n<li style=\"text-align:center\">Blood cultures for <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> are often positive.</li>\n<li style=\"text-align:center\">The <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> may be necessary for diagnosing <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> <span class=\"customMeta\" data-dictid=\"3963c4741d1692777185554f5ff7c6\">cryptococcoma</span> and to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> it from immune <span class=\"customMeta\" data-dictid=\"13783dcacb1692777197d7062e0d6e\">reconstitution</span> syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Induction therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">IV <span class=\"customMeta\" data-dictid=\"2aca559df7169277718182de664e44\">amphotericin B</span> (0.7 mg/kg daily) or liposomal amphotericin (4–6 mg/kg daily) plus <span class=\"customMeta\" data-dictid=\"bb3e410d281692777202dc2b43aaf7\">flucytosine</span> (25 mg/kg qid) for at least 2 weeks.</li>\n<li style=\"text-align:center\">Monitor <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function to avoid <span class=\"customMeta\" data-dictid=\"bb3e410d281692777202dc2b43aaf7\">flucytosine</span> toxicity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Maintenance Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">Amphotericin should be continued until <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> culture is negative, followed by <span class=\"customMeta\" data-dictid=\"e3d616618b16927772022df400a411\">fluconazole</span> (400 mg/d PO for 8 weeks, then 200 mg/d) until CD4+ T-cell count &gt;200 cells/μL for 6 months.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 y/o HIV-positive patient with a CD4+ count of 50/μL presents with fever, headache, nausea, and altered mental status. A lumbar puncture is performed, and the cerebrospinal fluid (CSF) shows elevated opening pressure. A specific staining test and MRI of the brain reveal the following. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Tuberculous meningitis", "correct": false}, {"label": "B", "text": "Cryptococcal meningitis", "correct": true}, {"label": "C", "text": "Cytomegalovirus encephalitis", "correct": false}, {"label": "D", "text": "Toxoplasmosis", "correct": false}], "correct_answer": "B. Cryptococcal meningitis", "question_images": ["https://image.prepladder.com/notes/CSZraRDPISfLnZyOT6fg1744385226.png"], "explanation_images": ["https://image.prepladder.com/notes/kaWcmYSb9G4UGqTULNyP1744385025.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Staining </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Imaging</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ryptococcal &lt;span class=\" custommeta\"=\"\" data-dictid=\"7d8f74eaae16927771928214d10c17\"/>meningitis GMS stain\" data-author=\"Milman, Tatyana &amp; Mirani, Neena &amp; Turbin, Roger.\" data-hash=\"9471\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Budding-yeast-organisms-stain-with-Gomori-methenamine-silver-stain-A-GMS-stain-high_fig2_26730355\" data-tags=\"\" height=\"262\" src=\"https://image.prepladder.com/notes/0bml9xZFEGtT8JPvftVT1744385361.png\" width=\"343\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<figure class=\"caption_element\"><img alt=\"Cryptococcus India Ink Stain\" data-author=\"Milman, Tatyana &amp; Mirani, Neena &amp; Turbin, Roger.\" data-hash=\"9466\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Budding-yeast-organisms-stain-with-Gomori-methenamine-silver-stain-A-GMS-stain-high_fig2_26730355\" data-tags=\"\" height=\"218\" src=\"https://image.prepladder.com/notes/kaWcmYSb9G4UGqTULNyP1744385025.png\" width=\"290\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n<p style=\"text-align:center\"><strong>India ink <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> of <span class=\"customMeta\" data-dictid=\"df1857b4a6169277718597e7b3325d\">Cryptococcus</span> neoformans</strong></p>\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Cryptococcal &lt;span class=\" custommeta\"=\"\" data-dictid=\"7d8f74eaae16927771928214d10c17\"/>meningitis Gram Stain\" data-author=\"Scott, Keela &amp; Smith, Caitlyn &amp; Walker, Daniel &amp; Fender, Belinder. \" data-hash=\"9477\" data-license=\"Scott, Keela &amp; Smith, Caitlyn &amp; Walker, Daniel &amp; Fender, Belinder. \" data-source=\"Scott, Keela &amp; Smith, Caitlyn &amp; Walker, Daniel &amp; Fender, Belinder. \" data-tags=\"\" height=\"237\" src=\"https://image.prepladder.com/notes/6mrKIrI183p1A0oxfZeg1744385621.png\" width=\"311\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><br/>\n<br/>\n\t\t\t </p>\n<p style=\"text-align: center;\"><strong>Gram <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> of the <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> reveals clusters of thin-walled, <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> forms of various sizes with narrow-based <span class=\"customMeta\" data-dictid=\"38e3eb755216927771834bb7e72a61\">budding</span> consistent with Cryptococcus.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Cryptococcal &lt;span class=\" custommeta\"=\"\" data-dictid=\"7d8f74eaae16927771928214d10c17\"/>meningitis MRI\" data-author=\"Weerakkody Y, Sharma R, Kumar K\" data-hash=\"9469\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/cns-cryptococcosis-2\" data-tags=\"\" height=\"190\" src=\"https://image.prepladder.com/notes/CSZraRDPISfLnZyOT6fg1744385226.png\" width=\"169\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n\t\t\t \n\n\t\t\t<p><strong>MRI showing “Soap bubble appearance” of C.Neoformans</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34 y/o man with a history of HIV/AIDS presents to the ED with complaints of a severe headache, fever, and confusion. His CD4+ T-cell count is 150 cells/μL. Neurological examination reveals right-sided weakness and difficulty speaking. An MRI of the patient is given below. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Initiate treatment with sulfadiazine and pyrimethamine with leucovorin.", "correct": true}, {"label": "B", "text": "Perform a brain biopsy to confirm the diagnosis.", "correct": false}, {"label": "C", "text": "Order a chest X-ray to rule out tuberculosis.", "correct": false}, {"label": "D", "text": "Start empiric treatment for bacterial meningitis.", "correct": false}], "correct_answer": "A. Initiate treatment with sulfadiazine and pyrimethamine with leucovorin.", "question_images": ["https://image.prepladder.com/notes/crwdDBrNKXsdigysD1e91744385827.png"], "explanation_images": ["https://image.prepladder.com/notes/crwdDBrNKXsdigysD1e91744385827.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cerebral Toxoplasmosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Toxoplasmosis</strong> is a common secondary <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> infection in <strong>AIDS patients</strong>, but its <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> is decreasing due to ART.</li>\n<li style=\"text-align:center\">Occurs typically when <strong>CD4+ T-cell counts are &lt;200/μL</strong>.</li>\n<li style=\"text-align:center\">Often represents the <strong>reactivation</strong> of <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> <strong>T. gondii</strong> tissue cysts.</li>\n<li style=\"text-align:center\">Screening for <strong>IgG antibodies to T. gondii</strong> is recommended at <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> diagnosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Cerebral toxoplasmosis</strong> usually arises from <span class=\"customMeta\" data-dictid=\"eee52fe3cc16927771970c8dffdfd2\">reactivation</span> of <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> cysts.</li>\n<li style=\"text-align:center\">It is <strong>10 times more common</strong> in <span class=\"customMeta\" data-dictid=\"54c9b9047b1692777198623ba47972\">seropositive</span> patients than <span class=\"customMeta\" data-dictid=\"676cb5b15c16927771987d192e19d6\">seronegative</span> ones.</li>\n<li style=\"text-align:center\">Presents with <strong>fever, headache, and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits</strong> (e.g., seizures, hemiparesis, aphasia).</li>\n<li style=\"text-align:center\"><strong>Cerebral oedema</strong> may cause <strong>confusion, dementia, lethargy</strong>, and progressing to coma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>MRI</strong> typically shows <strong>multiple lesions with ring enhancement</strong> and <strong>surrounding oedema</strong>.</li>\n<li style=\"text-align:center\">If <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> is unavailable, <strong>double-dose contrast CT</strong> may be used.</li>\n<li style=\"text-align:center\"><strong>Brain biopsy</strong> is <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> but reserved for patients who fail <strong>2-4 weeks of <span class=\"customMeta\" data-dictid=\"f6a1e7d76a16927771874857c00281\">empiric</span> therapy</strong>. <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">Standard treatment: <strong>sulfadiazine + pyrimethamine</strong> with <strong>leucovorin</strong> for 4-6 weeks.</li>\n<li style=\"text-align:center\">Alternatives: <strong>clindamycin + pyrimethamine</strong>, <strong>atovaquone + pyrimethamine</strong>, or <strong>azithromycin + <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">pyrimethamine</span> + rifabutin</strong>.</li>\n<li style=\"text-align:center\"><strong>Relapses are common</strong>; maintenance therapy (sulfadiazine, pyrimethamine, leucovorin) is recommended if <strong>CD4+ T-cell counts &lt;200/μL</strong>.</li>\n<li style=\"text-align:center\"><strong>Primary prophylaxis</strong>: <strong>TMP-SMX</strong> in patients with <strong>CD4+ &lt;100μL</strong> and <strong>T. gondii IgG</strong>.\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"Cerebral Toxoplasmosis\" data-author=\"Jha P, Chieng R,\" data-hash=\"9480\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/neurotoxoplasmosis\" data-tags=\"\" height=\"318\" src=\"https://image.prepladder.com/notes/crwdDBrNKXsdigysD1e91744385827.png\" width=\"288\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n<li style=\"text-align:center\"><strong>Secondary prophylaxis/maintenance</strong> may be discontinued if <strong>CD4+ counts &gt;200/μL for 6 months</strong> under effective ART.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42 y/o woman with a history of HIV/AIDS presents to the neurology clinic with progressive weakness in her right arm and difficulty walking over the past month. She also reports occasional blurred vision and trouble speaking. Her CD4+ T-cell count is 80 cells/μL, and her current ART has been suboptimal. An MRI of the patient is given below. Which of the following findings would be most indicative of the condition affecting this patient?", "options": [{"label": "A", "text": "Presence of JC virus DNA in the CSF.", "correct": true}, {"label": "B", "text": "Multiple enhancing lesions on MRI.", "correct": false}, {"label": "C", "text": "Significant headache and fever.", "correct": false}, {"label": "D", "text": "Rapid improvement of symptoms after starting a new ART regimen.", "correct": false}], "correct_answer": "A. Presence of JC virus DNA in the CSF.", "question_images": ["https://image.prepladder.com/notes/K20VecgC3gIQE4LOGXHE1744386955.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Progressive <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> leukoencephalopathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Progressive <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> <span class=\"customMeta\" data-dictid=\"4bedf4cd6916927771914575b6a4b5\">leukoencephalopathy</span> (PML)</strong> is a serious <span class=\"customMeta\" data-dictid=\"5204097a961692777194904909b6fe\">opportunistic</span> <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> infection in <strong>AIDS</strong> patients, caused by the <strong>JC virus</strong>.</li>\n<li style=\"text-align:center\"><strong>JC virus</strong> is a <strong>human polyomavirus</strong>; around <strong>80%</strong> of adults have antibodies to it, but less than <strong>10%</strong> of healthy adults show ongoing replication.</li>\n<li style=\"text-align:center\">PML is the only known clinical disease caused by the JC virus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>PML lesions</strong> start as small <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> of <strong>demyelination</strong> in the <strong>subcortical white matter</strong>, eventually coalescing.</li>\n<li style=\"text-align:center\">The <strong>cerebral hemispheres, cerebellum</strong>, and <strong>brainstem</strong> can be involved.</li>\n<li style=\"text-align:center\">Neurological deficits are <strong>multifocal</strong> and often <strong>protracted</strong>. Symptoms include <strong>ataxia, hemiparesis, visual defects, aphasia</strong>, and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> deficits.</li>\n<li style=\"text-align:center\"><strong>Seizures</strong> occur in ~20% of patients.</li>\n<li style=\"text-align:center\"><strong>Headache, fever, nausea, and vomiting</strong> are uncommon and suggest other diagnoses. <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>MRI</strong> shows <strong>multiple, non-enhancing <span class=\"customMeta\" data-dictid=\"faffdfe705169277720242bf7ee9b5\">white matter</span> lesions</strong>, particularly in the <strong>occipital and <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> lobes</strong>. <strong>(Option B ruled out)</strong></li>\n<li style=\"text-align:center\">Lesions appear <strong>hyperintense</strong> on <strong>T2-weighted images</strong> and <strong>hypointense</strong> on <strong>T1-weighted images</strong>.</li>\n<li style=\"text-align:center\"><strong>JC virus DNA in CSF</strong> has a <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> sensitivity of <strong>76%</strong> and <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> close to <strong>100%</strong>.\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"Progressive &lt;span class=\" custommeta\"=\"\" data-dictid=\"225e0697ea1692777193892a2c34c7\"/>Multifocal Leucoencephalopathy\" data-author=\"Radswiki T, Sharma R, Nassar I\" data-hash=\"9504\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/progressive-multifocal-leukoencephalopathy\" data-tags=\"\" height=\"346\" src=\"https://image.prepladder.com/notes/6rE8Mi2loxH9wAD48Epv1744387259.png\" width=\"298\" /&gt;\n\t\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">No <span class=\"customMeta\" data-dictid=\"a4a589776216927771991b881f95b1\">specific treatment</span> exists for PML, but <strong>ART</strong> has improved survival rates, with some patients surviving <strong>&gt;15 years</strong>.</li>\n<li style=\"text-align:center\">Before ART, <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> survival was <strong>3-6 months</strong>.</li>\n<li style=\"text-align:center\"><strong>ART</strong> can cause <strong>paradoxical worsening</strong> due to immune <span class=\"customMeta\" data-dictid=\"13783dcacb1692777197d7062e0d6e\">reconstitution</span> syndrome (IRIS). <strong>(Option D ruled out)</strong></li>\n<li style=\"text-align:center\">Only <strong>~50%</strong> of patients show <strong>neurological improvement</strong> with ART.</li>\n<li style=\"text-align:center\">A <strong>CD4+ T-cell count &gt;100/μL</strong> and maintaining an <strong>HIV <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> load &lt;500 copies/mL</strong> are associated with a favourable prognosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman is suspected of having myasthenia gravis. The neurologist decides to perform the Tensilon test using edrophonium bromide. Which of the following statements is TRUE regarding the Tensilon test?", "options": [{"label": "A", "text": "The effects of the test last for about 10 minutes", "correct": false}, {"label": "B", "text": "It is a highly specific and sensitive test for myasthenia gravis", "correct": false}, {"label": "C", "text": "Muscle function typically improves within 30 seconds of injection", "correct": true}, {"label": "D", "text": "Intravenous atropine is unnecessary during the procedure", "correct": false}], "correct_answer": "C. Muscle function typically improves within 30 seconds of injection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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She is diagnosed with bilateral optic neuritis secondary to neuromyelitis optica (NMO). Which of the following is not a typical feature of bilateral optic neuritis in NMO?", "options": [{"label": "A", "text": "Eye pain, especially with eye movement", "correct": false}, {"label": "B", "text": "Central or paracentral scotomas", "correct": false}, {"label": "C", "text": "Unilateral involvement of the optic nerve", "correct": true}, {"label": "D", "text": "Decreased visual acuity", "correct": false}], "correct_answer": "C. Unilateral involvement of the optic nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:454px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Domain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Numbness, tingling, or cold sensations in limbs</p>\n<p>Often progresses proximally (up to the trunk)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness, stiffness, or heaviness in limbs (mostly legs)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sphincters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urgency or difficulty in urination</p>\n<p>This can lead to <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:479px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vision Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Partial or complete loss in one or both eyes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">Acuity</span> Decrease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blurry or <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> sharpness of vision <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reduced Color Perception</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diminished ability to see colours accurately</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Atrophy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pale <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc due to nerve <span class=\"customMeta\" data-dictid=\"3ace01719a1692777202ddafcebbc4\">fibre</span> loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Afferent Pupillary Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delayed <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> response in the affected eye</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain with Eye Movement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eye pain, especially with <span class=\"customMeta\" data-dictid=\"01f54c5c291692777184570c298c6d\">central vision</span> loss <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scotoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Central or <span class=\"customMeta\" data-dictid=\"fcf447f5781692777194d3d1d4e7e5\">paracentral</span> blind spots in vision <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with asymmetric muscle weakness in the arms and legs. Nerve conduction studies reveal focal demyelination with conduction block. Which of the following conditions is most likely indicated by these findings?", "options": [{"label": "A", "text": "Amyotrophic Lateral Sclerosis (ALS)", "correct": false}, {"label": "B", "text": "Multifocal Motor Neuropathy with Conduction Block (MMN)", "correct": true}, {"label": "C", "text": "Diabetic Polyneuropathy", "correct": false}, {"label": "D", "text": "Charcot-Marie-Tooth Disease", "correct": false}], "correct_answer": "B. Multifocal Motor Neuropathy with Conduction Block (MMN)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MMN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ALS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> Studies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shows <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> with/without <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> block</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> and motor <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> studies; may show <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> motor <span class=\"customMeta\" data-dictid=\"1313ac90ca16927771807502911c57\">action potential</span> amplitude</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness in specific muscles; asymmetrical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progressive muscle weakness; can be <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> or asymmetrical</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Potential Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Axonal <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">Multifocal</span> Neuropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasculitis (systemic or non-systemic)</li>\n<li>Diabetes mellitus</li>\n<li>Sarcoidosis</li>\n<li>Infections (HIV, <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> C, Lyme disease, leprosy, diphtheria)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Demyelinating <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">Multifocal</span> Neuropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multifocal motor neuropathy</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> neuropathies</li>\n<li>Multifocal <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> demyelinating <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> and motor <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> (MADSAM)</li>\n<li>Hereditary <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> with a <span class=\"customMeta\" data-dictid=\"6fc754288b1692777196b7664d3a9a\">predisposition</span> to pressure palsy</li>\n<li>Lymphoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child diagnosed with Spinal Muscular Atrophy (SMA), which of the following symptoms is not typically associated with SMA?", "options": [{"label": "A", "text": "Muscle weakness in distal limbs", "correct": true}, {"label": "B", "text": "Scoliosis", "correct": false}, {"label": "C", "text": "Joint contractures", "correct": false}, {"label": "D", "text": "Respiratory infections", "correct": false}], "correct_answer": "A. Muscle weakness in distal limbs", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thorough medical history, physical examination, and neurological assessment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Genetic Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood tests identify mutations in the SMN1 gene, detecting ~95% of SMA cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Electromyography (EMG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses muscle and nerve function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> Studies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates the <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> of muscles and nerves.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Supportive Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aims to optimise quality of life; includes:</p>\n<ul>\n<li>Physical therapy</li>\n<li>Nutritional support</li>\n<li>Respiratory care</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>FDA-Approved Treatments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nusinersen (Spinraza):</strong></p>\n<ul>\n<li><strong>Increases SMN protein production</strong> by<strong> modifying <span class=\"customMeta\" data-dictid=\"5948ed9b541692777199d94749e06a\">splicing</span> of the SMN2 gene.</strong></li>\n<li>Significant<strong> improvements in motor function for SMA types I, II, and III.</strong></li>\n<li>Other emerging therapies are under investigation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onasemnogene Abeparvovec (</strong><strong>Zolgensma):</strong></p>\n<ul>\n<li>It is a gene therapy that<strong> delivers a functional copy of the SMN1 gene to motor neurons,</strong> enabling the production of the SMN protein.</li>\n<li>It is approved for<strong> children under 2 years with SMA.</strong></li>\n<li>This treatment has been shown to enhance muscle movement, function, and overall survival.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risdiplam (Evrysdi)</strong></p>\n<ul>\n<li>It is an <strong>oral medication</strong> that <strong>increases the production of SMN protein </strong>in the body.</li>\n<li>It is approved for the treatment of SMA in <strong>adults and children aged 2 months and older</strong>.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old woman with Amyotrophic Lateral Sclerosis (ALS) is experiencing significant difficulty swallowing and has been advised to consider a feeding intervention. Which treatment option is most appropriate for enhancing her quality of life and potentially extending survival?", "options": [{"label": "A", "text": "Riluzole", "correct": false}, {"label": "B", "text": "Highly selective vagotomy", "correct": false}, {"label": "C", "text": "Percutaneous Gastrostomy (PEG)", "correct": true}, {"label": "D", "text": "Palliative Care", "correct": false}], "correct_answer": "C. Percutaneous Gastrostomy (PEG)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Riluzole </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glutamate release antagonist.</li>\n<li>Prolongs <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> survival by 2–3 months.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Significantly prolongs survival and improves quality of life.</li>\n<li>Best for those with better <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> function.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Percutaneous <span class=\"customMeta\" data-dictid=\"544c039e7e1692777188f951bd6895\">Gastrostomy</span> (PEG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Enhances quality of life and may extend survival.</li>\n<li>Effective even in later disease stages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Multidisciplinary Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves a team of specialists:</li>\n<li>Physiotherapists, speech and occupational therapists, dietitians, neurologists, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> specialists, and <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> care teams.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman presents with muscle weakness, fasciculations, and difficulty swallowing. Electromyography (EMG) shows evidence of widespread denervation and reinnervation. Which of the following tests is least useful in diagnosing Amyotrophic Lateral Sclerosis (ALS)?", "options": [{"label": "A", "text": "Electromyography (EMG)", "correct": false}, {"label": "B", "text": "Genetic testing", "correct": false}, {"label": "C", "text": "Spinal fluid analysis", "correct": true}, {"label": "D", "text": "Nerve conduction studies", "correct": false}], "correct_answer": "C. Spinal fluid analysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old woman presents with muscle weakness in her hands and frequent cramping in her legs. She also reports difficulty swallowing and slurred speech. O/E, she has muscle wasting, fasciculations in her arms, and increased muscle tone. Which of the following signs or symptoms is not typically associated with Amyotrophic Lateral Sclerosis (ALS)?", "options": [{"label": "A", "text": "Fasciculations", "correct": false}, {"label": "B", "text": "Dysphagia", "correct": false}, {"label": "C", "text": "Sensory loss", "correct": true}, {"label": "D", "text": "Muscle wasting", "correct": false}], "correct_answer": "C. Sensory loss", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Amyotrophic <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">Sclerosis</span> (ALS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common; combined upper and lower <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> signs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> Atrophy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly lower <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Sclerosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily affects upper motor neurons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">Bulbar</span> Palsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early involvement of tongue, palate, and pharyngeal muscles (dysarthria, dysphagia)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with progressive weakness in his limbs, accompanied by muscle wasting and dysarthria. Neurological examination reveals both upper and lower motor neuron signs. Based on the clinical features, which of the following conditions is the most likely diagnosis?", "options": [{"label": "A", "text": "Progressive Muscular Atrophy", "correct": false}, {"label": "B", "text": "Progressive Lateral Sclerosis", "correct": false}, {"label": "C", "text": "Amyotrophic Lateral Sclerosis", "correct": true}, {"label": "D", "text": "Progressive Bulbar Palsy", "correct": false}], "correct_answer": "C. Amyotrophic Lateral Sclerosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of MND</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor <span class=\"customMeta\" data-dictid=\"17d10546871692777193f302d45980\">Neuron</span> Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amyotrophic <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Sclerosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both <strong>upper and lower motor</strong> neurons</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of MND.</strong></p>\n<p>Weakness and muscle wasting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">Atrophy</span> </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predominantly lower motor</strong> neurons</p>\n<p>Described as a \"<strong>pure lower motor neuron</strong>\" variant.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness and <span class=\"customMeta\" data-dictid=\"9971eacaaf1692777202d2ece15a2a\">wasting</span> of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> limb muscles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">Sclerosis</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primarily upper motor</strong> neurons</p>\n<p>Characterized as a \"<strong>pure upper motor neuron</strong>\" variant.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spasticity, few lower <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> signs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">Bulbar</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">Palsy</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early involvement of <strong>cranial nerves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysarthria, dysphagia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A genetic study of a family with a history of Amyotrophic Lateral Sclerosis (ALS) reveals a mutation in the SOD1 gene. Which of the following statements about this mutation is correct?", "options": [{"label": "A", "text": "SOD1 mutations account for approximately 50% of all familial ALS cases", "correct": false}, {"label": "B", "text": "The SOD1 gene is responsible for the majority of sporadic ALS cases", "correct": false}, {"label": "C", "text": "Mutations in the SOD1 gene are linked to oxidative stress in motor neurons", "correct": true}, {"label": "D", "text": "SOD1 is linked to MND and frontotemporal dementia.", "correct": false}], "correct_answer": "C. Mutations in the SOD1 gene are linked to oxidative stress in motor neurons", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Mutations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormalities in the <strong>SOD1 gene</strong> account for ~20% of <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> <span class=\"customMeta\" data-dictid=\"bcbb4d995e1692777181cfd5d50680\">ALS</span> cases. <strong>(Option A ruled out)</strong></p>\n<p><strong>C9orf72 gene</strong> is <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to MND and <span class=\"customMeta\" data-dictid=\"d57a339d6116927772031e53a22701\">frontotemporal</span> dementia. <strong>(Option D ruled out)</strong></p>\n<p><strong>Importance of Testing</strong>: Genetic tests for SOD1, FUS, TARDBP, and C9orf72 help assess disease risk in families.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental Toxins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potential role of toxins in neurodegenerative diseases like ALS, though no <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> environmental <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> has been identified.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The precise cause of <span class=\"customMeta\" data-dictid=\"a325d0c14e16927771992fe8a96758\">sporadic</span> <span class=\"customMeta\" data-dictid=\"bcbb4d995e1692777181cfd5d50680\">ALS</span> is still unknown. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuron Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progressive <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of upper and lower motor neurons in the brain and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protein Inclusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The presence of protein aggregates may contribute to <span class=\"customMeta\" data-dictid=\"bcbb4d995e1692777181cfd5d50680\">ALS</span> pathogenesis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with acute vision loss and limb weakness. She is diagnosed with Neuromyelitis Optica Spectrum Disorder (NMOSD). Which of the following treatments is most commonly used to manage acute attacks of NMOSD?", "options": [{"label": "A", "text": "Azathioprine", "correct": false}, {"label": "B", "text": "Plasmapheresis", "correct": true}, {"label": "C", "text": "Cyclophosphamide", "correct": false}, {"label": "D", "text": "Monoclonal antibodies", "correct": false}], "correct_answer": "B. Plasmapheresis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monoclonal Antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Targeted therapies block specific immune components involved in NMOSD. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complement Inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medications that target the <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> system to reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and damage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female experiences bilateral vision loss and lower limb weakness. MRI of the spinal cord shows lesions spanning more than three segments. What is the most specific test for diagnosing Neuromyelitis Optica Spectrum Disorder (NMOSD)?", "options": [{"label": "A", "text": "Presence of oligoclonal bands in CSF", "correct": false}, {"label": "B", "text": "AQP4-IgG antibody testing", "correct": true}, {"label": "C", "text": "Evoked potential studies", "correct": false}, {"label": "D", "text": "Brain MRI findings", "correct": false}], "correct_answer": "B. AQP4-IgG antibody testing", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Key for visualizing brain and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord lesions, ruling out other causes.</p>\n<p><strong>Brain MRI:</strong> Can show high-signal lesions, typically in <span class=\"customMeta\" data-dictid=\"a71c8cfa8216927771955861218d80\">periventricular</span> areas. <strong>(Option D ruled out)</strong></p>\n<p><strong>Spinal MRI:</strong> Reveals lesions over three <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> segments, distinguishing NMOSD from MS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cerebrospinal Fluid (CSF) Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lumbar <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> to assess <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and rule out other conditions.</p>\n<p><strong>Pleocytosis:</strong> Increased lymphocytes may be observed.</p>\n<p><strong>Oligoclonal Bands:</strong> Less common in NMOSD compared to MS. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Evoked Potentials</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It measures the brain's <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> in response to stimuli; it is less used with <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> advancement. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exclusion Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rule out infections, vitamin B12 deficiency, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> via blood tests.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A medicine resident describes a typical case of a 35-year-old woman who began experiencing intermittent visual disturbances, with painful eye movement and muscle weakness. After an MRI showed lesions in her brain, the diagnosis of multiple sclerosis was confirmed. He explains that these lesions occur because certain cells cross the blood-brain barrier and mistakenly attack the myelin around the nerves in the central nervous system. Which cells is he describing?", "options": [{"label": "A", "text": "Oligodendrocytes", "correct": false}, {"label": "B", "text": "T lymphocytes", "correct": true}, {"label": "C", "text": "Microglia", "correct": false}, {"label": "D", "text": "Astrocyte cells", "correct": false}], "correct_answer": "B. T lymphocytes", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/nx9TwV8P7PQSqSZqF5JL1744388867.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old Asian woman presents to the emergency department with sudden bilateral vision changes and progressive weakness in her limbs. She has also experienced severe headaches and persistent nausea over the past week. Laboratory tests reveal positive IgG antibodies against aquaporin-4. Which of the following best describes the pathophysiological process occurring in her condition?", "options": [{"label": "A", "text": "Anti-AQP4 antibodies directly kill neurons", "correct": false}, {"label": "B", "text": "Anti-AQP4 antibodies cause astrocyte damage via complement activation", "correct": true}, {"label": "C", "text": "AQP4 antibodies block oligodendrocyte function", "correct": false}, {"label": "D", "text": "AQP4 antibodies create a toxic cerebrospinal fluid environment", "correct": false}], "correct_answer": "B. Anti-AQP4 antibodies cause astrocyte damage via complement activation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29-year-old African woman presents with a sudden onset of blurred vision in both eyes and weakness in her arms and legs. She reports a recent episode of severe headaches and nausea. Neurological examination reveals significant visual impairment and marked upper and lower extremity weakness. Serum testing shows the presence of IgG antibodies against aquaporin-4. Where are the aquaporin-4 antibodies primarily concentrated in the central nervous system?", "options": [{"label": "A", "text": "Area postrema", "correct": false}, {"label": "B", "text": "Spinal cord", "correct": false}, {"label": "C", "text": "Circumventricular areas", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Aspect Details</li><li>↳ Aspect</li><li>↳ Aspect</li><li>↳ Aspect</li><li>↳ Details</li><li>↳ Details</li><li>↳ Details</li><li>↳ Autoantibody IgG antibodies against aquaporin-4 (AQP4)</li><li>↳ Autoantibody</li><li>↳ Autoantibody</li><li>↳ Autoantibody</li><li>↳ IgG antibodies against aquaporin-4 (AQP4)</li><li>↳ IgG antibodies against aquaporin-4 (AQP4)</li><li>↳ IgG antibodies against aquaporin-4 (AQP4)</li><li>↳ Prevalence Present in 60% to 90% of NMOSD patients</li><li>↳ Prevalence</li><li>↳ Prevalence</li><li>↳ Prevalence</li><li>↳ Present in 60% to 90% of NMOSD patients</li><li>↳ Present in 60% to 90% of NMOSD patients</li><li>↳ Present in 60% to 90% of NMOSD patients</li><li>↳ Specificity 90%</li><li>↳ Specificity</li><li>↳ Specificity</li><li>↳ Specificity</li><li>↳ 90%</li><li>↳ 90%</li><li>↳ 90%</li><li>↳ Sensitivity 70% to 90%</li><li>↳ Sensitivity</li><li>↳ Sensitivity</li><li>↳ Sensitivity</li><li>↳ 70% to 90%</li><li>↳ 70% to 90%</li><li>↳ 70% to 90%</li><li>↳ AQP4 function Transmembrane water channel on astrocyte foot processes</li><li>↳ AQP4 function</li><li>↳ AQP4 function</li><li>↳ AQP4 function</li><li>↳ Transmembrane water channel on astrocyte foot processes</li><li>↳ Transmembrane water channel on astrocyte foot processes</li><li>↳ Transmembrane water channel on astrocyte foot processes</li><li>↳ Concentration Areas Optic nerve Spinal cord Area postrema Circumventricular areas (e.g., periaqueductal gray matter)</li><li>↳ Concentration Areas</li><li>↳ Concentration Areas</li><li>↳ Concentration Areas</li><li>↳ Optic nerve Spinal cord Area postrema Circumventricular areas (e.g., periaqueductal gray matter)</li><li>↳ Optic nerve Spinal cord Area postrema Circumventricular areas (e.g., periaqueductal gray matter)</li><li>↳ Optic nerve</li><li>↳ Spinal cord</li><li>↳ Area postrema</li><li>↳ Circumventricular areas (e.g., periaqueductal gray matter)</li><li>↳ Role in NMOSD Autoimmune demyelinating astrocytopathy</li><li>↳ Role in NMOSD</li><li>↳ Role in NMOSD</li><li>↳ Role in NMOSD</li><li>↳ Autoimmune demyelinating astrocytopathy</li><li>↳ Autoimmune demyelinating astrocytopathy</li><li>↳ Autoimmune demyelinating astrocytopathy</li><li>↳ Mechanism of Action AQP4-IgG mediates perivascular lymphocytic infiltration</li><li>↳ Mechanism of Action</li><li>↳ Mechanism of Action</li><li>↳ Mechanism of Action</li><li>↳ AQP4-IgG mediates perivascular lymphocytic infiltration</li><li>↳ AQP4-IgG mediates perivascular lymphocytic infiltration</li><li>↳ AQP4-IgG mediates perivascular lymphocytic infiltration</li><li>↳ Outcome Leads to axonal loss with a preference for areas rich in AQP4</li><li>↳ Outcome</li><li>↳ Outcome</li><li>↳ Outcome</li><li>↳ Leads to axonal loss with a preference for areas rich in AQP4</li><li>↳ Leads to axonal loss with a preference for areas rich in AQP4</li><li>↳ Leads to axonal loss with a preference for areas rich in AQP4</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autoantibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>IgG antibodies against aquaporin-4 (AQP4)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Present in 60% to 90% of NMOSD patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Specificity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>90%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sensitivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>70% to 90%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>AQP4 function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Transmembrane <span class=\"customMeta\" data-dictid=\"2860fb05a316927772020985f74bf7\">water channel</span> on <span class=\"customMeta\" data-dictid=\"2f9ce365c11692777182e657d6ad5d\">astrocyte</span> foot processes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Concentration Areas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Optic nerve</li>\n<li>Spinal cord</li>\n<li>Area postrema</li>\n<li>Circumventricular areas (e.g., <span class=\"customMeta\" data-dictid=\"c51baf41771692777195b4b3432d4b\">periaqueductal</span> gray matter)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Role in NMOSD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Autoimmune demyelinating astrocytopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>AQP4-IgG mediates <span class=\"customMeta\" data-dictid=\"a606b55b4316927771956c3cb0d383\">perivascular</span> lymphocytic infiltration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Outcome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Leads to axonal loss with a preference for areas rich in AQP4</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old African woman presents with four months of progressive bilateral visual loss and temporal headaches. Neurological examination reveals flaccid paraplegia and sensory loss below T4. Serum testing shows the presence of aquaporin-4 antibodies. Which of the following MRI findings is incorrect for this condition?", "options": [{"label": "A", "text": "Longitudinally extensive lesions in the spinal cord are found with ≥3 vertebral segments.", "correct": false}, {"label": "B", "text": "Optic nerve lesions are typically short and localized.", "correct": true}, {"label": "C", "text": "Brain MRI may show peri-ependymal lesions around the ventricular system", "correct": false}, {"label": "D", "text": "Normal-appearing tissue is limited to lesional tracts and associated cortex.", "correct": false}], "correct_answer": "B. Optic nerve lesions are typically short and localized.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/RlAo8Sb3VkcGGlJqUDyH1744330040.png", "https://image.prepladder.com/notes/GUdLuvBEijHSpE7UKDzD1744330177.png", "https://image.prepladder.com/notes/ZecqeGTKYTMl0xtvBvFm1744330279.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spinal Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Longitudinally extensive lesions (≥3 vertebral segments)<strong> (Option A)</strong></li>\n<li>Central/gray matter involvement</li>\n<li>T1 hypointensity in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> lesions</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Spinal cord MRI NMO\" data-author=\"Nasrin Asgari, Hanne Pernille Bro Skejoe, Soeren Thue Lillevang, Troels Steenstrup, Egon Stenager &amp; Kirsten Ohm Kyvik \" data-hash=\"9006\" data-license=\"CC BY\" data-source=\"https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-13-33#rightslink\" data-tags=\"\" height=\"315\" src=\"https://image.prepladder.com/notes/RlAo8Sb3VkcGGlJqUDyH1744330040.png\" width=\"189\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Long-length</strong>/posterior-chiasmal lesions.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Optic nerve MRI NMO\" data-author=\"Jessica A. Kraker, John Chen\" data-hash=\"9008\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Neuromyelitis-optica-spectrum-disorder-NMOSD-Magnetic-resonance-imaging-MRI-showing_fig1_372937891\" data-tags=\"\" height=\"243\" src=\"https://image.prepladder.com/notes/GUdLuvBEijHSpE7UKDzD1744330177.png\" width=\"252\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Brain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Periependymal lesions around the <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> system <strong>(Option C)</strong></li>\n<li>Hemispheric tumefactive lesions</li>\n<li>Cloud-like enhancing lesions.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"MRI Brain NMO\" data-author=\"I. K. Sand\" data-hash=\"9010\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Neuromyelitis-Optica-Spectrum-Disorders.-Sand/d0c7236f3e84ae3009ec6abc510031390292645f\" data-tags=\"\" height=\"271\" src=\"https://image.prepladder.com/notes/ZecqeGTKYTMl0xtvBvFm1744330279.png\" width=\"245\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Normal-appearing tissue involvement is limited to lesional tracts and associated <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> <strong>(Option D)</strong></li>\n<li>Reduced lesional myo-inositol on MRS.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 36-year-old Caucasian woman presents with a history of limb weakness, gait unsteadiness, and paresthesias. She experiences an electric shock sensation that radiates down her spine when flexing her neck. An MRI of the brain is given below. What is the most appropriate treatment for this patient’s condition?", "options": [{"label": "A", "text": "High-dose IV corticosteroids", "correct": true}, {"label": "B", "text": "Oral dimethyl fumarate", "correct": false}, {"label": "C", "text": "Ocrelizumab", "correct": false}, {"label": "D", "text": "Baclofen", "correct": false}], "correct_answer": "A. High-dose IV corticosteroids", "question_images": ["https://image.prepladder.com/notes/3KWaVhH3oCjPChihpDfP1744329829.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:692px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Interventions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute Exacerbations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>High-dose IV corticosteroids\n\t\t\t\t<ul>\n<li>first-line treatment for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> flares<strong> (Option A)</strong></li>\n</ul>\n</li>\n<li>Plasma exchange\n\t\t\t\t<ul>\n<li>for patients who do not respond to corticosteroids.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Disease-Modifying Therapies </strong><strong>(Option B, C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Natalizumab and Ocrelizumab are<strong> highly effective</strong> for patients who haven’t responded to other therapies.\n\t\t\t\t<ul>\n<li>Natalizumab: blocks <span class=\"customMeta\" data-dictid=\"03f1cf44de16927771903f3806de84\">integrin</span> α4, preventing <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> <span class=\"customMeta\" data-dictid=\"2b1931a185169277718065e3fa42dd\">adhesion</span> to endothelial cells.\n\t\t\t\t\t<ul>\n<li>It has a risk of PML</li>\n</ul>\n</li>\n<li>Ocrelizumab: targets and depletes CD20-positive B cells.</li>\n</ul>\n</li>\n<li>Patients with less active disease may be started on oral medications like Dimethyl <span class=\"customMeta\" data-dictid=\"0063169a1b1692777203ba89eb2363\">fumarate</span> or Fingolimod (sphingosine-1-phosphate modulator)</li>\n<li>β-interferon and Glatiramer have the highest safety profiles but lower effectiveness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptomatic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Baclofen\n\t\t\t\t<ul>\n<li>used for spasticity<strong> (Option D)</strong></li>\n</ul>\n</li>\n<li>Cholinergic\n\t\t\t\t<ul>\n<li>for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention</li>\n</ul>\n</li>\n<li>Anticholinergics\n\t\t\t\t<ul>\n<li>for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> incontinence</li>\n</ul>\n</li>\n<li>Carbamazepine, amitriptyline\n\t\t\t\t<ul>\n<li>for painful paresthesias</li>\n</ul>\n</li>\n<li>Antidepressants</li>\n<li>Neurogenic <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> treatments\n\t\t\t\t<ul>\n<li>Catheterization, <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> antagonists, <span class=\"customMeta\" data-dictid=\"3cb8b8422c16927771836b57b4c79e\">botulinum toxin</span> injection</li>\n</ul>\n</li>\n<li>Spasticity treatments (GABA B <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> agonists)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with a 2-day history of acute, painful vision loss in her left eye, associated with a dull ache that worsens with eye movement. She also reports episodes of leg weakness, difficulty maintaining balance, and tingling sensations in her arms. Her medical history includes recurrent episodes of blurred vision and fatigue, particularly worsening in warm conditions. What is the diagnostic test of choice for this condition?", "options": [{"label": "A", "text": "Visual evoked potential", "correct": false}, {"label": "B", "text": "Lumbar puncture", "correct": false}, {"label": "C", "text": "MRI of the brain and spinal cord", "correct": true}, {"label": "D", "text": "Blood test for oligoclonal bands", "correct": false}], "correct_answer": "C. MRI of the brain and spinal cord", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fEWgVIvwtOVGPIVEhzjT1740605676.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Imaging <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> of choice for MS</li>\n<li>Shows multiple asymmetric, <span class=\"customMeta\" data-dictid=\"a71c8cfa8216927771955861218d80\">periventricular</span> <span class=\"customMeta\" data-dictid=\"faffdfe705169277720242bf7ee9b5\">white matter</span> lesions (Dawson fingers)</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"256\" src=\"https://image.prepladder.com/content/fEWgVIvwtOVGPIVEhzjT1740605676.png\" width=\"319\"/></p>\n<p style=\"text-align: center;\"><strong>Red arrowheads <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as Dawson fingers</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Active lesions enhanced with <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">gadolinium</span> due to increased <span class=\"customMeta\" data-dictid=\"fe1a980b121692777182f88db01254\">BBB</span> permeability</li>\n<li>Presence of plaques and black holes (T1-weighted)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Visual Evoked Potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Assesses <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve damage <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CSF Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>↑IgG index indicates <span class=\"customMeta\" data-dictid=\"02d3150bf71692777190d8129891c2\">intrathecal</span> synthesis</li>\n<li>Agarose electrophoresis: &gt; 2 <span class=\"customMeta\" data-dictid=\"754705a861169277719425d87c6742\">oligoclonal</span> bands (not found in serum)</li>\n</ul>\n<p><strong>(Option D)</strong></p>\n<ul>\n<li>Lumbar puncture:\n\t\t\t\t<ul>\n<li>can provide supportive evidence <strong>(Option B)</strong></li>\n<li>&gt; 5 cells/microliter; protein &gt; 1g, cells &gt; 75 suggests alternative diagnosis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a person with 2 or more attacks and clinical evidence of 2 or more lesions, what additional criteria are required for a diagnosis of Multiple Sclerosis?", "options": [{"label": "A", "text": "None, dissemination in space and in time are met", "correct": true}, {"label": "B", "text": "Presence of enhancing and non-enhancing lesions on MRI", "correct": false}, {"label": "C", "text": "Presence of CSF oligoclonal bands", "correct": false}, {"label": "D", "text": "New T2 or enhancing MRI lesion compared to baseline", "correct": false}], "correct_answer": "A. None, dissemination in space and in time are met", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2017 McDonald Criteria for the Diagnosis of MS (Multiple Sclerosis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional criteria to make MS diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>…in a person who has experienced a typical attack/CIS at onset</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 or more attacks and clinical evidence of 2 or more lesions; OR</p>\n<p>2 or more attacks and clinical evidence of 1 <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with clear historical evidence of prior attack involving <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in different location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None, <span class=\"customMeta\" data-dictid=\"a4f2fe962416927771863f05865f8f\">DIS</span> and DIT have been <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 or more attacks and clinical evidence of 1 lesion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DIS shown by one of these criteria:</p>\n<p>- additional clinical attack implicating different <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> site</p>\n<p>- 1 or more MS-typical T2 lesions in 2 or more areas of CNS: periventricular, cortical, juxtacortical, infratentorial, or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 attack and clinical evidence of 2 or more lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DIT shown by one of these criteria:</p>\n<p>- Additional clinical attack</p>\n<p>- Simultaneous presence of both enhancing and non-enhancing MS typical <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> lesions, or new T2 or enhancing <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> compared to <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> scan (without regard to timing of <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> scan)<strong> (Options B &amp; D ruled out)</strong></p>\n<p>- <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> <span class=\"customMeta\" data-dictid=\"754705a861169277719425d87c6742\">oligoclonal</span> bands <strong> (Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 attack and clinical evidence of 1 lesion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DIS shown by one of these criteria:</p>\n<p>- Additional attack implicating different <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> site</p>\n<p>- 1 or more MS-typical T2 lesions in 2 or more areas of CNS: periventricular, cortical, juxtacortical, infratentorial, or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord</p>\n<p>AND</p>\n<p>DIT shown by one of these criteria:</p>\n<p>- additional clinical attack</p>\n<p>- Simultaneous presence of both enhancing and non-enhancing MS typical <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> lesions, or new T2 or enhancing <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> compared to <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> scan (without regard to timing of <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> scan)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> <span class=\"customMeta\" data-dictid=\"754705a861169277719425d87c6742\">oligoclonal</span> bands</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>…in a person who has a steady <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of the disease since the onset</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 year of disease <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> (retrospective or prospective)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DIS shown by at least two of these criteria:</p>\n<p>- 1 or more MS-typical T2 lesions (periventricular, cortical, juxtacortical, or infratentorial)</p>\n<p>- 2 or more T2 <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord lesions</p>\n<p>- <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> <span class=\"customMeta\" data-dictid=\"754705a861169277719425d87c6742\">oligoclonal</span> bands</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding One and a Half Syndrome in multiple sclerosis is not true?", "options": [{"label": "A", "text": "It is characterized by ipsilateral horizontal gaze palsy", "correct": false}, {"label": "B", "text": "Limited adduction of the ipsilateral eye", "correct": false}, {"label": "C", "text": "The contralateral eye exhibits exotropia and abduction nystagmus.", "correct": false}, {"label": "D", "text": "Vertical gaze and convergence are typically impaired in this syndrome.", "correct": true}], "correct_answer": "D. Vertical gaze and convergence are typically impaired in this syndrome.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/EWT7GSWoVppuB1B7Wyxn1744389103.png", "https://image.prepladder.com/notes/pEE4oRiq265OZMAPpGno1744389241.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with a known diagnosis of multiple sclerosis presents to the emergency department with sudden-onset double vision. On examination, the left eye has slowed adduction when attempting to look to the right, and there is horizontal nystagmus in the right eye when it is abducting. Which of the following best explains the underlying pathology of this patient’s symptoms?", "options": [{"label": "A", "text": "Lesion in the right lateral rectus muscle", "correct": false}, {"label": "B", "text": "Lesion in the left sixth cranial nerve", "correct": false}, {"label": "C", "text": "Lesion in the left medial longitudinal fasciculus", "correct": true}, {"label": "D", "text": "Lesion in the right sixth cranial nerve", "correct": false}], "correct_answer": "C. Lesion in the left medial longitudinal fasciculus", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/uyHRMzlhtk0ByCG6BZDk1744323236.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman with a known diagnosis of multiple sclerosis presents with complaints of increased fatigue and worsening of her neurological symptoms after spending a day in the sauna. Her vision becomes blurry, and her leg weakness worsens. Which of the following best describes her experience?", "options": [{"label": "A", "text": "Lhermitte’s symptoms", "correct": false}, {"label": "B", "text": "Uthoff’s symptoms", "correct": true}, {"label": "C", "text": "Optic neuritis", "correct": false}, {"label": "D", "text": "Internuclear ophthalmoplegia", "correct": false}], "correct_answer": "B. Uthoff’s symptoms", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paresthesias: tingling, prickling sensations, “pins and needles,” or painful burning.</li>\n<li>Hypesthesia: <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> sensation, numbness, or a “dead” feeling.</li>\n<li>Unpleasant sensations: feelings that body parts are swollen, wet, raw, or tightly wrapped.</li>\n<li>Pain is a common symptom of MS.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">neuritis</span> (ON) </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diminished visual acuity.</li>\n<li>Decreased colour perception in the central field of vision.</li>\n<li>May progress to severe visual loss.</li>\n<li>Periorbital pain.</li>\n<li>Fundoscopic examination: normal or <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> (papillitis), <span class=\"customMeta\" data-dictid=\"dd5d862f051692777194647422e1c9\">pallor</span> of the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc (optic atrophy).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weakness of the limbs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of strength, speed, dexterity, and <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> disturbance.</li>\n<li><strong>Exercise-induced weakness is a <span class=\"customMeta\" data-dictid=\"769a2723f11692777184d095072e51\">characteristic symptom</span> of MS.</strong></li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> type weakness accompanied by other <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">pyramidal</span> signs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Facial weakness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lesion in the <span class=\"customMeta\" data-dictid=\"5e4684038e16927771967a14f73f37\">pons</span> may resemble <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> Bell’s palsy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spasticity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spontaneous and movement-induced muscle spasms.</li>\n<li>Painful spasms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual blurring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to ON (optic neuritis) or diplopia.</li>\n<li>Diplopia is caused by <span class=\"customMeta\" data-dictid=\"d9d0d4abe31692777190f27bfd9349\">internuclear</span> <span class=\"customMeta\" data-dictid=\"2cc1b4ff2216927771940a80e764a2\">ophthalmoplegia</span> (INO) or <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> of the sixth <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve. <strong>(Option D ruled out)</strong></li>\n<li>Bilateral INO is particularly suggestive of MS.</li>\n<li>Other gaze disturbances in MS:\n\t\t\t\t<ul>\n<li>Horizontal gaze palsy</li>\n<li>One-and-a-half syndrome (horizontal gaze <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> plus an INO)</li>\n<li>Acquired <span class=\"customMeta\" data-dictid=\"1c0fa3a5271692777195d724d73281\">pendular</span> nystagmus</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ataxia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cerebellar tremors.</li>\n<li>Cerebellar dysarthria.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertigo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lesion in the brainstem.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ancillary symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paroxysmal symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brief duration (10s to 2 min), <span class=\"customMeta\" data-dictid=\"a386d4402b169277718999a5a8e452\">high frequency</span> (5–40 episodes per day), no change of consciousness or change in background <span class=\"customMeta\" data-dictid=\"58dc8fba4a1692777187888ca9e3bd\">electroencephalogram</span> during episodes, and a <span class=\"customMeta\" data-dictid=\"7fe60173fc1692777198c84099eccc\">self-limited</span> course.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lhermitte’s symptom </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An electric shock-like sensation that radiates down the back into the legs.</p>\n<p>Typically <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> by <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> or other movements of the neck.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trigeminal neuralgia, <span class=\"customMeta\" data-dictid=\"c8d13416611692777188045903896d\">hemifacial</span> spasm, and <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> neuralgia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Demyelinating lesions involve the root entry or exit zone of the fifth, seventh, and ninth <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve, respectively.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Facial myokymia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent rapid flickering contractions of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> musculature</p>\n<p>Slow spread of <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> across the face.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heat sensitivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uthoff symptoms:</strong> Neurological symptoms develop from heat exposure, such as steam baths and saunas. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bladder dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present in &gt;90% of MS patients.</p>\n<p>Detrusor hyperreflexia.</p>\n<p>Detrusor <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> <span class=\"customMeta\" data-dictid=\"65c199df631692777186e19246ba19\">dyssynergia</span> - hesitancy, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention, <span class=\"customMeta\" data-dictid=\"c2c7c471601692777194cbef97853e\">overflow</span> incontinence, and <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bowel dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Constipation, faecal <span class=\"customMeta\" data-dictid=\"026c92ea6316927772013c7cfd287b\">urgency</span> or <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> incontinence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cognitive dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Memory loss.</p>\n<p>Impaired attention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Psychiatric symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depression.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fatigue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90% of patients experience fatigue.</p>\n<p>It causes work-related disability.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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Further evaluation reveals antibodies against muscle-specific kinase (MuSK). Which of the following best describes the mechanism involved in this patient’s condition?", "options": [{"label": "A", "text": "Destruction of the myelin sheath around peripheral nerves", "correct": false}, {"label": "B", "text": "Impaired regulation and maintenance of acetylcholine receptors", "correct": true}, {"label": "C", "text": "Blockade of presynaptic voltage-gated calcium channels", "correct": false}, {"label": "D", "text": "Inhibition of acetylcholine release from synaptic vesicles", "correct": false}], "correct_answer": "B. Impaired regulation and maintenance of acetylcholine receptors", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Target</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-AChR antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acetylcholine receptors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks transmission &amp; reduces receptors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-MuSK antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscle-specific <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (MuSK)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disrupts <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> regulation and stability</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:574px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Penicillamine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may induce a persistent myasthenic syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aminoglycosides, Quinolones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can worsen <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> blockade; it must be avoided</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with fluctuating muscle weakness, especially affecting her speech and swallowing. Repetitive nerve stimulation shows a decremental response. Her blood tests are negative for acetylcholine receptor (AChR) antibodies. Which of the following antibodies is most likely responsible for her symptoms?", "options": [{"label": "A", "text": "Anti-dsDNA antibodies", "correct": false}, {"label": "B", "text": "Anti-MuSK antibodies", "correct": true}, {"label": "C", "text": "Anti-TPO antibodies", "correct": false}, {"label": "D", "text": "Anti-Ro antibodies", "correct": false}], "correct_answer": "B. Anti-MuSK antibodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoantibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Target</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AChR antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acetylcholine receptors (AChR) on the <span class=\"customMeta\" data-dictid=\"978bd0e89f1692777196add72e1254\">postsynaptic</span> membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks signal transmission, leading to muscle weakness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MuSK antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle-specific <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (MuSK)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impairs AChR clustering and maintenance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in AChR-negative patients; associated with <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> muscle weakness (speech, swallowing, chewing issues)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman with a known diagnosis of myasthenia gravis presents to the clinic with worsening symptoms, including difficulty in lifting her arms and shortness of breath. On examination, you notice that her eyelids are drooping, and she has double vision. What is the most significant risk associated with her current condition if not addressed promptly?", "options": [{"label": "A", "text": "Impaired vision", "correct": false}, {"label": "B", "text": "Aspiration due to swallowing difficulties", "correct": false}, {"label": "C", "text": "Respiratory failure", "correct": true}, {"label": "D", "text": "Muscle atrophy", "correct": false}], "correct_answer": "C. Respiratory failure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:579px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Affected Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ocular muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Mimics central eye movement disorders.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cogan's lid <span class=\"customMeta\" data-dictid=\"4f7448b3e51692777201ff5cafde0d\">twitch</span> sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Upper <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> rises briefly after looking down for some time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Shoulder <span class=\"customMeta\" data-dictid=\"a1d37a92d41692777188e12a817797\">girdle</span> muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Difficulty in overhead activities like combing hair.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Respiratory muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Weakness may cause <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> risks.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old man presents to the emergency department with acute muscle weakness, double vision, and difficulty swallowing. He has a history of myasthenia gravis and has been experiencing increased fatigue over the past few days. Which of the following clinical features would best help differentiate a myasthenic crisis from a cholinergic crisis?", "options": [{"label": "A", "text": "Muscle fasciculations", "correct": false}, {"label": "B", "text": "Small pupils", "correct": false}, {"label": "C", "text": "Response to edrophonium", "correct": true}, {"label": "D", "text": "Pallor and sweating", "correct": false}], "correct_answer": "C. Response to edrophonium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Myasthenic Crisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cholinergic Crisis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Exacerbation of MG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Excessive <span class=\"customMeta\" data-dictid=\"16b654488116927771813c39bf19e7\">anticholinesterase</span> use</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Severe muscle weakness, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Fasciculations, paralysis, small pupils <strong>(Options A &amp; B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Other Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Pallor, sweating, excessive <span class=\"customMeta\" data-dictid=\"f3c45b71f616927771983a1da80a25\">salivation</span> <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Response to edrophonium test <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Can confirm <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> origin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with symptoms of fluctuating double vision and drooping eyelids that worsen throughout the day. Neurological examination reveals no other muscular involvement. Blood tests confirm the presence of antibodies against muscle-specific kinase (MuSK). What is the most appropriate management strategy for this patient?", "options": [{"label": "A", "text": "Initiate high-dose corticosteroids as the first-line treatment.", "correct": false}, {"label": "B", "text": "Recommend immediate thymectomy regardless of symptom severity.", "correct": false}, {"label": "C", "text": "Start anticholinesterase medications and consider immunosuppressants if symptoms persist.", "correct": true}, {"label": "D", "text": "Advise the patient to undergo regular monitoring without any treatment.", "correct": false}], "correct_answer": "C. Start anticholinesterase medications and consider immunosuppressants if symptoms persist.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/A8wscDduvLat5Beqqxb71744387579.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Intermittent <span class=\"customMeta\" data-dictid=\"e18c2053271692777194e62a208e01\">ptosis</span> (drooping <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> that worsens with the day) and <span class=\"customMeta\" data-dictid=\"1458c330411692777186cd49bb6a30\">diplopia</span> (double vision).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Absence of Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">No muscle weakness in other body parts (e.g., chewing, swallowing, limb movement).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Potential for Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">May progress to generalized MG but has an excellent <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> if it remains ocular.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Repetitive nerve <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> studies: </strong>Produces decremental response.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Repitative nerve stimulation\" data-author=\"NA\" data-hash=\"9510\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"365\" src=\"https://image.prepladder.com/notes/A8wscDduvLat5Beqqxb71744387579.png\" width=\"365\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\">Blood tests for AChR and MuSK antibodies.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Generalized MG:</strong></p>\n<p style=\"text-align:center\"><strong>Drug of choice: </strong><strong>Pyridostigmine </strong>(Anticholinesterase medications)</p>\n<p style=\"text-align:center\"><strong>If symptoms persist: </strong>Steroids &amp; Mycophenolate</p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>OcularMyasthenia Gravis:</strong></p>\n<p style=\"text-align:center\"><strong>DOC: </strong><strong>Pyridostigmine</strong></p>\n<p style=\"text-align:center\"><strong>If symptoms persist: </strong>Immunotherapy</p>\n<p style=\"text-align:center\"><strong>Other Drugs: </strong></p>\n<ul>\n<li style=\"text-align:center\">Glucocorticoids</li>\n<li style=\"text-align:center\">o Mycophenolate</li>\n<li style=\"text-align:center\">o Rituximab</li>\n<li style=\"text-align:center\">o Eculizumab</li>\n</ul>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Myasthenia Crisis:</strong></p>\n<ul>\n<li style=\"text-align:center\">Intravenous immunoglobulins</li>\n<li style=\"text-align:center\">Plasmapheresis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with fluctuating muscle weakness, particularly affecting her eyelids and causing double vision. A thorough clinical evaluation and diagnostic testing are performed. Which of the following diagnostic tests would most likely confirm the suspicion of Myasthenia Gravis?", "options": [{"label": "A", "text": "Muscle biopsy", "correct": false}, {"label": "B", "text": "Repetitive nerve stimulation (RNS)", "correct": true}, {"label": "C", "text": "Serum creatine kinase level", "correct": false}, {"label": "D", "text": "Electromyography (EMG)", "correct": false}], "correct_answer": "B. Repetitive nerve stimulation (RNS)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/yPws74QCe9iBYwhLEFhX1744376283.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tensilon Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administers edrophonium <span class=\"customMeta\" data-dictid=\"749f9a02041692777183f4f13efcc5\">bromide</span> intravenously.</p>\n<p>May show <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> muscle function improvement; not highly reliable.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Repetitive Nerve <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> (RNS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specialized nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> study.</p>\n<p>Reveals a <span class=\"customMeta\" data-dictid=\"6c8c4bed32169277718685fa72d8d1\">decremental response</span> in <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> with repeated stimulation, indicating impaired <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> transmission.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibody Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects auto-antibodies related to MG.</p>\n<p><strong>Acetylcholine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> (AChR) Antibodies:</strong> Most common, block AChR function.</p>\n<p><strong>Muscle-Specific <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> (MuSK) Antibodies:</strong> Disrupt AChR clustering and stabilization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thoracic CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Essential to rule out thymoma, especially in patients with negative AChR <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> tests.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lambert-Eaton Myasthenic Syndrome (LEMS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle weakness, particularly in limbs, due to autoantibodies against voltage-gated <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Botulism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare illness caused by a bacterial <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> leading to muscle paralysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscular Dystrophies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genetic disorders causing progressive muscle <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> and weakness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Myopathies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Result from defects in muscle cell <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> pathways, causing weakness and other symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug-Induced Myopathies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle weakness caused by side effects of certain medications, such as <span class=\"customMeta\" data-dictid=\"2d286fa70b1692777199aba0434a49\">statins</span> and corticosteroids.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents with weakness in her arms and difficulty in swallowing. The neurologist suspects myasthenia gravis (MG) and considers treatment options. Which of the following treatments is most appropriate for this patient to increase acetylcholine activity at the neuromuscular junction?", "options": [{"label": "A", "text": "Physostigmine", "correct": false}, {"label": "B", "text": "Glucocorticoid treatment", "correct": false}, {"label": "C", "text": "Pyridostigmine", "correct": true}, {"label": "D", "text": "Intravenous immunoglobulin", "correct": false}], "correct_answer": "C. Pyridostigmine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Common Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of Side Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolongs <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> action by inhibiting acetylcholinesterase.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyridostigmine (anticholinesterase)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhoea and colic controlled with propantheline.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cholinergic Crisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distinction Method</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overdose of <span class=\"customMeta\" data-dictid=\"16b654488116927771813c39bf19e7\">anticholinesterase</span> drugs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle fasciculation, paralysis, pallor, sweating, excessive salivation, constricted pupils.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical features or small doses of edrophonium.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Use Case</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Intravenous Immunoglobulin</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapidly reduces weakness by <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> production.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute symptom relief.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Plasma Exchange</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removes antibodies from the blood for a brief marked improvement.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myasthenic crisis or pre-operative preparation.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dosage/Administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Glucocorticoid Treatment</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varies; initiated in the hospital.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improves symptoms but may precede exacerbation; long-term use carries risks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Azathioprine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 mg/kg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces <span class=\"customMeta\" data-dictid=\"6045a2ba311692777188aaeacafe4f\">glucocorticoid</span> dosage; effects may be delayed for months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mycophenolate Mofetil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less commonly used</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Another <span class=\"customMeta\" data-dictid=\"498d3df3a416927771894f595a597a\">immunosuppression</span> option.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Thymectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Consider for patients &lt;45 years old with symptoms beyond <span class=\"customMeta\" data-dictid=\"7d57c304c01692777187da125d18d8\">extraocular</span> muscles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pending <span class=\"customMeta\" data-dictid=\"df216bc99216927771841f3321f8cb\">clinical trial</span> confirmation of efficacy.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Outcomes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Variability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Remissions may occur spontaneously.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ocular Myasthenia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excellent <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> with minimal disability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Young Females with Generalised Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May benefit from thymectomy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Older Patients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less likely to experience remission, even with treatment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Disease Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> is uncommon more than 5 years after onset.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with known myasthenia gravis presents to the emergency department with severe respiratory distress. He is diagnosed with a myasthenic crisis. Which of the following treatments is most appropriate for immediate management of this patient's condition?", "options": [{"label": "A", "text": "Oral corticosteroids", "correct": false}, {"label": "B", "text": "Intravenous immunoglobulin (IVIg)", "correct": true}, {"label": "C", "text": "Azathioprine", "correct": false}, {"label": "D", "text": "Plasma exchange (PLEX)", "correct": false}], "correct_answer": "B. Intravenous immunoglobulin (IVIg)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Life-threatening condition due to muscle weakness affecting breathing, leading to <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Triggers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infection</li>\n<li>Surgery</li>\n<li>Stress</li>\n<li>Certain medications</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Respiratory Support</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ensure adequate breathing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May involve providing oxygen or mechanical ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> (IVIg)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduce harmful <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> levels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps improve <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> by <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> antibodies in the blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Plasma Exchange (PLEX)</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Remove harmful antibodies from blood.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to IVIg; generally used when IVIg is ineffective or cannot be tolerated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Corticosteroids</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suppress the immune system.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can improve symptoms but may have significant side effects.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunosuppressants</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suppress the immune response.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Options include <span class=\"customMeta\" data-dictid=\"80fd8ffd0816927771826bfe7129d6\">azathioprine</span> or mycophenolate mofetil, which help manage the condition.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man presents with progressive muscle weakness, dry mouth, and absent tendon reflexes. He has a history of smoking. Electrophysiological testing reveals post-tetanic potentiation of motor response to nerve stimulation at a frequency of 20–50/sec. Which of the following treatments is most appropriate for this patient?", "options": [{"label": "A", "text": "Corticosteroids", "correct": false}, {"label": "B", "text": "3,4-Diaminopyridine", "correct": true}, {"label": "C", "text": "Azathioprine", "correct": false}, {"label": "D", "text": "Intravenous immunoglobulin (IVIg)", "correct": false}], "correct_answer": "B. 3,4-Diaminopyridine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A condition causing muscle weakness due to impaired transmission across the <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> junction, similar to <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">myasthenia</span> gravis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inflammatory</li>\n<li>Paraneoplastic (associated with underlying malignancies, particularly small-cell lung cancer).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antibodies to <span class=\"customMeta\" data-dictid=\"e91c7a22e71692777196ef9e02b8c0\">presynaptic</span> voltage-gated <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channels impair <span class=\"customMeta\" data-dictid=\"64a186134416927772008b8bbb3070\">transmitter</span> release, unlike <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">myasthenia</span> gravis, which involves antibodies against <span class=\"customMeta\" data-dictid=\"978bd0e89f1692777196add72e1254\">postsynaptic</span> <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> receptors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Muscle weakness</li>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (e.g., dry mouth)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Key Clinical Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absence of <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> reflexes, which may return after sustained <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of the affected muscle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnostic Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Electrophysiological testing showing post-tetanic <span class=\"customMeta\" data-dictid=\"b37151676316927771965b0c50d9a0\">potentiation</span> of motor response to nerve <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> at a frequency of 20–50/sec is indicative of LEMS.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism/Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>3,4-Diaminopyridine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enhances <span class=\"customMeta\" data-dictid=\"e28fd027b416927771932bc23ba0a5\">neurotransmitter</span> release at the <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> junction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pyridostigmine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> levels, improving <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> transmission.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunosuppression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> against voltage-gated <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channels.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myasthenia Gravis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lambert-Eaton <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">Myasthenia</span> Syndrome </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibodies to post-synaptic <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> receptors</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibodies to pre-synaptic <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channels</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually <strong>acute</strong> or subacute, but can also be chronic.</li>\n<li>Typically occurs in younger women (20s-30s) or older <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> (&gt;60s).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gradual onset, often <strong>subacute</strong> or <strong>chronic</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Worsens</strong> with activity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Improves</strong> with repetitive use of muscles</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Decremental response</strong> on repetitive nerve stimulation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Incremental response</strong> on repetitive nerve stimulation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Rarely associated</strong> with cancer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Frequently associated</strong> with small-cell lung cancer (SCLC)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman is suspected of having myasthenia gravis. The neurologist decides to perform the Tensilon test using edrophonium bromide. Which of the following statements is TRUE regarding the Tensilon test?", "options": [{"label": "A", "text": "The effects of the test last for about 10 minutes", "correct": false}, {"label": "B", "text": "It is a highly specific and sensitive test for myasthenia gravis", "correct": false}, {"label": "C", "text": "Muscle function typically improves within 30 seconds of injection", "correct": true}, {"label": "D", "text": "Intravenous atropine is unnecessary during the procedure", "correct": false}], "correct_answer": "C. Muscle function typically improves within 30 seconds of injection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 19 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 62-year-old man presents to the medicine clinic with complaints of postural instability, frequent falls, and urinary incontinence over the past year. His family reports that he has also been experiencing difficulty with coordination and has developed a noticeable tremor. Neurological examination reveals bradykinesia, rigidity, and dysarthria. An MRI of the brain is performed and the image is shown below. What MRI finding is likely to be seen in this patient?", "options": [{"label": "A", "text": "Iron deposition in the brain’s striatum", "correct": false}, {"label": "B", "text": "Hot cross bun sign in the pons", "correct": true}, {"label": "C", "text": "Hummingbird sign", "correct": false}, {"label": "D", "text": "Red nucleus degeneration", "correct": false}], "correct_answer": "B. Hot cross bun sign in the pons", "question_images": ["https://image.prepladder.com/notes/aXnjQQLLAV0P9h11ZlZ71744333695.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT a characteristic common to both tauopathies and synucleinopathies?", "options": [{"label": "A", "text": "Neurodegeneration caused by protein aggregation", "correct": false}, {"label": "B", "text": "Spread of aggregates through cell-to-cell transmission", "correct": false}, {"label": "C", "text": "Predominant involvement of α-synuclein protein", "correct": true}, {"label": "D", "text": "Pathological findings include neuronal inclusions and glial inclusions", "correct": false}], "correct_answer": "C. Predominant involvement of α-synuclein protein", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Tauopathies</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Synucleinopathies</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurodegenerative diseases are caused by <span class=\"customMeta\" data-dictid=\"349c5a4f5d169277720062d348498a\">tau</span> protein aggregation.</li>\n<li>This leads to neurodegeneration, affecting <span class=\"customMeta\" data-dictid=\"66a72871741692777184da29e3ed5d\">cognition</span> and motor function.</li>\n<li>Tau aggregates spread through cell-to-cell transmission, advancing disease progression.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Common Tauopathies:</strong></p>\n<ul>\n<li><strong>Alzheimer’s Disease (AD)</strong></li>\n<li>Pick’s Disease (PiD)</li>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"5ef5f7d035169277719997649dc97a\">Supranuclear</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">Palsy</span> (PSP)</li>\n<li>Corticobasal <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">Degeneration</span> (CBD):</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">Traumatic</span> <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">Encephalopathy</span> (CTE)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Pathological Classification:</strong></p>\n<ul>\n<li>Tauopathies are categorised by <span class=\"customMeta\" data-dictid=\"349c5a4f5d169277720062d348498a\">tau</span> isoforms: 3R, 4R, and 3R/4R.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurodegenerative diseases marked by α-synuclein protein aggregation.</li>\n<li>α-Syn aggregates cause neurodegeneration, <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> through the brain and contributing to disease progression.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Common Synucleinopathies:</strong></p>\n<ul>\n<li><strong>Parkinson’s Disease (PD)</strong></li>\n<li><strong>Dementia with <span class=\"customMeta\" data-dictid=\"4c05b8138d16927771911348e3ada9\">Lewy Bodies</span> (DLB)</strong></li>\n<li><strong>Multiple System <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">Atrophy</span> (MSA)</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Neuropathological Findings:</strong></p>\n<ul>\n<li>Neuronal inclusions, astrocytic pathology, and glial inclusions in the affected areas.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man with advanced Parkinson's disease is considered for deep brain stimulation (DBS) after experiencing significant motor fluctuations and dyskinesias despite optimal medication therapy. Which of the following brain structures is most commonly targeted in DBS to improve tremor, bradykinesia, and rigidity?", "options": [{"label": "A", "text": "Ventral Intermediate Nucleus of the Thalamus", "correct": false}, {"label": "B", "text": "Subthalamic Nucleus (STN)", "correct": true}, {"label": "C", "text": "Globus Pallidus Internus (GPi)", "correct": false}, {"label": "D", "text": "Caudate Nucleus", "correct": false}], "correct_answer": "B. Subthalamic Nucleus (STN)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old woman with Parkinson's disease has been on levodopa therapy but continues to experience significant \"off\" time, where her symptoms worsen before her next dose. Her neurologist is considering adding a medication to enhance her treatment regimen. Which of the following classes of drugs is most appropriate for reducing \"off\" time in this patient?", "options": [{"label": "A", "text": "Benzodiazepines", "correct": false}, {"label": "B", "text": "Anticholinergic agents", "correct": false}, {"label": "C", "text": "Adenosine A2A receptor antagonists", "correct": true}, {"label": "D", "text": "Dopamine agonists", "correct": false}], "correct_answer": "C. Adenosine A2A receptor antagonists", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with Parkinson's disease is currently on levodopa therapy but is experiencing significant motor fluctuations and \"wearing off\" between doses. His neurologist is considering adding a medication to improve his overall motor function. Which of the following is a commonly used dopamine agonist that could be added to his treatment regimen?", "options": [{"label": "A", "text": "Ropinirole", "correct": true}, {"label": "B", "text": "Selegiline", "correct": false}, {"label": "C", "text": "Entacapone", "correct": false}, {"label": "D", "text": "Trihexyphenidyl", "correct": false}], "correct_answer": "A. Ropinirole", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man with a diagnosis of Parkinson's disease has been experiencing increased motor fluctuations despite being on a stable dose of levodopa for the past two years. He reports that his symptoms improve shortly after taking his medication but then return before his next dose is due. The physician considers adding a medication to help extend the effect of his current treatment. Which of the following is the most appropriate addition to his regimen?", "options": [{"label": "A", "text": "Dopamine agonist", "correct": false}, {"label": "B", "text": "COMT inhibitor", "correct": true}, {"label": "C", "text": "Anticholinergic agent", "correct": false}, {"label": "D", "text": "Beta blocker", "correct": false}], "correct_answer": "B. COMT inhibitor", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old woman presents with a 1-year history of progressive difficulty controlling her right arm. She reports that her arm occasionally moves on its own, and she has trouble performing simple tasks like buttoning her shirt. On examination, she has dystonic posturing of the right hand, mild bradykinesia, and intermittent myoclonic jerks. Her cognitive function appears intact except for mild apraxia. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Parkinson's disease", "correct": false}, {"label": "B", "text": "Corticobasal syndrome", "correct": true}, {"label": "C", "text": "Multiple system atrophy", "correct": false}, {"label": "D", "text": "Progressive supranuclear palsy", "correct": false}], "correct_answer": "B. Corticobasal syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presents with his family, who report that over the past year, he has developed significant personality changes. He has become socially inappropriate, often acting impulsively and showing a lack of empathy. He also struggles to initiate tasks and frequently forgets appointments. On examination, his language production is impaired, though his comprehension remains intact. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Alzheimer's disease", "correct": false}, {"label": "B", "text": "Vascular dementia", "correct": false}, {"label": "C", "text": "Frontotemporal dementia (FTD)", "correct": true}, {"label": "D", "text": "Lewy body dementia", "correct": false}], "correct_answer": "C. Frontotemporal dementia (FTD)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with frequent, unexplained falls, a stiff, jerky gait, and difficulty looking down. On examination, vertical gaze palsy, axial rigidity with neck hyperextension, and square wave jerks in his eye movements are present. MRI of this patient is shown below. Which MRI finding is most characteristic of this patient's condition?", "options": [{"label": "A", "text": "Mulberry Sign", "correct": false}, {"label": "B", "text": "Hot cross bun sign in the pons", "correct": false}, {"label": "C", "text": "Hummingbird sign", "correct": true}, {"label": "D", "text": "Target Sign", "correct": false}], "correct_answer": "C. Hummingbird sign", "question_images": ["https://image.prepladder.com/notes/J0Whbu6aC3xPMRDJgBkq1744334024.png"], "explanation_images": ["https://image.prepladder.com/notes/iGiahur46lx9o8Mp33wn1744334176.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 53-year-old male has a combination of postural instability, frequent falls, and urinary incontinence. His wife reports that he has also developed erectile dysfunction. Upon examination, he exhibits bradykinesia, rigidity, dysarthria, and postural hypotension. MRI brain image is shown below. Which of the following treatment strategies is/are most appropriate for managing his orthostatic hypotension?", "options": [{"label": "A", "text": "Increase physical therapy", "correct": false}, {"label": "B", "text": "Initiate levodopa", "correct": false}, {"label": "C", "text": "High-salt diet and midodrine", "correct": true}, {"label": "D", "text": "Domperidone and soft diet", "correct": false}], "correct_answer": "C. High-salt diet and midodrine", "question_images": ["https://image.prepladder.com/notes/aXnjQQLLAV0P9h11ZlZ71744333695.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman presents with noticeable changes in her movement. Her family reports that she has been experiencing increased difficulty with her balance and has developed a stooped posture. During the examination, you observe bradykinesia and rigidity, particularly in her left arm. She also mentions feeling more tired than usual and has trouble initiating movements. At this stage of her disease, which of the following areas is least likely to be affected?", "options": [{"label": "A", "text": "Peripheral enteric system", "correct": false}, {"label": "B", "text": "Dorsal nucleus of the vagus", "correct": false}, {"label": "C", "text": "Anterior olfactory nucleus", "correct": false}, {"label": "D", "text": "Telencephalic cortex", "correct": true}], "correct_answer": "D. Telencephalic cortex", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 1 (Pre-symptomatic)</strong></p>\n\t\t\t \n\n\t\t\t<p>Non-motor symptoms are early</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"85c304623c1692777187da4d1f1ee7\">enteric</span> system <strong>(Option A)</strong>\n<ul>\n<li>Constipation</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"30cac2b1a216927771941c69ff66a3\">olfactory</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> <strong>(Option C)</strong>\n<ul>\n<li>Anosmia</li>\n</ul>\n</li>\n<li>Dorsal motor <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> of the <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> <strong> (Option B)</strong>\n<ul>\n<li>Cardiac denervation</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 2 (Symptomatic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Substantia <span class=\"customMeta\" data-dictid=\"f2fc45b6181692777193ed78c4835a\">nigra</span> <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> compacta <strong>(Hallmark)</strong>\n<ul>\n<li>Motor symptoms of PD</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 3 (Symptomatic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Telencephalic cortex\n\t\t\t\t<ul>\n<li>Cognitive impairment</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old patient presents with resting tremor, rigidity, and bradykinesia. The physician suspects Parkinson's disease and orders a DaTscan to aid in the diagnosis. Which of the following is the primary purpose of using a DaTscan in this patient?", "options": [{"label": "A", "text": "To detect structural abnormalities in the brain, such as hydrocephalus or masses", "correct": false}, {"label": "B", "text": "To evaluate dopamine transporter function and confirm reduced dopamine uptake in the basal ganglia", "correct": true}, {"label": "C", "text": "To measure the patient’s response to dopaminergic treatment", "correct": false}, {"label": "D", "text": "To determine the exact location of neuronal loss in the substantia nigra", "correct": false}], "correct_answer": "B. To evaluate dopamine transporter function and confirm reduced dopamine uptake in the basal ganglia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Investigating Parkinson’s disease (PD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically sufficient to diagnose PD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To rule out other conditions with similar symptoms, such as:</p>\n<p>Normal pressure hydrocephalus,</p>\n<p>Subcortical stroke.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DaTscan </strong>[Dopamine <span class=\"customMeta\" data-dictid=\"850b296dd316927772005b651f6e87\">transporter</span> single-photon emission <span class=\"customMeta\" data-dictid=\"44b07c254816927771855a12777513\">computed tomography</span> (SPECT)]</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses functional aspects of the <span class=\"customMeta\" data-dictid=\"6aec63ba2e1692777186e5809a7376\">dopaminergic</span> system.</p>\n<p>Reduced <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</p>\n<p>It is not useful in assessing structural abnormalities.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Levodopa Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A positive response to <span class=\"customMeta\" data-dictid=\"398108f4501692777191f60f958fb2\">levodopa</span> is a strong indicator of Parkinson’s Disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to exclude other causes like:</p>\n<p>Bleeding,</p>\n<p>Stroke,</p>\n<p>Hydrocephalus,</p>\n<p>Mass lesions,</p>\n<p>Wilson disease.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old boy has tremors, stiffness, and difficulty walking. He has no family history of Parkinson’s disease. On examination, bradykinesia, rigidity, and postural instability were found. Genetic testing reveals a mutation associated with juvenile-onset Parkinson’s disease. Which gene is most likely responsible for his condition?", "options": [{"label": "A", "text": "PARK-GBA", "correct": false}, {"label": "B", "text": "PARK-LRRK2", "correct": false}, {"label": "C", "text": "PARK-Parkin", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. PARK-Parkin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Genetic Causes of Parkinson’s Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classical PD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PARK-SNCA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Missense mutations cause classical Parkinsonism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PARK-LRRK2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinically typical PD.</p>\n<p>Most common gene causing PD in Ashkenazi Jews and North African Berber Arabs.</p>\n<p>Most common gene responsible for <strong>sporadic cases. </strong><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PARK-VPS35</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinically typical PD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PARK-GBA (glucocerebrosidase gene)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinically typical PD—possibly faster <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> and greater risk of cognitive impairment.</p>\n<p><strong>Most common genetic</strong> association with PD. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early-onset PD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PARK-Parkin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often presents with dystonia, typically in a leg.</p>\n<p>Most common gene <strong>responsible for juvenile-onset PD.</strong><strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PARK-PINK1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often presents with psychiatric features.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PARK-DJ1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman is concerned about her mother, who recently developed hand tremors. She is worried because her friend's mother was diagnosed with Parkinson's disease. Which of the following is NOT a typical clinical feature of atypical parkinsonism?", "options": [{"label": "A", "text": "Slow ocular saccades", "correct": false}, {"label": "B", "text": "Resting tremor", "correct": true}, {"label": "C", "text": "Early gait impairment", "correct": false}, {"label": "D", "text": "Poor response to Levodopa", "correct": false}], "correct_answer": "B. Resting tremor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0i6tzGOoKlB1jfVKJKg71740585488.png", "https://image.prepladder.com/content/aa5DMIrXaHDwPqsDO06i1740585459.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atypical <span class=\"customMeta\" data-dictid=\"af42cffef41692777194ceaa162eeb\">Parkinsonian</span> syndromes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multiple-system <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> (MSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cerebellar type (MSA-c) Prominent cerebellar sign.</li>\n<li>Parkinson type (MSA-p)</li>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> - <span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\">orthostatic</span> hypotension</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"484\" src=\"https://image.prepladder.com/content/0i6tzGOoKlB1jfVKJKg71740585488.png\" width=\"480\"/></p>\n<p><strong>The hot cross <span class=\"customMeta\" data-dictid=\"eeb0ec7e661692777183f957a8794b\">bun</span> sign refers to the <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> appearance of the <span class=\"customMeta\" data-dictid=\"5e4684038e16927771967a14f73f37\">pons</span> when T2 hyperintensity forms a cross on <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> images, representing selective <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"b32e60f29a16927771963de1f70fd5\">pontocerebellar</span> tracts and <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> <span class=\"customMeta\" data-dictid=\"127f1d277616927771975f15621776\">raphe</span> nuclei</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"5ef5f7d035169277719997649dc97a\">supranuclear</span> palsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slow <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> saccades, <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> apraxia, and restricted vertical eye movements with particular <strong>impairment of downward gaze</strong> <strong>(Option A ruled out)</strong></li>\n<li>Hyperextension of the neck with early <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> and falls</li>\n<li>In later stages, speech and <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> difficulty and cognitive <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> are present</li>\n</ul>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"442\" src=\"https://image.prepladder.com/content/aa5DMIrXaHDwPqsDO06i1740585459.png\" width=\"480\"/>\n<p><strong>The hummingbird sign (green dotted) refers to the <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of the <span class=\"customMeta\" data-dictid=\"d26464df7216927771923483619265\">midbrain</span> <span class=\"customMeta\" data-dictid=\"179c453c141692777200a24c41363a\">tegmentum</span> with preserved pons. The appearance resembling the head and body of a hummingbird)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticobasal syndrome (CBS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cortical <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> disturbances: apraxia, agnosia, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> limb myoclonus, or alien limb phenomenon (limb assumes a position in space without the patient’s awareness of its location or recognizing that the limb belongs to them)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frontotemporal dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Behavioral, communication, and language issues</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old man presents to the ophthalmologist due to difficulty with his vision following a recent corneal injury. He reports a 6-month history of tremors in his hands and increasing difficulty with speech. His family mentions changes in his behaviour, including increased irritability and episodes of abdominal pain. His eye appears as shown below. Which of the following conditions is most likely associated with this patient?", "options": [{"label": "A", "text": "Wilson’s Disease", "correct": true}, {"label": "B", "text": "Parkinson's Disease", "correct": false}, {"label": "C", "text": "Huntington’s Disease", "correct": false}, {"label": "D", "text": "Spinocerebellar Ataxia", "correct": false}], "correct_answer": "A. Wilson’s Disease", "question_images": ["https://image.prepladder.com/notes/VMivBoro3xtgH9O75cPE1744460639.png"], "explanation_images": ["https://image.prepladder.com/notes/VMivBoro3xtgH9O75cPE1744460639.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Wilson’s Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Autosomal recessive; <strong>ATP7B gene</strong> mutation</li>\n<li>Toxic <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation</li>\n<li>Neurological: dysarthria, tremor, dystonia, parkinsonism</li>\n<li>Other: <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> and psychiatric involvement</li>\n<li>Kayser–Fleischer rings present on examination <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Huntington’s Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Autosomal dominant; <span class=\"customMeta\" data-dictid=\"74dd17aa171692777200dcc186c177\">trinucleotide</span> repeat disorder- <strong>CAG repeats</strong></li>\n<li>Primarily chorea, but can have parkinsonism</li>\n<li>Juvenile <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> (Westphal variant) presents with <span class=\"customMeta\" data-dictid=\"79e3ef49fd16927771947736a23989\">parkinsonism</span> before age 20</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spinocerebellar <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">Ataxia</span> (SCA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Multiple subtypes (SCA2, SCA3, SCA17)</li>\n<li>Parkinsonism can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> PD, especially in SCA2</li>\n<li>Features include ataxia, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy, and additional neurological signs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"5880c0054116927772031676750cea\">FMR1 gene</span> premutation</li>\n<li>Symptoms: cerebellar ataxia, intention tremor, <span class=\"customMeta\" data-dictid=\"79e3ef49fd16927771947736a23989\">parkinsonism</span> (bradykinesia, postural instability)</li>\n<li>Often misdiagnosed as MSA</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Frontotemporal <span class=\"customMeta\" data-dictid=\"41cc5ad93c169277718553c6b948a3\">Dementia</span> with Parkinsonism(Pick’s Disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Typically seen in behavioural variant</li>\n<li>Rigidity and <span class=\"customMeta\" data-dictid=\"4f6882021f1692777183fa4ca2038d\">bradykinesia</span> are prominent</li>\n<li>Variable <span class=\"customMeta\" data-dictid=\"398108f4501692777191f60f958fb2\">levodopa</span> response; associated with tau/TDP-43 pathology</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Neurodegeneration with Brain Iron Accumulation (NBIA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"e2952dfc311692777187fa773bcc9f\">extrapyramidal</span> syndrome</li>\n<li>PKAN: <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">pyramidal</span> and <span class=\"customMeta\" data-dictid=\"e2952dfc311692777187fa773bcc9f\">extrapyramidal</span> features, \"eye-of-the-tiger\" sign on MRI</li>\n<li>PLAN: can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> PD, with good <span class=\"customMeta\" data-dictid=\"398108f4501692777191f60f958fb2\">levodopa</span> response but other neurological signs</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman with a history of psychiatric disorders is being treated for her symptoms with various medications. Considering the pharmacological classes of her current treatment, which of the following medications is least likely to contribute to the development of Parkinsonism?", "options": [{"label": "A", "text": "Haloperidol", "correct": false}, {"label": "B", "text": "Risperidone", "correct": false}, {"label": "C", "text": "Domperidone", "correct": true}, {"label": "D", "text": "Metoclopramide", "correct": false}], "correct_answer": "C. Domperidone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Typical antipsychotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chlorpromazine, Prochlorperazine, Perphenazine, Fluphenazine, Promethazine, Haloperidol, Pimozide, Sulpiride</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Atypical antipsychotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Risperidone, Olanzapine, Ziprasidone, Aripiprazole</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Dopamine depleters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Reserpine, Tetrabenazine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Calcium-channel blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Flunarizine, Cinnarizine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antiemetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Metoclopramide, Levosulpiride, Clebopride</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:599px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Atypical antipsychotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Clozapine, Quetiapine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mood stabilizer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lithium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antiemetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Domperidone, Itopride</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antidepressants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>SSRI: Citalopram, Fluoxetine, Paroxetine, Sertraline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antiepileptic drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Valproic Acid, Phenytoin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man presents with difficulty initiating movements. He experiences a resting tremor in his hands and has noticed a decline in his balance, leading to several near falls. His family mentions he seems less engaged in activities he once enjoyed. He is at risk of developing all non-motor symptoms except:", "options": [{"label": "A", "text": "REM disorders", "correct": false}, {"label": "B", "text": "Decreased sweating", "correct": true}, {"label": "C", "text": "Restless leg syndrome", "correct": false}, {"label": "D", "text": "Urinary urgency", "correct": false}], "correct_answer": "B. Decreased sweating", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Non-Motor Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autonomic Dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Neurogenic <span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\">orthostatic</span> hypotension</li>\n<li>Increased sweating</li>\n<li>Oily skin</li>\n<li>Constipation</li>\n<li>Sexual dysfunction</li>\n<li>Urinary urgency</li>\n<li>Dysphagia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Neuropsychiatric Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Dementia (advanced disease)</li>\n<li>Executive/visuospatial dysfunction</li>\n<li>Visual hallucinations</li>\n<li>Delusions</li>\n<li>Sleep disorders\n\t\t\t\t<ul>\n<li>Insomnia</li>\n<li>Restless leg syndrome</li>\n<li>REM disorders</li>\n<li>Daytime sleepiness with sleep attacks</li>\n<li>Vivid dreams</li>\n<li>Sleep <span class=\"customMeta\" data-dictid=\"c3bbd691781692777203582ec44b8c\">fragmentation</span> (night awakenings)</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Depression</li>\n<li>Anxiety</li>\n<li>Apathy</li>\n<li>Anosmia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect based on the diagnostic criteria for Parkinson's Disease (PD)?", "options": [{"label": "A", "text": "Clinically established PD requires the absence of absolute exclusion criteria", "correct": false}, {"label": "B", "text": "Clinically probable PD can be diagnosed with two red flags and no supportive criteria", "correct": true}, {"label": "C", "text": "One red flag requires at least one supportive criterion for diagnosis", "correct": false}, {"label": "D", "text": "No more than two red flags are allowed for the diagnosis of PD", "correct": false}], "correct_answer": "B. Clinically probable PD can be diagnosed with two red flags and no supportive criteria", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Motor Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Unilateral at onset, with possible <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> side</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Asymmetry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Asymmetric symptoms, often worse on one side</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Unilateral <span class=\"customMeta\" data-dictid=\"300f03be1a169277719719e4585899\">resting tremor</span> (4–6 Hz) that improves with movement and worsens with distraction</li>\n<li>Characterized by a \"pill-rolling\" quality from thumb and finger movements</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rigidity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Increased resistance to <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement</li>\n<li>It can be uniform (lead pipe) or cogwheel (oscillating joint movements)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Akinesia/Bradykinesia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lack of or slowness of movements; manifests as:\n\t\t\t\t<ul>\n<li>Narrow-based shuffling <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> with shortened strides</li>\n<li>Lack of arm swing</li>\n<li>Small handwriting (micrographia)</li>\n<li>Hypomimia (masked face/limited <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expressions)</li>\n<li>Hypophonia (soft speech)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Postural Instability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Characterized by a flexed <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> posture</li>\n<li>Loss of balance during stopping/turning, and an increased risk of frequent falls</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Category</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Criteria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Absolute <span class=\"customMeta\" data-dictid=\"1cc6e4677116927771870a10c66fe7\">Exclusion</span> Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Cerebellar signs</li>\n<li>Supranuclear gaze palsy</li>\n<li>Established diagnosis of BVFTD</li>\n<li>Parkinsonism restricted to lower limbs only for &gt;3 years</li>\n<li>Treatment with antidopaminergic or dopamine-depletion agents</li>\n<li>Absence of response to levodopa</li>\n<li>Sensory-cortical loss</li>\n<li>No evidence of <span class=\"customMeta\" data-dictid=\"6aec63ba2e1692777186e5809a7376\">dopaminergic</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> in functional imaging</li>\n<li>Other parkinsonism-inducing condition</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Red Flags</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Rapid deterioration of gait</li>\n<li>Absence of motor symptom <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> over 5 years</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> dysfunction</li>\n<li>Respiratory dysfunction</li>\n<li>Early severe <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> failure</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> falls due to misbalance</li>\n<li>Disproportionate anterocollis</li>\n<li>Absence of common non-motor features of disease during &gt;5 years</li>\n<li>Pyramidal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> signs</li>\n<li>Bilateral symmetric presentation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Supportive Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Clear and dramatic positive response to <span class=\"customMeta\" data-dictid=\"6aec63ba2e1692777186e5809a7376\">dopaminergic</span> therapy</li>\n<li>Levodopa-induced dyskinesia</li>\n<li>Documentation of <span class=\"customMeta\" data-dictid=\"300f03be1a169277719719e4585899\">resting tremor</span> of a limb</li>\n<li>Positive <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test of either <span class=\"customMeta\" data-dictid=\"30cac2b1a216927771941c69ff66a3\">olfactory</span> loss or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> <span class=\"customMeta\" data-dictid=\"c35382d7d61692777185a1eeeb333c\">denervation</span> on scintigraphy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presents with a 2-year history of progressive motor symptoms, including a resting tremor in his right hand, increased stiffness in his limbs, a shuffling gait, reduced facial expression, and difficulty initiating movement. Using the brain diagram provided, identify the region affected by his condition.", "options": [{"label": "A", "text": "Substantia nigra", "correct": true}, {"label": "B", "text": "Hippocampus", "correct": false}, {"label": "C", "text": "Cerebral cortex", "correct": false}, {"label": "D", "text": "Cerebellum", "correct": false}], "correct_answer": "A. Substantia nigra", "question_images": ["https://image.prepladder.com/notes/9jSBaByV28n0eCdXaxTp1744460356.png"], "explanation_images": ["https://image.prepladder.com/notes/9jSBaByV28n0eCdXaxTp1744460356.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Initial Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Damage to <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> nigra</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Consequence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"6aec63ba2e1692777186e5809a7376\">dopaminergic</span> neurons in <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> <span class=\"customMeta\" data-dictid=\"f2fc45b6181692777193ed78c4835a\">nigra</span> <strong>(pars compacta)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Decrease in <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autopsy findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Depigmentation of <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> nigra</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Microscopic findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Inclusion bodies called Lewy bodies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Composition of Lewy Bodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Composed of α-synuclein (intracellular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> inclusions)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 29 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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He also had an episode of vomiting and a history of weakness on the left side of his body. Which of the following is incorrect regarding hypertensive management in this case?", "options": [{"label": "A", "text": "In hemorrhagic stroke, reduce the BP to less than 160/100 mmHg with antihypertensives to prevent rebleed", "correct": false}, {"label": "B", "text": "In hemorrhagic stroke, aggressive use of IV antihypertensive if SBP &amp;gt; 220", "correct": false}, {"label": "C", "text": "In the ER, multiple blood pressure readings should be taken before starting antihypertensive therapy", "correct": false}, {"label": "D", "text": "In ischemic stroke, BP should be reduced to &amp;lt;140/90 mmHg immediately", "correct": true}], "correct_answer": "D. In ischemic stroke, BP should be reduced to &lt;140/90 mmHg immediately", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "LMN (Lower Motor Neuron) lesions are associated with which of the following? Decrease in muscle tone Spastic paralysis Babinski positive Fasciculations", "options": [{"label": "A", "text": "1, 2", "correct": false}, {"label": "B", "text": "1, 4", "correct": true}, {"label": "C", "text": "1, 2, 3, 4", "correct": false}, {"label": "D", "text": "1, 2, 3", "correct": false}], "correct_answer": "B. 1, 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Upper <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">Motor Neuron</span> (UMN) Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lower <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">Motor Neuron</span> (LMN) Lesion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lesion Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Motor cortex, connection from motor <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> to <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> in pons</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facial nucleus, anywhere along CN VII</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Side</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contralateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscles Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper and lower muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Forehead Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spared, due to <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> UMN innervation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affected</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable; depends on size of lesion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomplete eye <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (dry eyes, corneal ulceration), hyperacusis, loss of taste on <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> tongue</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:480px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Motor <span class=\"customMeta\" data-dictid=\"17d10546871692777193f302d45980\">Neuron</span> Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>UMN Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>LMN Lesion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weakness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrophy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fasciculations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rigidity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reflexes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Babinski sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spastic paresis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flaccid paralysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clasp knife spasticity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In children with Guillain-Barré Syndrome (GBS), all are true except?", "options": [{"label": "A", "text": "Areflexia of the affected limb is a mandatory diagnostic criteria", "correct": false}, {"label": "B", "text": "Plasmapheresis is not preferred in refractory cases", "correct": true}, {"label": "C", "text": "Intravenous immunoglobulin is the first line of management", "correct": false}, {"label": "D", "text": "Albuminocytological dissociation in CSF is characteristic", "correct": false}], "correct_answer": "B. Plasmapheresis is not preferred in refractory cases", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Variant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Autoantibodies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> <span class=\"customMeta\" data-dictid=\"25cf8215eb1692777186f0ab76dc34\">Demyelinating Polyneuropathy</span> (AIDP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common in Europe and North America, marked by <strong>segmental demyelination</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgG Anti-GM1</strong>, <strong>IgG Anti-GQ1b</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Axonal Variants (AMAN/AMSAN)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More prevalent in China and Japan, often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> with <strong>Campylobacter jejuni</strong> infection.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgG Anti-GM1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Miller Fisher Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by a <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> of <strong>ophthalmoplegia, ataxia, and areflexia</strong>, the best-recognized variant.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-GQ1b</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> (distal to proximal)</li>\n<li>Areflexia</li>\n<li>Weakness in legs, causing rubbery legs and <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> to stand</li>\n<li>Truncal paralysis, quadriplegia</li>\n<li>Difficulty handling secretions leading to <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia</li>\n<li>Diaphragmatic <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> or <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> leading to <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure within hours, <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">Ventilatory</span> support required in 30% of cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glove-and-stocking distribution paresthesias</li>\n<li>Loss of proprioception</li>\n<li>Pain in neck/shoulders similar to over-exercised muscles</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autonomic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orthostatic hypotension</li>\n<li>Wide fluctuations of blood pressure</li>\n<li>Arrhythmias</li>\n<li>Neurogenic shock</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lumbar Puncture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> protein (100-1000 mg/dL) with normal <span class=\"customMeta\" data-dictid=\"09be7d1f11169277720210bf5b0280\">WBC</span> count (albuminocytologic dissociation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal findings (&lt;48 hours), protein rise seen by 7 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrodiagnostic Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolonged F-wave latencies, indicating <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> (early in AIDP)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:470px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mnemonic: FAME</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>F</strong>laccid <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> Weakness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Areflexia </strong><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CytoAlbuminologic <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> (Elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> protein, normal WBC)</strong><strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M</strong>onophasic Illness (Symptoms develop over 12 hours to 28 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>E</strong>lectrodiagnostic findings consistent with demyelination</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The CSF findings in bacterial meningitis would include which of the following?", "options": [{"label": "A", "text": "Elevated protein and decreased glucose", "correct": true}, {"label": "B", "text": "Normal white blood cell count", "correct": false}, {"label": "C", "text": "Decreased protein and elevated glucose", "correct": false}, {"label": "D", "text": "Elevated WBC count with normal glucose", "correct": false}], "correct_answer": "A. Elevated protein and decreased glucose", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:698px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predominant Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polymorphonuclear Neutrophils (PMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elevated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fungal/Tubercular Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straw-colored (TB meningitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viral Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or</p>\n<p>Turbid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with fluctuating muscle weakness, especially affecting her speech and swallowing. Repetitive nerve stimulation shows a decremental response. Her blood tests are negative for acetylcholine receptor (AChR) antibodies. Which of the following antibodies is most likely responsible for her symptoms?", "options": [{"label": "A", "text": "Anti-dsDNA antibodies", "correct": false}, {"label": "B", "text": "Anti-MuSK antibodies", "correct": true}, {"label": "C", "text": "Anti-TPO antibodies", "correct": false}, {"label": "D", "text": "Anti-Ro antibodies", "correct": false}], "correct_answer": "B. Anti-MuSK antibodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autoantibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Target</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AChR antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acetylcholine receptors (AChR) on the <span class=\"customMeta\" data-dictid=\"978bd0e89f1692777196add72e1254\">postsynaptic</span> membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks signal transmission, leading to muscle weakness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MuSK antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle-specific <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (MuSK)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impairs AChR clustering and maintenance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in AChR-negative patients; associated with <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> muscle weakness (speech, swallowing, chewing issues)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old patient presents with left-sided arm and leg weakness, right-sided facial paralysis, and difficulty with horizontal eye movements. Based on the clinical presentation, which of the following syndromes is most consistent with these symptoms?", "options": [{"label": "A", "text": "Foville syndrome", "correct": false}, {"label": "B", "text": "Benedict's syndrome", "correct": false}, {"label": "C", "text": "Millard-Gubler syndrome", "correct": true}, {"label": "D", "text": "Wallenberg syndrome", "correct": false}], "correct_answer": "C. Millard-Gubler syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Millard-Gu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Millard-Gubler syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Contralateral <span class=\"customMeta\" data-dictid=\"4e69f1c7691692777188a80c8ffd0d\">hemiplegia</span> (due to <span class=\"customMeta\" data-dictid=\"a218fdbabf1692777185a2d48a9e1c\">corticospinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement), <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> CN VI and VII <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (resulting in <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> and gaze palsy)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Lesion in the <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> pons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Distinguished from other <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> syndromes like Foville (involves more extensive gaze palsy), Benedict’s (midbrain involvement), and Wallenberg (lateral <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> syndrome)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>The clinical features of <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4e69f1c7691692777188a80c8ffd0d\">hemiplegia</span> with <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> CN VI and VII <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> are classic for Millard-Gubler syndrome due to a <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> lesion.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient is having a headache and confusion. A brain tumor diagnosis is made. Family history reveals brain and kidney tumors. Choose the correct option:", "options": [{"label": "A", "text": "Neurofibromatosis", "correct": false}, {"label": "B", "text": "Li fraumeni syndrome", "correct": false}, {"label": "C", "text": "VHL Syndrome", "correct": true}, {"label": "D", "text": "Churg strauss syndrome", "correct": false}], "correct_answer": "C. VHL Syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - VHL\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>VHL syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brain tumors (hemangioblastomas), <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> tumors (renal cell carcinoma), pheochromocytomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmed by genetic testing for VHL gene mutations and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies for tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distinguishing Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of both brain and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> tumors aligns with VHL syndrome</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the confirmatory test for the above condition?", "options": [{"label": "A", "text": "CBNAAT of CSF", "correct": false}, {"label": "B", "text": "PET Scan", "correct": false}, {"label": "C", "text": "NMR Spectroscopy", "correct": true}, {"label": "D", "text": "MRI aerial scan", "correct": false}], "correct_answer": "C. NMR Spectroscopy", "question_images": ["https://image.prepladder.com/content/tsNQMEgOZh54SE8i59yS1724935249.png"], "explanation_images": [], "explanation": "<p>Correct Option C - NMR S\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Condition</strong></td>\n<td>Differentiation between <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">Tuberculoma</span> and <span class=\"customMeta\" data-dictid=\"c3a0aace09169277719372a3673fa8\">Neurocysticercosis</span> in cases of ring-enhancing brain lesions.</td>\n</tr>\n<tr>\n<td><strong>Key <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Modality</strong></td>\n<td>NMR Spectroscopy</td>\n</tr>\n<tr>\n<td><strong>Associated <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Findings</strong></td>\n<td>Ring-enhancing lesions on MRI, which may be indicative of either <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">tuberculoma</span> or neurocysticercosis.</td>\n</tr>\n<tr>\n<td><strong>Rationale for Diagnosis</strong></td>\n<td>NMR <span class=\"customMeta\" data-dictid=\"b858e183101692777198186309ea61\">Spectroscopy</span> provides detailed biochemical and chemical information about lesions, helping <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">tuberculoma</span> and neurocysticercosis.</td>\n</tr>\n<tr>\n<td><strong>Differential Diagnosis</strong></td>\n<td>Use of <span class=\"customMeta\" data-dictid=\"b52e55eaf516927771936aa6597a65\">NMR</span> <span class=\"customMeta\" data-dictid=\"b858e183101692777198186309ea61\">Spectroscopy</span> to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">tuberculoma</span> (caused by TB) and <span class=\"customMeta\" data-dictid=\"c3a0aace09169277719372a3673fa8\">neurocysticercosis</span> (caused by <span class=\"customMeta\" data-dictid=\"257d4bebe61692777200356be57185\">Taenia</span> solium).</td>\n</tr>\n<tr>\n<td><strong>Importance of Confirmation</strong></td>\n<td>Accurate <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> between these conditions is crucial for appropriate treatment decisions (antitubercular therapy vs. <span class=\"customMeta\" data-dictid=\"d12d4e204f16927771816b085d8b78\">antiparasitic</span> therapy).</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Seizures are seen in what percentage of RTA patients with brain contusion/loss of consciousness?", "options": [{"label": "A", "text": "Development of seizures in 17%", "correct": true}, {"label": "B", "text": "Development of seizures in 45%", "correct": false}, {"label": "C", "text": "Development of seizures in 75%", "correct": false}, {"label": "D", "text": "No relation between trauma and seizures", "correct": false}], "correct_answer": "A. Development of seizures in 17%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient had features of resting tremors, bradykinesia, and postural instability. He became bedridden and died due to respiratory failure. A brain biopsy is likely to show which of the following?", "options": [{"label": "A", "text": "Lewy bodies", "correct": true}, {"label": "B", "text": "Hirano bodies", "correct": false}, {"label": "C", "text": "Guarneri bodies", "correct": false}, {"label": "D", "text": "Negri bodies", "correct": false}], "correct_answer": "A. Lewy bodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Pathophysiology of Parkinson’s Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Damage to <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> nigra</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Consequence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"6aec63ba2e1692777186e5809a7376\">dopaminergic</span> neurons in <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> <span class=\"customMeta\" data-dictid=\"f2fc45b6181692777193ed78c4835a\">nigra</span> <strong>(pars compacta)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Decrease in <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Autopsy findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Depigmentation of <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> nigra</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Microscopic findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Inclusion bodies called <strong>Lewy bodies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Composition of Lewy Bodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Composed of α-synuclein (intracellular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> inclusions)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient is having the following hand movements. In which of the following conditions would this be seen?", "options": [{"label": "A", "text": "Thyrotoxicosis", "correct": false}, {"label": "B", "text": "Hypercarbia", "correct": true}, {"label": "C", "text": "Hemiballismus", "correct": false}, {"label": "D", "text": "Hypoxia", "correct": false}], "correct_answer": "B. Hypercarbia", "question_images": ["https://image.prepladder.com/content/4ibSmf9JnLAr5V6DhQ0Y1747302620.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the outpatient department with complaints of daytime sleepiness and nighttime sleeplessness. His wife reports that he snores at night. Which of the following statements about his condition is incorrect?", "options": [{"label": "A", "text": "The tone of the pharyngeal muscles is increased", "correct": true}, {"label": "B", "text": "Low oxygen saturation triggers waking up at night", "correct": false}, {"label": "C", "text": "Episodes of apnea increase stress on the heart", "correct": false}, {"label": "D", "text": "Low oxygen stimulates respiratory effort", "correct": false}], "correct_answer": "A. The tone of the pharyngeal muscles is increased", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - The tone of the pharyngeal muscles is increased: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following is a risk factor for secondary headache and need further workup except?", "options": [{"label": "A", "text": "50 years old with first severe headache", "correct": false}, {"label": "B", "text": "Presence of cord-like vessels in the temporal area", "correct": false}, {"label": "C", "text": "Cocaine abuse", "correct": true}, {"label": "D", "text": "Subacute worsening of headache symptoms", "correct": false}], "correct_answer": "C. Cocaine abuse", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Cocaine abuse: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old girl presents with generalized muscle weakness and protrusion of the eyelids (ptosis) that worsens as the day progresses. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia Gravis", "correct": true}, {"label": "B", "text": "Fibromyalgia", "correct": false}, {"label": "C", "text": "Myotonic Dystrophy", "correct": false}, {"label": "D", "text": "Guillain-Barré Syndrome", "correct": false}], "correct_answer": "A. Myasthenia Gravis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:580px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Affected Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ocular muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mimics central eye movement disorders.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cogan's lid <span class=\"customMeta\" data-dictid=\"4f7448b3e51692777201ff5cafde0d\">twitch</span> sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> rises briefly after looking down for some time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shoulder <span class=\"customMeta\" data-dictid=\"a1d37a92d41692777188e12a817797\">girdle</span> muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Difficulty in overhead activities like combing hair.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weakness may cause <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> risks.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with a unilateral throbbing headache that worsens with exposure to bright light. She occasionally skips breakfast. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hunger headache", "correct": false}, {"label": "B", "text": "Migraine", "correct": true}, {"label": "C", "text": "Tension headache", "correct": false}, {"label": "D", "text": "Cluster headache", "correct": false}], "correct_answer": "B. Migraine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features of Migraine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Premonitory (Prodromal) Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neck discomfort</li>\n<li>Cognitive <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> (brain “fog”)</li>\n<li>Mood changes</li>\n<li>Fatigue</li>\n<li>Yawning/sleepiness</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> and thirst</li>\n<li>Food cravings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aura</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neurologic disturbances (e.g., visual disturbances like scintillating scotoma)</li>\n<li>Due to Cerebral vasoconstriction. Therefore prevention is by Vasodilators.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Headache Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Nausea/vomiting</li>\n<li>Sensory sensitivities:\n\t\t\t\t<ul>\n<li>Photophobia (sensitivity to light)</li>\n<li>Phonophobia (sensitivity to sound)</li>\n<li>Osmophobia (sensitivity to smells)</li>\n<li>Allodynia (pain from non-painful stimuli)</li>\n<li>Vertigo</li>\n</ul>\n</li>\n<li>Due to cerebral vasodilation. So treatment is Vasoconstrictors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Postdrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tiredness</li>\n<li>Weariness</li>\n<li>Impaired concentration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Simplified Diagnostic Criteria for <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">Migraine</span> by International Headache Society:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Criteria:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Repeated attacks of headache lasting 4–72h in patients with a normal physical examination, no other reasonable cause for the headache, and:</p>\n<p> </p>\n<p><strong>At least 2 of the following features:</strong></p>\n<ul>\n<li><strong>Unilateral pain</strong></li>\n<li><strong>Throbbing pain</strong></li>\n<li>Aggravation by movement</li>\n<li>Moderate or severe intensity</li>\n</ul>\n<p> </p>\n<p><strong>Plus at least 1 of the following features: </strong></p>\n<ul>\n<li>Nausea/vomiting</li>\n<li><strong>Photophobia </strong>and phonophobia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lumbar puncture was performed on a patient in a sitting position, and the patient is now experiencing a very severe headache. Which of the following is NOT a recommended management strategy for a post-lumbar puncture headache?", "options": [{"label": "A", "text": "Lie in a supine position", "correct": false}, {"label": "B", "text": "Administer intravenous caffeine", "correct": false}, {"label": "C", "text": "Restrict water intake", "correct": true}, {"label": "D", "text": "Perform a low-volume blood patch", "correct": false}], "correct_answer": "C. Restrict water intake", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man experiences initial paralysis in both legs, which then progresses to affect both upper limbs as well. Over time, he shows slight improvement in upper limbs but no improvement in his lower trunk and both legs. Based on this description, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Diplegia", "correct": true}, {"label": "B", "text": "Quadriplegia", "correct": false}, {"label": "C", "text": "Paraplegia", "correct": false}, {"label": "D", "text": "Monoplegia", "correct": false}], "correct_answer": "A. Diplegia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient presents with fever, headache, and vomiting that have persisted for the past 2 weeks. On examination, nuchal rigidity is noted. The results of a lumbar puncture (LP) are as follows: Opening Pressure: Elevated Cells: Predominantly polymorphonuclear leukocytes (PMNs) Sugar: 35 mg/dl Protein: 200 mg/dl Color: Slightly cloudy appearance Based on these findings, which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Meningoencephalitis", "correct": false}, {"label": "B", "text": "Viral Meningitis", "correct": false}, {"label": "C", "text": "Tuberculosis Meningitis", "correct": false}, {"label": "D", "text": "Bacterial Meningitis", "correct": true}], "correct_answer": "D. Bacterial Meningitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Predominant Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polymorphonuclear Neutrophils (PMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fungal/Tubercular Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Straw-colored (TB meningitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Viral Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or</p>\n<p>Turbid</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with ptosis, diplopia, and generalized muscle weakness that worsens with activity and improves with rest. She has difficulty chewing and swallowing, especially in the evening. A Tensilon test is positive. Which investigation is most likely to confirm the diagnosis?", "options": [{"label": "A", "text": "CT scan of the chest", "correct": false}, {"label": "B", "text": "SFEMG", "correct": true}, {"label": "C", "text": "Anti-acetylcholine receptor antibody test", "correct": false}, {"label": "D", "text": "MRI of the brain", "correct": false}], "correct_answer": "B. SFEMG", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Evaluation: Recognizing the Signs</strong></p>\n<ul>\n<li><strong>History:</strong>\n<ul>\n<li>Focus on the onset, progression, <span class=\"customMeta\" data-dictid=\"e127a25c621692777186ed98a403f9\">diurnal</span> variation and fluctuating muscle weakness.</li>\n</ul>\n</li>\n<li><strong>Physical Examination:</strong>\n<ul>\n<li>Assess muscle strength.</li>\n<li>Identify characteristic signs:\n\t\t\t\t\t<ul>\n<li>Ptosis</li>\n<li>Diplopia</li>\n<li>Cogan's lid <span class=\"customMeta\" data-dictid=\"4f7448b3e51692777201ff5cafde0d\">twitch</span> sign</li>\n</ul>\n</li>\n<li>Rule out other neurological conditions.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Tests: Confirming the Suspicion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tensilon Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administers edrophonium <span class=\"customMeta\" data-dictid=\"749f9a02041692777183f4f13efcc5\">bromide</span> intravenously.</li>\n<li>May show <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> muscle function improvement; not highly reliable.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Repetitive Nerve <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> (RNS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Specialized nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> study.</li>\n<li>Reveals a <span class=\"customMeta\" data-dictid=\"6c8c4bed32169277718685fa72d8d1\">decremental response</span> in <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> with repeated stimulation, indicating impaired <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> transmission.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Single Fiber Electromyography (SFEMG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>SFEMG techniques allow assessment of two important features of the motor unit: <span class=\"customMeta\" data-dictid=\"1d0e5cde0f169277719080688fceb7\">jitter</span> and <span class=\"customMeta\" data-dictid=\"2a75426b7c16927772022a333fb6fa\">fiber density</span> (FD).</li>\n<li>SFEMG is the<strong> most sensitive clinical test </strong>for <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> disease and is often <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> in clinically unaffected muscles in patients with <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">myasthenia</span> gravis (MG) and Lambert-Eaton <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">myasthenia</span> (LEM).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antibody Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detects auto-antibodies related to MG.</li>\n<li><strong>Acetylcholine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> (AChR) Antibodies:</strong> Most common, block AChR function.</li>\n<li><strong>Muscle-Specific Kinase (MuSK) Antibodies:</strong> Disrupt AChR clustering and stabilization.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thoracic CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Essential to rule out thymoma, especially in patients with negative AChR <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> tests.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is observed in the case of an abnormal accumulation of misfolded protein?", "options": [{"label": "A", "text": "Creutzfeldt jakob disease", "correct": true}, {"label": "B", "text": "Nephritic syndrome", "correct": false}, {"label": "C", "text": "Sickle cell anemia", "correct": false}, {"label": "D", "text": "Megaloblastic anemia", "correct": false}], "correct_answer": "A. Creutzfeldt jakob disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Creutzfeldt jak\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male patient suffers from schizophrenia. He is currently receiving clozapine treatment. Why does he require frequent blood monitoring?", "options": [{"label": "A", "text": "Agranulocytosis", "correct": true}, {"label": "B", "text": "Myocarditits", "correct": false}, {"label": "C", "text": "Cerebral bleed", "correct": false}, {"label": "D", "text": "Seizures", "correct": false}], "correct_answer": "A. Agranulocytosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Agranu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly patient was brought to the OPD with complaints of tremors, stoop posture and slow movements. His son also gives a history of the patient forgetting day to day activities. What is the possible cause of this condition?", "options": [{"label": "A", "text": "Normal pressure hydrocephalus (NPH)", "correct": false}, {"label": "B", "text": "Hypothyroidism", "correct": false}, {"label": "C", "text": "Lewy body", "correct": true}, {"label": "D", "text": "Vitamin B12 deficiency", "correct": false}], "correct_answer": "C. Lewy body", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 year old man present with sudden onset of right sided hemiparesis for last 3 hours. BP is 200/100 mmHg. NCCT Head showed brain bleed and right hemiparesis. All of the following are to be done for management, Except?", "options": [{"label": "A", "text": "Thrombolysis", "correct": true}, {"label": "B", "text": "BP Control", "correct": false}, {"label": "C", "text": "Edema management", "correct": false}, {"label": "D", "text": "Elective hyperventilation", "correct": false}], "correct_answer": "A. Thrombolysis", "question_images": ["https://image.prepladder.com/content/2mOGpEJOPfjS8POg8ryK1692706376.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old patient weighing 80 kilograms has been diagnosed with an acute ischemic stroke and is recommended for thrombolysis with alteplase. What should the initial stat dose in milligrams be?", "options": [{"label": "A", "text": "8", "correct": true}, {"label": "B", "text": "10", "correct": false}, {"label": "C", "text": "12", "correct": false}, {"label": "D", "text": "15", "correct": false}], "correct_answer": "A. 8", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presents with movement disorder and tremors in hand, along with the development of cognitive and emotional problems. Which of the following medical disorders is the likely diagnosis?", "options": [{"label": "A", "text": "Parkinson's disease", "correct": false}, {"label": "B", "text": "Frederich's ataxia", "correct": false}, {"label": "C", "text": "Alzheimer’s disease", "correct": false}, {"label": "D", "text": "Huntington's disease", "correct": true}], "correct_answer": "D. Huntington's disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Hunting\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "65-year-old man is brought to the hospital with complaints of suddenly not making any sense while speaking using non-sensical grammar though he can speak quickly. He could communicate effectively prior to this. Which of the following defect is present in this patient?", "options": [{"label": "A", "text": "Motor aphasia", "correct": false}, {"label": "B", "text": "Anomic aphasia", "correct": false}, {"label": "C", "text": "Fluent aphasia", "correct": true}, {"label": "D", "text": "Conduction aphasia", "correct": false}], "correct_answer": "C. Fluent aphasia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Fluent aph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Scissoring gait will occur due to increases firing of Which of the following nerve?", "options": [{"label": "A", "text": "Superior gluteal nerve", "correct": false}, {"label": "B", "text": "Inferior gluteal nerve", "correct": false}, {"label": "C", "text": "Obturator nerve", "correct": true}, {"label": "D", "text": "Femoral nerve", "correct": false}], "correct_answer": "C. Obturator nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"215af9957a1692777194e73b21a340\"&gt;Obturator&lt;/span&gt; Nerv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient diagnosed with Dialysis Dementia, what deposition is seen in the cerebral cortex?", "options": [{"label": "A", "text": "Amyloid beta-2", "correct": true}, {"label": "B", "text": "Amyloid beta microglobulin", "correct": false}, {"label": "C", "text": "Amyloid transthyretin", "correct": false}, {"label": "D", "text": "Amyloid Beta", "correct": false}], "correct_answer": "A. Amyloid beta-2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Amyloid beta-2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Antibody seen in Acute Inflammatory Demyelinating Polyneuropathy will belong to which class?", "options": [{"label": "A", "text": "Ig G", "correct": true}, {"label": "B", "text": "Ig M", "correct": false}, {"label": "C", "text": "Ig E", "correct": false}, {"label": "D", "text": "Ig A", "correct": false}], "correct_answer": "A. Ig G", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - (IgG)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient presents with high-grade fever for the past week. On examination neck stiffness and Kernig's sign were positive. CSF analysis showed lymphocytosis protein - 8 g/L, glucose - 20 mg/dl while RBS = 140 mg/dl. What is your diagnosis?", "options": [{"label": "A", "text": "Tubercular meningitis", "correct": true}, {"label": "B", "text": "Coxsackie meningitis", "correct": false}, {"label": "C", "text": "Bacterial meningitis", "correct": false}, {"label": "D", "text": "HSV -1 encephalitis", "correct": false}], "correct_answer": "A. Tubercular meningitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LRXPegyBrxT9XqPk7OI81745925190.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Symptoms and Clinical Features:</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Headache</strong>, slight <strong>mental changes</strong>, and <strong>low-grade fever</strong> can develop over weeks, often accompanied by <strong>malaise</strong>, <strong>anorexia</strong>, and <strong>irritability</strong>.</li>\n<li>More severe cases present with <strong>confusion</strong>, <strong>lethargy</strong>, <strong>neck rigidity</strong>, and <strong>altered sensorium</strong>.</li>\n<li>Disease progression: evolves over 1–2 weeks, longer than bacterial meningitis.</li>\n<li><strong>Cranial nerve palsies</strong>, especially <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> nerves, are common due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> at the base of the brain.</li>\n<li>May result in <strong>coma</strong>, <strong>hydrocephalus</strong>, and <strong>intracranial hypertension</strong> if untreated.</li>\n<li><strong>Cerebral ischemia</strong> can result from the involvement of cerebral arteries.</li>\n<li><strong>Tuberculoma</strong> (space-occupying lesion) may cause seizures and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological signs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>CSF Findings:</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Elevated <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count</strong> (up to 1000/μL, predominantly lymphocytes).</li>\n<li><strong>High protein content</strong> (1-8 g/L).</li>\n<li><strong>Low glucose</strong><strong> concentration</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Investigation of Choice:</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Culture of CSF</strong> (gold standard, takes 4-8 weeks, positive in ~50%).</li>\n<li><strong>Smear for <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB)</strong> (low sensitivity, positive in 10-40%).</li>\n<li><strong>PCR</strong> for <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> DNA (variable sensitivity).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Imaging:</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT/MRI</strong> may show <strong>hydrocephalus</strong> and <strong>abnormal enhancement</strong> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns or ependyma.</li>\n<li><strong>Tuberculomas</strong> appear as contrast-enhanced ring lesions on imaging.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ma, Huanjie &amp; Liu, Yuan &amp; Zhuang, Caiyu &amp; Shen, Yuanyu &amp; Wu, Renhua. \" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Axial-a-coronal-b-and-sagittal-c-contrast-enhanced-T1-weighted-MRI-demonstrate_fig1_329533654\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/LRXPegyBrxT9XqPk7OI81745925190.png\" width=\"3841\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>MRI showing ring-enhanced lesions- tuberculoma</strong><strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Treatment:</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Empirical therapy</strong> is often initiated based on suspicion.</li>\n<li><strong>Initial drug regimen</strong>: Isoniazid, Rifampin, Pyrazinamide, Ethambutol, and Pyridoxine.</li>\n<li><strong>Duration</strong>: 6–12 months depending on response.</li>\n<li><strong>Dexamethasone</strong> (12–16 mg/day) for 3 weeks, tapered for 3 more weeks (recommended for HIV-negative patients).</li>\n<li><strong>Tuberculoma</strong> may require a <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for diagnosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Predominant Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bacterial Meningitis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polymorphonuclear Neutrophils (PMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fungal/</strong><strong>Tubercular</strong><strong> Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straw-colored (TB meningitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viral Meningitis</strong></p>\n<p><strong>(Option B &amp; D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Turbid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A stroke patient presents with an inability to identify objects but can determine the colour, texture, and shape of objects. Which of the following lobes is involved?", "options": [{"label": "A", "text": "Frontal lobe", "correct": false}, {"label": "B", "text": "Parietal lobe", "correct": false}, {"label": "C", "text": "Temporal lobe", "correct": true}, {"label": "D", "text": "Occipital lobe", "correct": false}], "correct_answer": "C. Temporal lobe", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features of Left <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">Lobe</span> Stroke</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features of Right <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">Lobe</span> Stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Impaired language and memory: </strong>Difficulty with spoken language and remembering verbal information.</li>\n<li><strong>Fluent (Wernicke’s) aphasia: </strong>Fluent speech with incorrect words, affecting language comprehension.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Poor <span class=\"customMeta\" data-dictid=\"2e00fbba5016927772022f51502629\">visual memory</span> and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> awareness: </strong>Difficulty recognizing visual patterns and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> information.</li>\n<li><strong>Prosopagnosia</strong>: Inability to recognize faces, including familiar ones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>General Features of <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">Lobe</span> Stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Poor memory: </strong>Difficulty recalling memories and learning new information.</li>\n<li><strong>Prosopagnosia: </strong>Trouble recognizing faces and objects.</li>\n<li><strong>Fluent aphasia: </strong>Specifically in left-sided strokes, affecting speech fluency but with incorrect word use.</li>\n<li><strong>Visual perception difficulties: </strong>Challenges with interpreting the <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> and surroundings.</li>\n<li><strong>Trouble processing sound:</strong> Inability to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> or process sounds correctly.</li>\n<li><strong>Visual agnosia: </strong>Inability to recognize visually presented objects despite otherwise normal visual field, acuity, colour vision, brightness, discrimination, language, and memory.</li>\n<li><strong>Emotional and behavioural changes:</strong> Varying behaviours due to damage to the amygdala, such as aggression, passiveness, or difficulty interpreting <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> cues.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is brought to the OPD by his wife complaining about difficulty in expressing emotions and not taking part in daily activities. On examination, resting tremors and rigidity are noted. Given the possible diagnosis, which part of the brain is affected in this patient?", "options": [{"label": "A", "text": "Basal ganglia", "correct": true}, {"label": "B", "text": "Hippocampus", "correct": false}, {"label": "C", "text": "Cerebellum", "correct": false}, {"label": "D", "text": "Premotor cortex", "correct": false}], "correct_answer": "A. Basal ganglia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\"&gt;Basal&lt;/span&gt; gang\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Area of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Consequences </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Frontal Lobe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Disinhibition and deficits in concentration, orientation, judgment</li>\n<li>May have reemergence of <span class=\"customMeta\" data-dictid=\"6d6e7d903b169277719662541dd5e2\">primitive</span> reflexes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Frontal Eye Fields</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eyes look toward the lesion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Paramedian <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">Pontine</span> <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">Reticular</span> Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eyes look away from the side of the lesion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medial <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">Longitudinal</span> Fasciculus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Internuclear <span class=\"customMeta\" data-dictid=\"2cc1b4ff2216927771940a80e764a2\">ophthalmoplegia</span> (impaired <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> eye; <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> of <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> eye with abduction).</li>\n<li>Eg: Multiple sclerosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dominant <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">Parietal</span> Cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gerstmann syndrome: </strong>Agraphia, acalculia, finger agnosia, left-right disorientation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nondominant <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">Parietal</span> Cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hemispatial <span class=\"customMeta\" data-dictid=\"bc4fd945b61692777193cadcf42cfb\">neglect</span> syndrome: </strong>Agnosia of the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> side of the world.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hippocampus (Bilateral)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterograde amnesia: Inability to make new memories.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Basal Ganglia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>May result in tremors at rest, chorea, and athetosis.</li>\n<li>Eg: Parkinson disease, Huntington disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subthalamic Nucleus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contralateral hemiballismus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mammillary Bodies (Bilateral)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Wernicke-Korsakoff syndrome: </strong>Confusion, ataxia, nystagmus, ophthalmoplegia, memory loss (anterograde and <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> amnesia), confabulation, personality changes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Amygdala (Bilateral)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Klüver-Bucy syndrome: </strong>Disinhibited behavior (eg, hyperphagia, hypersexuality, hyperorality).</li>\n<li>Eg: HSV-1 encephalitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Superior Colliculus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Parinaud syndrome: </strong>Paralysis of <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">conjugate</span> vertical gaze (rostral <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> also involved).</li>\n<li>Eg: Stroke, hydrocephalus, pinealoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reticular Activating System (Midbrain)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reduced levels of <span class=\"customMeta\" data-dictid=\"bf639c9a2316927771825e1632d9fb\">arousal</span> and <span class=\"customMeta\" data-dictid=\"882ef330fb16927772022093f7518f\">wakefulness</span> (eg, coma).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cerebellar Hemisphere</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intention tremor, limb ataxia, loss of balance; damage to <span class=\"customMeta\" data-dictid=\"a9c41a58d816927771847775d63d96\">cerebellum</span> → <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> deficits; fall toward side of lesion.</li>\n<li>(Cerebellar hemispheres are laterally located and affect <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> limbs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cerebellar Vermis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Truncal ataxia</li>\n<li>Dysarthria</li>\n<li>(Vermis is centrally located and affects central body)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presented to the emergency room with seizures. He has a history of fever, headache, and confusion. An MRI brain was done, and it showed inflammation involving the bitemporal lobe. What is the most likely etiology for this presentation?", "options": [{"label": "A", "text": "Cytomegalovirus", "correct": false}, {"label": "B", "text": "Toxoplasma gondii", "correct": false}, {"label": "C", "text": "Herpes simplex virus", "correct": true}, {"label": "D", "text": "Mycobacterium tuberculosis", "correct": false}], "correct_answer": "C. Herpes simplex virus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wXxKq1GTlkJ95fi4DbdB1745317164.png"], "explanation": "<p>Correct Answer C - Herpes simplex virus</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CSF findings in <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glucose (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Protein (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>WBC (per µL)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Bacterial </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&lt;40</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&gt;45</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&gt;1000</p>\n<p style=\"text-align:center\">(PMNs)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Viral </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">20-80</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">25-500</p>\n<p style=\"text-align:center\">(Predominantly lymphocytes)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TB </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&lt;50 in 75% cases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">100-200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">25-100</p>\n<p style=\"text-align:center\">(Predominantly lymphocytes)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fungal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓ to normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">150-300</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">40-600</p>\n<p style=\"text-align:center\">(Lymphocytes or PMNs, depending on the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organism)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Parasitic </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">50-200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">150-2000</p>\n<p style=\"text-align:center\">(↑↑ Eosinophils) (≥50%)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presents with sensory loss and weakness of limbs for 3 months. He also has angular stomatitis. On examination, there is loss of proprioception, vibration sensations, UMN-type lower limb weakness, and absent ankle reflex. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Extradural cord compression", "correct": false}, {"label": "B", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "C", "text": "Multiple sclerosis", "correct": false}, {"label": "D", "text": "Subacute combined degeneration of the cord", "correct": true}], "correct_answer": "D. Subacute combined degeneration of the cord", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9wvg5iydcOXxkZYRf1g51745917379.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 78-year-old woman presents with a progressive decline in daily activity. She gives a history of convulsions and visual hallucinations. She does not talk to anyone and keeps looking at the sky. Pathological examination shows the presence of Lewy bodies within the neurons. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Parkinson's disease", "correct": true}, {"label": "B", "text": "Prion disease", "correct": false}, {"label": "C", "text": "Huntington's chorea", "correct": false}, {"label": "D", "text": "Alzheimer's disease", "correct": false}], "correct_answer": "A. Parkinson's disease", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Alzheimer's Disease (AD) (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common type of dementia, characterized by <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> plaques and <span class=\"customMeta\" data-dictid=\"349c5a4f5d169277720062d348498a\">tau</span> tangles in the brain.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Memory loss, especially short-term memory</li>\n<li>Disorientation</li>\n<li>Language difficulties</li>\n<li>Impaired judgment and reasoning</li>\n<li>Personality changes</li>\n<li>Progressive cognitive decline2</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vascular Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Results from damage to blood vessels in the brain, leading to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow. Often follows a stroke or series of small strokes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stepwise <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of cognitive decline</li>\n<li>Memory loss</li>\n<li>Impaired executive function</li>\n<li>Gait disturbances</li>\n<li>Personality and mood changes</li>\n<li>Signs of previous strokes (e.g., hemiparesis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lewy Body Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> protein deposits (Lewy bodies) in the brain, affecting cognitive and motor functions.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visual hallucinations</li>\n<li>Parkinsonism (e.g., tremor, rigidity)</li>\n<li>Cognitive fluctuations</li>\n<li>Memory impairment</li>\n<li>REM sleep behavior disorder</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Frontotemporal <span class=\"customMeta\" data-dictid=\"41cc5ad93c169277718553c6b948a3\">Dementia</span> (FTD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Characterized by <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> in the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> and <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> lobes, often with personality and behavioral changes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Personality and behavior changes (e.g., disinhibition, apathy)</li>\n<li>Language difficulties (e.g., aphasia)</li>\n<li>Lack of empathy</li>\n<li>Impulsive behaviors</li>\n<li>Social withdrawal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mixed Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A combination of Alzheimer's disease and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> dementia. Common in elderly patients.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms of both Alzheimer's and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> dementia</li>\n<li>Cognitive decline with stepwise progression</li>\n<li>Memory problems</li>\n<li>Behavioral changes</li>\n<li>Motor problems (e.g., <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> disturbances)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Parkinson's Disease Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs in patients with Parkinson's disease, typically years after motor symptoms begin.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Memory loss</li>\n<li>Cognitive impairment</li>\n<li>Attention deficits</li>\n<li>Executive dysfunction</li>\n<li>Visual hallucinations</li>\n<li>Parkinsonism (e.g., bradykinesia, tremor)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Huntington's Disease</strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Genetic disorder characterized by progressive motor, cognitive, and psychiatric decline.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involuntary movements (chorea)</li>\n<li>Memory impairment</li>\n<li>Personality changes (e.g., irritability, depression)</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> and motor function</li>\n<li>Progressive dementia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Creutzfeldt-Jakob Disease (CJD)</strong></p>\n<p style=\"text-align:center\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare <strong>prion disease </strong>causing rapid neurodegeneration, often with fatal progression.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid onset of dementia</li>\n<li>Motor symptoms (e.g., ataxia, myoclonus)</li>\n<li>Visual disturbances</li>\n<li>Psychiatric symptoms (e.g., depression)</li>\n<li>Death usually within 1-2 years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Wernicke-Korsakoff Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficiency, often due to alcohol abuse. Can lead to brain damage and dementia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Amnesia (anterograde and retrograde)</li>\n<li>Confabulation</li>\n<li>Ataxia</li>\n<li>Nystagmus</li>\n<li>Neurological abnormalities due to <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficiency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Normal Pressure <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">Hydrocephalus</span> (NPH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A condition where <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid accumulates in the brain ventricles, leading to cognitive decline.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gait disturbances (shuffling walk)</li>\n<li>Urinary incontinence</li>\n<li>Dementia</li>\n<li>Enlargement of the ventricles on brain imaging</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with a fever for 11 days with neck rigidity. A lumbar puncture was done, and it showed predominantly lymphocytes, sugar- 50mg, and protein- 3000mg/dl. Cobweb coagulum was noted. Gram-staining was negative. The patient's chest X-ray shows upper lobe involvement with hilar lymph node enlargement.", "options": [{"label": "A", "text": "Tuberculous meningitis", "correct": true}, {"label": "B", "text": "Bacterial meningitis", "correct": false}, {"label": "C", "text": "Fungal meningitis", "correct": false}, {"label": "D", "text": "Viral meningitis", "correct": false}], "correct_answer": "A. Tuberculous meningitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/a3EMLFScCiRRxQgk2lNH1746188962.png", "https://image.prepladder.com/content/Yz8DGL2bN8FqpeYrp6mC1746188971.png"], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\"&gt;Tuberculous&lt;/span&gt; meningitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tuberculous Meningitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms and Clinical Features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Headache</strong>, slight <strong>mental changes</strong>, and <strong>low-grade fever</strong> can develop over weeks, often accompanied by <strong>malaise</strong>, <strong>anorexia</strong>, and <strong>irritability</strong>.</p>\n</li>\n<li>\n<p>More severe cases present with <strong>confusion</strong>, <strong>lethargy</strong>, <strong>neck rigidity</strong>, and <strong>altered sensorium</strong>.</p>\n</li>\n<li>\n<p>Disease progression: evolves over 1–2 weeks, longer than bacterial meningitis.</p>\n</li>\n<li>\n<p><strong>Cranial nerve palsies</strong>, especially <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> nerves, are common due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> at the base of the brain.</p>\n</li>\n<li>\n<p>May result in <strong>coma</strong>, <strong>hydrocephalus</strong>, and <strong>intracranial hypertension</strong> if untreated.</p>\n</li>\n<li>\n<p><strong>Cerebral ischemia</strong> can result from the involvement of cerebral arteries.</p>\n</li>\n<li>\n<p><strong>Tuberculoma</strong> (space-occupying lesion) may cause seizures and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological signs.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CSF Findings:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Elevated <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count</strong> (up to 1000/μL, predominantly lymphocytes).</p>\n</li>\n<li>\n<p><strong>High protein content</strong> (1–8 g/L).</p>\n</li>\n<li>\n<p><strong>Cobweb Coagulum: </strong>Clear fluid in a test tube with a cobweb at the bottom</p>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"557\" src=\"https://image.prepladder.com/content/a3EMLFScCiRRxQgk2lNH1746188962.png\" width=\"557\"/></p>\n<ul>\n<li>\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> concentration</strong>.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation of Choice:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Culture of CSF</strong> (gold standard, takes 4–8 weeks, positive in ~50%).</p>\n</li>\n<li>\n<p><strong>Smear for <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB)</strong> (low sensitivity, positive in 10–40%).</p>\n</li>\n<li>\n<p><strong>PCR</strong> for Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> DNA (variable sensitivity).</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>CT/MRI</strong> may show <strong>hydrocephalus</strong> and <strong>abnormal enhancement</strong> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns or ependyma.</p>\n</li>\n<li>\n<p><strong>Tuberculomas</strong> appear as contrast-enhanced ring lesions on imaging.</p>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Morteza Sanei Taheri, Mohammad Ali Karimi, Hamidreza Haghighatkhah, Ramin Pourghorban, Mohammad Samadian, Hosein Delavar Kasmaei\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2015/202806\" data-tags=\"\" height=\"405\" src=\"https://image.prepladder.com/content/Yz8DGL2bN8FqpeYrp6mC1746188971.png\" width=\"355\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>MRI showing ring-enhanced lesions -tuberculoma </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Empirical therapy</strong> is often initiated based on suspicion.</p>\n</li>\n<li>\n<p><strong>Initial drug regimen</strong>: isoniazid, rifampin, pyrazinamide, ethambutol, and pyridoxine.</p>\n</li>\n<li>\n<p><strong>Duration</strong>: 6–12 months depending on response.</p>\n</li>\n<li>\n<p><strong>Dexamethasone</strong> (12–16 mg/day) for 3 weeks, tapered for 3 more weeks (recommended for HIV-negative patients).</p>\n</li>\n<li>\n<p><strong>Tuberculoma</strong> may require a <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for diagnosis.</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presents with a severe headache. He has never experienced a headache of this severity before. He has hypertension and nuchal rigidity on examination. Which of the following could be the diagnosis?", "options": [{"label": "A", "text": "Cluster headache", "correct": false}, {"label": "B", "text": "Subarachnoid haemorrhage", "correct": true}, {"label": "C", "text": "Encephalitis", "correct": false}, {"label": "D", "text": "Meningitis", "correct": false}], "correct_answer": "B. Subarachnoid haemorrhage", "question_images": ["https://image.prepladder.com/content/LJwnJvESxw27H5DP8wlw1746189105.png"], "explanation_images": ["https://image.prepladder.com/content/EGVS1inb7DWN05YHQTla1746189320.png"], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\"&gt;Subarachnoid&lt;/span&gt; haemorrhage</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subarachnoid hemorrhage- Etiology, Risk factors and Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Subarachnoid <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">Hemorrhage</span> (SAH): Blood accumulation in the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space.</p>\n</li>\n<li>\n<p>Causes: Often due to <strong>aneurysm <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> (~85%) </strong>or <strong>trauma</strong>.</p>\n</li>\n<li>\n<p><strong>Non-traumatic SAH</strong> is most commonly caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of a <strong>saccular aneurysm</strong>.</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Clinical Impact: High mortality and morbidity; often presents with a sudden, severe headache <strong>(worst headache of life).</strong></p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Complications: Seizures, vasospasm, hydrocephalus, and delayed <span class=\"customMeta\" data-dictid=\"1d859d0b0416927771841b2915a839\">cerebral ischemia</span> (DCI).</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Age: Most aSAH occurs between ages 40-60, mean <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> age 50-55 and slightly more prevalent in females.</p>\n</li>\n<li>\n<p>Risk Factors: Smoking and history of ruptured aneurysms increase SAH risk.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Aneurysmal SAH (aSAH):</strong></p>\n<ul>\n<li>\n<p>Risk Factors: <strong>Hypertension</strong>, <strong>smoking</strong>, family history, <strong>alcohol </strong>use, <strong>sympathomimetic drugs</strong>, and <strong>estrogen deficiency</strong>.</p>\n</li>\n<li>\n<p>Rupture Risk: <strong>(Option D)</strong></p>\n<ul>\n<li>\n<p>Age &gt;60</p>\n</li>\n<li>\n<p>Posterior <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> aneurysms</p>\n</li>\n<li>\n<p>Atherosclerosis</p>\n</li>\n<li>\n<p>Aneurysm size</p>\n<ul>\n<li>\n<p>Aneurysms &lt;10 mm: ~0.1% annual <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk.</p>\n</li>\n<li>\n<p>Aneurysms ≥10 mm: 0.5–1% annual <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk.</p>\n</li>\n<li>\n<p>Giant aneurysms (&gt;2.5 cm): ~6% <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk in first year.</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Family history</p>\n</li>\n<li>\n<p>Previous SAH</p>\n</li>\n<li>\n<p>ADPKD</p>\n</li>\n</ul>\n</li>\n</ul>\n</li>\n<li>\n<p><strong>Nonaneurysmal SAH (NASAH):</strong></p>\n<ul>\n<li>\n<p><strong>Perimesencephalic NASAH</strong>: Localized blood in perimesencephalic cisterns, normal angiography, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> course.</p>\n</li>\n<li>\n<p><strong>Occult Aneurysm</strong>: Small aneurysms missed on initial angiography, detectable on repeat imaging.</p>\n</li>\n<li>\n<p><strong>Vascular Malformations:</strong> Includes <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> malformations (AVM) and <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> fistulae. Treated with surgery or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> interventions.</p>\n</li>\n<li>\n<p><strong>Intracranial Arterial Dissection:</strong> Diagnosed by angiography, causes severe bleeding, treated with surgery or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> methods.</p>\n</li>\n<li>\n<p>Other Causes: <strong>Cocaine abuse,</strong> <strong>cerebral <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> angiopathy, cerebral <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> thrombosis, sickle cell disorders, moyamoya disease, cerebral vasculitis, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders.</strong></p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Hemodynamic Stress</strong>: Central to <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> formation, especially at arterial bifurcations.</p>\n</li>\n<li>\n<p><strong>Aneurysm Rupture:</strong> Causes neurological damage through <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of adjacent brain tissue and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> from <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow.</p>\n<ul>\n<li>\n<p>Mechanisms: Hemodynamic stress and <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (matrix <strong>metalloproteinase (MMP)-mediated <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> of <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> matrix) </strong>weaken the arterial wall, promoting <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> formation and rupture.</p>\n</li>\n<li>\n<p>Inflammatory Response: Macrophages and smooth muscle cells drive these degenerative processes.</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>\"Thunderclap headache\" - <strong>worst headache of life</strong></p>\n</li>\n<li>\n<p>Sudden onset severe headache</p>\n</li>\n<li>\n<p>Vomiting</p>\n</li>\n<li>\n<p>Variable LOC</p>\n</li>\n<li>\n<p>Meningismus</p>\n</li>\n<li>\n<p>Retinal hemorrhages</p>\n</li>\n<li>\n<p>Focal neurologic deficits</p>\n</li>\n<li>\n<p>Nuchal rigidity</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subarachnoid_hemorrhage#/media/File:SubarachnoidP.png\" data-tags=\"\" height=\"418\" src=\"https://image.prepladder.com/content/EGVS1inb7DWN05YHQTla1746189320.png\" width=\"373\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>CT Head</strong></p>\n<ul>\n<li>\n<p>Non-contrast CT is first-line</p>\n</li>\n<li>\n<p><strong>\"Star sign\" - blood in <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns</strong></p>\n</li>\n<li>\n<p>Sensitivity: 98-100% in first 12 hours</p>\n</li>\n</ul>\n<p><strong>Lumbar Puncture</strong></p>\n<ul>\n<li>\n<p>If CT negative</p>\n</li>\n<li>\n<p>Xanthochromia (takes 12h to develop)</p>\n</li>\n<li>\n<p>Elevated opening pressure</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old male with a history of respiratory tract infection 4 weeks ago is unable to stand or walk for the past 2 weeks and the weakness is progressive, ascending, and symmetrical in nature. The lower limbs were involved before and gradually the upper limbs were also affected. On examination you note areflexia. Pain and proprioception are preserved. Which of the following could be the diagnosis?", "options": [{"label": "A", "text": "Guillain-Barré syndrome", "correct": true}, {"label": "B", "text": "Myasthenia gravis", "correct": false}, {"label": "C", "text": "Polymyositis", "correct": false}, {"label": "D", "text": "Multiple sclerosis", "correct": false}], "correct_answer": "A. Guillain-Barré syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Guillain-Barré syndrome</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Progressive <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> paralysis</strong> (distal to proximal)</li>\n<li><strong>Areflexia</strong></li>\n<li>Weakness in legs causing rubbery legs and <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> to stand</li>\n<li>Truncal paralysis, quadriplegia, neck floppiness</li>\n<li>Bilateral 7th nerve palsy</li>\n<li>Bulbar palsy\n\t\t\t\t<ul>\n<li>Difficulty in handling secretions leading to <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia</li>\n<li>A leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> involvement.</li>\n</ul>\n</li>\n<li>Diaphragmatic paralysis\n\t\t\t\t<ul>\n<li>Ventilatory support is required in 30% of cases.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"c32b3a9fac16927771831530888fdf\">carbon dioxide</span> levels.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Sensory Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Glove-and-stocking distribution paresthesias</li>\n<li>Proprioception loss\n\t\t\t\t<ul>\n<li>Difficulty in climbing stairs</li>\n<li>Pain in the neck/arm/shoulder is similar to over-exercised muscle</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Sensory manifestations can occur before or along with motor manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Autonomic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"3704fc52401692777186c42775c9fb\">dysregulation</span> (e.g., <span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\">orthostatic</span> hypotension, bladder/bowel sparing/transient involvement)</li>\n<li>Wide fluctuations of blood pressure, arrhythmias, postural hypotension</li>\n<li>Reduced heart rate and blood pressure, <span class=\"customMeta\" data-dictid=\"fec88fc386169277719326fdef547f\">neurogenic</span> shock.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents with a history of headaches for the past 9 months that worsen in a recumbent position and improves as the day progresses. She also gives a history of taking oral contraceptives. Fundal examination shows papilledema. There are no focal neurological deficits. What is the probable cause of her headaches?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": false}, {"label": "B", "text": "Temporal arteritis", "correct": false}, {"label": "C", "text": "Chronic migraine", "correct": false}, {"label": "D", "text": "Pseudotumor cerebri", "correct": true}], "correct_answer": "D. Pseudotumor cerebri", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D- &lt;span class=\"customMeta\" data-dictid=\"d888653fcd1692777196e08285ad6d\"&gt;Pseudotumor&lt;/span&gt; cerebri</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pseudotumor <span class=\"customMeta\" data-dictid=\"5a4a970c4b1692777184108b0b09c8\">Cerebri</span> / <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">Intracranial</span> Hypertension</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A disorder associated with elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> pressure without obvious cause, commonly affecting young, <span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\">obese</span> females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Headache (worse on waking and with recumbency)</li>\n<li>Visual disturbances (may be transient)</li>\n<li>Can occur without visual problems</li>\n<li>Worse in morning or after lying down</li>\n<li>Pulsatile <span class=\"customMeta\" data-dictid=\"1e668dc8ba1692777200622a8a97f3\">tinnitus</span> may be present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> pressure (&gt;20-25 cm H2O)</li>\n<li>Normal MRI/MRV findings</li>\n<li>Normal neurological examination (except for papilledema)</li>\n<li>Papilledema may be present (but not required for diagnosis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acetazolamide (250-500 mg)</li>\n<li>Weight loss (if overweight)</li>\n<li>Serial <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> punctures may be needed</li>\n<li>Regular ophthalmologic monitoring</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Topiramate</li>\n<li>Other carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors</li>\n<li>CSF shunting procedures (if needed)</li>\n<li>Weight loss management programs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Regular <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> testing</li>\n<li>Ophthalmic examination</li>\n<li>CSF pressure monitoring</li>\n<li>Weight monitoring</li>\n<li>Headache diary</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Important Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fundoscopic exam should be performed even without overt <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> involvement</li>\n<li>Consider diagnosis in chronic <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> cases</li>\n<li>May require long-term management</li>\n<li>Early intervention is crucial for preventing vision loss</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male patient presents with ptosis and muscle weakness which reportedly worsens in the evening and improves in the morning. This is relieved by neostigmine. What is the likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "Huntington chorea", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "External ophthalmoplegia", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\"&gt;Myasthenia&lt;/span&gt; gravis </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features and Diagnosis of <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">Myasthenia</span> Gravis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diplopia, ptosis, dysarthria, dysphagia</li>\n<li>Weakness in oculomotor, pharyngeal, limb, neck extensors</li>\n<li>Fluctuation and fatigue worse with activity, improved by rest</li>\n<li>Fatiguability increases as the day passes (diurnal variation)</li>\n<li>Initial symptoms frequently <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> (diplopia/ptosis)</li>\n<li>Facial weakness produces \"snarling\" expression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eye movements and ptosis</li>\n<li>Assessment of <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> in neck and extremities</li>\n<li>Weakness following repetitive muscle activation</li>\n<li>Normal deep <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> reflexes</li>\n<li>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> abnormalities</li>\n<li>Symptoms relieved by Anticholinesterases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-AChR antibodies (positive in ~85% generalized MG)</li>\n<li>Anti-MuSK antibodies (in ~40% of AChR-negative cases)</li>\n<li>Repetitive nerve stimulation</li>\n<li>Single-fiber EMG</li>\n<li>CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> of chest (to evaluate thymus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Edrophonium (Tensilon) test: 2mg + 8mg IV</li>\n<li>Ice pack test for ptosis</li>\n<li>Fatigue testing (repeated muscle activation)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male patient presents with ptosis and muscle weakness which reportedly worsens in the evening and improves in the morning. This is relieved by neostigmine. What is the likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "Huntington chorea", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "External ophthalmoplegia", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\"&gt;Myasthenia&lt;/span&gt; gravis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features and Diagnosis of <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">Myasthenia</span> Gravis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diplopia, ptosis, dysarthria, dysphagia</li>\n<li>Weakness in oculomotor, pharyngeal, limb, neck extensors</li>\n<li>Fluctuation and fatigue worse with activity, improved by rest</li>\n<li>Fatiguability increases as the day passes (diurnal variation)</li>\n<li>Initial symptoms frequently <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> (diplopia/ptosis)</li>\n<li>Facial weakness produces \"snarling\" expression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eye movements and ptosis</li>\n<li>Assessment of <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> in neck and extremities</li>\n<li>Weakness following repetitive muscle activation</li>\n<li>Normal deep <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> reflexes</li>\n<li>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> abnormalities</li>\n<li>Symptoms relieved by Anticholinesterases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-AChR antibodies (positive in ~85% generalized MG)</li>\n<li>Anti-MuSK antibodies (in ~40% of AChR-negative cases)</li>\n<li>Repetitive nerve stimulation</li>\n<li>Single-fiber EMG</li>\n<li>CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> of chest (to evaluate thymus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Edrophonium (Tensilon) test: 2mg + 8mg IV</li>\n<li>Ice pack test for ptosis</li>\n<li>Fatigue testing (repeated muscle activation)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bell's palsy involves:", "options": [{"label": "A", "text": "Ipsilateral upper and lower halves of the face", "correct": true}, {"label": "B", "text": "Contralateral upper and lower halves of the face", "correct": false}, {"label": "C", "text": "Ipsilateral lower half of the face", "correct": false}, {"label": "D", "text": "Contralateral lower half of the face", "correct": false}], "correct_answer": "A. Ipsilateral upper and lower halves of the face", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ml933jIv0AqfHBxdAJm51746445675.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\"&gt;Ipsilateral&lt;/span&gt; upper and lower halves of the face</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bell’s Palsy</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"Bellspalsy - Bell's palsy - Wikipedia\" data-tags=\"\" height=\"451\" src=\"https://image.prepladder.com/content/Ml933jIv0AqfHBxdAJm51746445675.png\" width=\"305\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inflammation of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve</li>\n<li>HSV-1 reactivation- Common cause</li>\n<li>VZV <span class=\"customMeta\" data-dictid=\"eee52fe3cc16927771970c8dffdfd2\">reactivation</span> in Ramsay Hunt</li>\n<li>Edema within <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> canal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute onset (24-72 hours)</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis</li>\n<li>Loss of taste <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 2/3 tongue</li>\n<li>Hyperacusis (stapedius paralysis)</li>\n<li>Decreased tear production</li>\n<li>Bell's phenomenon present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical diagnosis primary</li>\n<li>EMG/NCS if no improvement</li>\n<li>MRI if <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> features</li>\n<li>CSF analysis if indicated</li>\n<li>Lyme titers in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment &amp; Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prednisone 60-80mg × 5 days</li>\n<li>Valacyclovir 1000mg TID × 5-7 days</li>\n<li>Eye protection crucial</li>\n<li>80% recovery rate</li>\n<li>Axonal <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> = worse prognosis</li>\n<li>Incomplete <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> in 1st week = best prognosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male patient presented with left-sided hemiparesis. Damage to which part of the internal capsule leads to this presentation?", "options": [{"label": "A", "text": "Retrolentiform", "correct": false}, {"label": "B", "text": "Sublentiform", "correct": false}, {"label": "C", "text": "Anterior limb", "correct": false}, {"label": "D", "text": "Posterior limb", "correct": true}], "correct_answer": "D. Posterior limb", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lacunar Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location of Infarct</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supplying Vessel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pure Motor Hemiparesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior limb</strong> of internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> or basis pontis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lenticulostriate arteries or <span class=\"customMeta\" data-dictid=\"6c178c36f616927771948cdea0dfae\">paramedian</span> <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Face, arm, and leg weakness on one side</strong> without sensory, visual, or cognitive deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pure <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> Stroke</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ventral <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> of thalamus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thalamogeniculate arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemisensory loss </strong>affecting face, arm, and leg without motor weakness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ataxic Hemiparesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior limb</strong> of internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> or basis pontis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lenticulostriate arteries or <span class=\"customMeta\" data-dictid=\"6c178c36f616927771948cdea0dfae\">paramedian</span> <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> with <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">pyramidal</span> signs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dysarthria-Clumsy Hand</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pons or internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> (genu)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Penetrating branches of <span class=\"customMeta\" data-dictid=\"cf3585c06f1692777182cba3cb4c97\">basilar</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or <span class=\"customMeta\" data-dictid=\"cba0c766911692777191b4bcb68f08\">lenticulostriate</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysarthria and <span class=\"customMeta\" data-dictid=\"f48ec32987169277718628dd3340d7\">dyspraxia</span> of hand without significant weakness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the site of the lesion that leads to the occurrence of hemiballismus in a patient displaying forceful, flinging movements?", "options": [{"label": "A", "text": "Putamen", "correct": false}, {"label": "B", "text": "Subthalamic nucleus", "correct": true}, {"label": "C", "text": "Caudate nucleus", "correct": false}, {"label": "D", "text": "Globus pallidus", "correct": false}], "correct_answer": "B. Subthalamic nucleus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Movement disorder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lesions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chorea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesions in the <strong>putamen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dystonia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesions in the<strong> <span class=\"customMeta\" data-dictid=\"86c230abe316927771889bbef8df5d\">globus</span> pallidus </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ballism/Hemiballismus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesion in <strong>subthalamic <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> (STN)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Huntington’s Disease (HD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesions in the<strong> <span class=\"customMeta\" data-dictid=\"1d14ed8c1216927771832ccea0c79f\">caudate</span> nucleus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sydenham's chorea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rheumatic heart disease</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rhythmic <span class=\"customMeta\" data-dictid=\"b763344b1d1692777194a36ec1f422\">oscillation</span> of a body part due to <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> muscle contractions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dystonia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involuntary, patterned, sustained, or repeated muscle contractions often associated with twisting movements and <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> posture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Athetosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slow, distal, writhing, <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">involuntary</span> movements with a propensity to affect the arms and hands (this represents a <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"61747121f116927771862fad303b93\">dystonia</span> with increased mobility).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chorea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, semipurposeful, graceful, dance like <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> patterned <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">involuntary</span> movements involving <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> or <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> muscle groups. When the movements are of large <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> and predominant <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> distribution, the term <strong>ballism</strong> is used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ballismus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Violent <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"2676c83ab91692777184b545be8b1b\">choreiform</span> movement composed of wild, flinging, large-amplitude movements most frequently affecting <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> limb muscles on one side of the body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myoclonus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden, brief (&lt;100 ms), jerklike, <span class=\"customMeta\" data-dictid=\"05b23267021692777182b55b0f89d7\">arrhythmic</span> muscle twitches.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brief, repeated, stereotyped muscle contractions that can often be suppressed for a short time. These can be simple and involve a single muscle group or complex and affect a range of motor activities.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not characteristic of Brown Sequard syndrome?", "options": [{"label": "A", "text": "Complete transection of spinal cord", "correct": true}, {"label": "B", "text": "Ipsilateral loss of vibration &amp;amp; touch", "correct": false}, {"label": "C", "text": "Contralateral loss of pain &amp;amp; temperature", "correct": false}, {"label": "D", "text": "Ipsilateral loss of proprioception", "correct": false}], "correct_answer": "A. Complete transection of spinal cord", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/7m1OvW5NfwxRLiRkz4mV1745308385.png", "https://image.prepladder.com/notes/cY8c3jh4c2Rdx6mxBeKY1745308490.png", "https://image.prepladder.com/notes/WjZD8ccubxyjir9RAz8Z1745308666.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ipsilateral (I/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contralateral (C/L)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>At the level of lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CST: LMN paralysis</li>\n<li>Dorsal column: loss of <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> <strong>(Option D)</strong> and <span class=\"customMeta\" data-dictid=\"dfc9bfb34d1692777196105fe5da3c\">proprioception</span> <strong>(Option B)</strong></li>\n<li>Radicular pain +</li>\n<li>Muscles- fasciculation, areflexia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Below the level of lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CST: UMN paralysis</li>\n<li>Dorsal column: Loss of <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> and proprioception</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spinothalamic tract: Loss of Pain and Temperature <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following clinical examination was performed. What lesion would cause an exaggerated reflex?", "options": [{"label": "A", "text": "Polyneuropathy", "correct": false}, {"label": "B", "text": "Radiculopathy", "correct": false}, {"label": "C", "text": "Upper motor neuron", "correct": true}, {"label": "D", "text": "Lower motor neuron", "correct": false}], "correct_answer": "C. Upper motor neuron", "question_images": ["https://image.prepladder.com/notes/muNv5Vnb8ncMvnraSXFn1746707704.png"], "explanation_images": ["https://image.prepladder.com/notes/QeOGGtGtzxo3pMTXnckI1745309105.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Upper Motor Neuron</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lower Motor Neuron</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrophy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fasciculations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spastic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distribution of Weakness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pyramidal/regional</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal/segmental</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscle Stretch Reflexes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperactive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypoactive/absent </strong><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Babinski Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20 year old male was brought for psychiatric evaluation for intellectual disability. On examination, his IQ was 45. He has a long face, large ears, large testis and a cardiac murmur and history of poor intellectual function is present in the paternal family. What is his diagnosis?", "options": [{"label": "A", "text": "Cushing’s syndrome", "correct": false}, {"label": "B", "text": "Rett syndrome", "correct": false}, {"label": "C", "text": "Fragile X syndrome", "correct": true}, {"label": "D", "text": "William syndrome", "correct": false}], "correct_answer": "C. Fragile X syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:575px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Genetic Basis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>CGG repeats on <strong>FMR-1 (Familial mental retardation) gene</strong> on X chromosome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CGG Repeat Numbers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Normal population: </strong>5-55 repeats</li>\n<li><strong>Carriers (premutation):</strong> 55-200 repeats</li>\n<li><strong>Fragile X Syndrome:</strong> &gt;200 repeats</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gender Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More common in males</li>\n<li>Females mostly carriers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Long face and large ears</strong></li>\n<li>Large mandible/Prominent jaw</li>\n<li>High arched palate</li>\n<li>Hyperextensible joints</li>\n<li><strong>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> prolapse</strong></li>\n<li><strong>Macroorchidism </strong>(seen in adolescent age group)</li>\n<li><strong>Intellectual disability</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features of female carriers </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>May be associated with<strong> <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> ovarian failure</strong></li>\n<li>10% may have an intellectual disability/low IQ</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment of Grade I Meningioma?", "options": [{"label": "A", "text": "Reassurance", "correct": false}, {"label": "B", "text": "Surgical excision", "correct": true}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Radiotherapy", "correct": false}], "correct_answer": "B. Surgical excision", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/tb7hCzU45sR2Swki0iUX1747902536.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the GCS of a patient with a head injury who opens her eyes in response to a loud voice, localizes pain and is confused and disoriented but can answer questions?", "options": [{"label": "A", "text": "E3 M5 V4", "correct": true}, {"label": "B", "text": "E3 M6 V5", "correct": false}, {"label": "C", "text": "E4 M4 V5", "correct": false}, {"label": "D", "text": "E3 M5 V5", "correct": false}], "correct_answer": "A. E3 M5 V4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:426px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Head Injury Severity: Clinical Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minor head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 15 with no LOC (loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 14 or 15 with LOC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 9 - 13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 3 - 8</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:297px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pupils Unreactive to Light</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pupil <span class=\"customMeta\" data-dictid=\"d4b70f945316927771972d75389cf0\">Reactivity</span> Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both Pupils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neither Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a major diagnostic criterion for neuromyelitis optica?", "options": [{"label": "A", "text": "Area postrema syndrome", "correct": false}, {"label": "B", "text": "Acute myelitis", "correct": false}, {"label": "C", "text": "Focal epilepsy", "correct": true}, {"label": "D", "text": "Optic neuritis", "correct": false}], "correct_answer": "C. Focal epilepsy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not show both hyperkinetic and hypokinetic movements?", "options": [{"label": "A", "text": "Parkinson’s disease", "correct": false}, {"label": "B", "text": "Wilson’s disease", "correct": false}, {"label": "C", "text": "Neurodegeneration with brain iron accumulation", "correct": false}, {"label": "D", "text": "Huntington’s chorea", "correct": true}], "correct_answer": "D. Huntington’s chorea", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "True about electroencephalogram (EEG) is all except:", "options": [{"label": "A", "text": "1-5% of the population can have epileptiform discharges", "correct": false}, {"label": "B", "text": "Scalp EEG may be helpful in localizing frontal lobe epilepsy", "correct": false}, {"label": "C", "text": "Doing EEG is mandatory for diagnosis of seizures", "correct": true}, {"label": "D", "text": "Progressive multifocal leukoencephalopathy shows triphasic and slow waves on EEG", "correct": false}], "correct_answer": "C. Doing EEG is mandatory for diagnosis of seizures", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man suddenly developed right-sided weakness and aphasia within 2 hours. His BP recorded was 160/110mmHg and NCCT was clear. What is the next step in management?", "options": [{"label": "A", "text": "CT angiography to look for large vessel occlusion", "correct": true}, {"label": "B", "text": "MRI to look for intact", "correct": false}, {"label": "C", "text": "Tab labetalol 10 mg stat", "correct": false}, {"label": "D", "text": "Thrombolysis", "correct": false}], "correct_answer": "A. CT angiography to look for large vessel occlusion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - CT &lt;span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\"&gt;angiography&lt;/span&gt; to look for large vessel occlusion:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Workup for stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Assessment and Stabilization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Upon arrival, ensure the <strong>ABCs </strong>(Airway, Breathing, Circulation) are stable.</li>\n<li><strong>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels </strong>should be checked quickly to address <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> or hyperglycemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Determining Stroke Type: <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> is Key</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <strong>non-contrast CT scan</strong> is the primary <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> for differentiating between ischemic and hemorrhagic strokes.</li>\n<li>Clinical features may suggest stroke type, but <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> is essential for confirmation as no clinical finding can definitively <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between the two.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Further Investigations: Uncovering the Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Detailed History and Physical Exam:</strong> Consider risk factors (hypertension, diabetes, smoking, atrial fibrillation, etc.) and perform a neurological exam to localize the affected brain area.</li>\n<li><strong>Laboratory Tests:</strong> Perform CBC, electrolytes, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, blood glucose, <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> profile, <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> studies, ESR, and <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> (to detect arrhythmias and signs of recent MI).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Visualizing the Cerebral Vasculature: <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> (CTA)</strong>: <strong>Assesses cerebral <span class=\"customMeta\" data-dictid=\"5e9945f4ca169277720145ab886b00\">vasculature</span> and identifies blockages/stenosis</strong>, but is<strong> performed after non-contrast CT has ruled out hemorrhage</strong> (not for stroke type differentiation).<strong> </strong></li>\n<li><strong>CT <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> Imaging</strong>: Assesses blood flow, identifying <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> and ischemic penumbra.</li>\n<li><strong>MRI: Provides more detail but takes longer than CT and is not as widely available, thus not the first <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> choice for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> stroke evaluation. (Option B)</strong></li>\n<li><strong>MRA:</strong> Offers detailed images of blood vessels, similar to CTA.</li>\n<li><strong>Cerebral Angiography:</strong> Gold standard for vessel evaluation, used when other techniques are inconclusive or before <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> intervention.</li>\n<li><strong>Ultrasound Techniques</strong>:<strong> </strong>Carotid <span class=\"customMeta\" data-dictid=\"4974dd3d1216927771864c9edc4933\">Duplex Ultrasonography</span> assesses <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> but is not a first-line <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> modality;<strong> <span class=\"customMeta\" data-dictid=\"53d1321235169277720009a5ac7833\">Transcranial</span> <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> (TCD) </strong>measures <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> <span class=\"customMeta\" data-dictid=\"12c4510e191692777201c23ec126a3\">velocity</span> in <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> arteries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tailoring Investigations Based on Stroke Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ischemic Stroke</strong>: Focuses on identifying the source of the <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> (cardioembolic, artery-to-artery embolic, small vessel disease).</li>\n<li><strong>Hemorrhagic Stroke:</strong> Investigations focus on identifying causes of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (e.g., hypertension, aneurysm, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> malformation).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Treatment of choice for an acute attack of cluster headache is:", "options": [{"label": "A", "text": "Oral sumatriptan", "correct": false}, {"label": "B", "text": "Subcutaneous sumatriptan", "correct": true}, {"label": "C", "text": "100% oxygen at 6 L/minute", "correct": false}, {"label": "D", "text": "100% oxygen at 8 L/minute", "correct": false}], "correct_answer": "B. Subcutaneous sumatriptan", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\"&gt;Subcutaneous&lt;/span&gt; su\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is preferred in the management of primary progressive multiple sclerosis?", "options": [{"label": "A", "text": "Natalizumab", "correct": false}, {"label": "B", "text": "Ocrelizumab", "correct": true}, {"label": "C", "text": "Fingolimod", "correct": false}, {"label": "D", "text": "Alemtuzumab", "correct": false}], "correct_answer": "B. Ocrelizumab", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Ocrelizumab</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Highly Effective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Moderately Effective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Modestly Effective</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-CD20 <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">Monoclonal</span> Antibodies: Ocrelizumab, Ofatumumab, Rituximab</li>\n<li><strong>Anti-α4 <span class=\"customMeta\" data-dictid=\"03f1cf44de16927771903f3806de84\">Integrin</span> <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">Monoclonal</span> Antibody: <span class=\"customMeta\" data-dictid=\"a21eba679f16927771937fbd0838ce\">Natalizumab</span> (Option A)</strong></li>\n<li>Mitoxantrone Hydrochloride</li>\n<li><strong>Anti-CD52 Antibody: <span class=\"customMeta\" data-dictid=\"0557fb010a16927771811dc695d483\">Alemtuzumab</span> (Option D)</strong></li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>S1P <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Modulators: Fingolimod</strong>, Ozanimod, Ponesimod <strong>(Option C)</strong></li>\n<li>Dimethyl Fumarate</li>\n<li>Cladribine</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Glatiramer acetate</li>\n<li>Interferon beta</li>\n<li>Teriflunomide</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 year old male patient presented with a history of bilateral lower limb weakness which progressed to his upper limbs in a year. On examination, he had weakness in both lower limbs and wasting in the left upper limb. Babinski sign was positive and the deep tendon reflexes were absent. He has no sensory loss or any autonomic dysfunction. What is the likely diagnosis?", "options": [{"label": "A", "text": "MS", "correct": false}, {"label": "B", "text": "ALS", "correct": true}, {"label": "C", "text": "GBS", "correct": false}, {"label": "D", "text": "Tropical spastic paraparesis", "correct": false}], "correct_answer": "B. ALS", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - ALS\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 37-year-old woman presents with headaches for 6 months. She has been taking analgesics regularly. The headache recently increased in severity for 3 days but was reduced by stopping the analgesic. What is the likely diagnosis?", "options": [{"label": "A", "text": "Medication overuse headache", "correct": true}, {"label": "B", "text": "Tension headache", "correct": false}, {"label": "C", "text": "Chronic migraine", "correct": false}, {"label": "D", "text": "Cluster headache", "correct": false}], "correct_answer": "A. Medication overuse headache", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presented with excessive fatiguability towards the end of the day that improved with rest. He also gives a history of ptosis and difficulty in speech and swallowing. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "Lambert-Eaton syndrome", "correct": false}, {"label": "C", "text": "Duchenne muscular dystrophy", "correct": false}, {"label": "D", "text": "Systemic lupus erythematosus", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Affected Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mimics central eye movement disorders.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cogan's lid <span class=\"customMeta\" data-dictid=\"4f7448b3e51692777201ff5cafde0d\">twitch</span> sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The upper <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> rises briefly after looking down for some time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shoulder <span class=\"customMeta\" data-dictid=\"a1d37a92d41692777188e12a817797\">girdle</span> muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Difficulty in overhead activities like combing hair.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness may cause <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> risks.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options has not been used as treatment for Guillain Barre syndrome?", "options": [{"label": "A", "text": "Steroids", "correct": true}, {"label": "B", "text": "Plasmapheresis", "correct": false}, {"label": "C", "text": "IVIG", "correct": false}, {"label": "D", "text": "Ventilator support", "correct": false}], "correct_answer": "A. Steroids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>IVIG (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Treatment of choice (TOC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Plasmapheresis (Plex) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Equally effective as IVIG; use either</li>\n<li>Functional improvement may occur &gt;1 week after treatment or show delayed response<strong> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Frequent assessment of <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> negative inspiratory force (NIF) and <span class=\"customMeta\" data-dictid=\"187bb6b3f61692777201956c59ce72\">vital capacity</span> determines need for <span class=\"customMeta\" data-dictid=\"dcf52bc6051692777189bc6d95b5e5\">ICU</span> admission and <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> support <strong>(Option D) </strong>due to impending <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Aggressive physical rehabilitation is imperative</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following arteries could have been involved in a patient who presents with vertigo, diplopia, hoarseness, dysphagia, left Horner's syndrome, and numbness in the left face and right side limbs?", "options": [{"label": "A", "text": "Posterior inferior cerebellar artery", "correct": true}, {"label": "B", "text": "Superior cerebellar artery", "correct": false}, {"label": "C", "text": "Anterior inferior cerebellar artery", "correct": false}, {"label": "D", "text": "Basilar artery", "correct": false}], "correct_answer": "A. Posterior inferior cerebellar artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1kmSlInaO1ovg1xrGq0g1745842076.png", "https://image.prepladder.com/content/YS4vBla38VjVnUHrOcvF1745842076.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the GCS Score in an intubated patient, with findings of eye movements to pain and abnormal flexion?", "options": [{"label": "A", "text": "E2VTM4", "correct": false}, {"label": "B", "text": "E2VTM3", "correct": false}, {"label": "C", "text": "E2VIM3", "correct": false}, {"label": "D", "text": "E2VNTM3", "correct": true}], "correct_answer": "D. E2VNTM3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"8\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glasgow <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">coma</span> scale </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye-opening </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal (non-intubated)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal (intubated) </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor activity </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented &amp; talks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seems able to talk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Verbal command</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Verbal stimuli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disoriented &amp; talks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Questionable ability to talk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Painful <span class=\"customMeta\" data-dictid=\"7d7e9fdf401692777199f2038941b6\">stimuli</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally unresponsive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decorticate/ <strong>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decerebrate/ <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">Abnormal</span> extension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No response</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"8\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to assess the level of consciousness in a patient with a head injury.</p>\n<ul>\n<li>Best total score: 15</li>\n<li>Mild injury: 13 to 15</li>\n<li>Moderate injury: 9 to 12</li>\n<li>Severe injury: 3 to 8</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pupils unreactive to light </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PRS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both pupils</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neither pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman who visits the clinic with complaints of frequent falls and walking difficulties. She also has a history of smoking and type-1 diabetes but no history of hypertension or coronary artery disease. During examination, the patient exhibits weakness in both lower limbs, absent DTR, as well as an unsteady gait. But, there is a decrease in proprioception and vibration sense in both lower limbs. Which of the following statements is correct about the above condition?", "options": [{"label": "A", "text": "Only the dorsal column is involved", "correct": false}, {"label": "B", "text": "All these patients with a neurological impairment will show macrocytosis", "correct": false}, {"label": "C", "text": "Vitamin B12 supplements do not improve this condition", "correct": false}, {"label": "D", "text": "Copper deficiency may produce similar symptoms", "correct": true}], "correct_answer": "D. Copper deficiency may produce similar symptoms", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subacute combined degeneration</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reversible <span class=\"customMeta\" data-dictid=\"429708823b1692777193bc84f81d9d\">myelopathy</span> mainly involving <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> column and <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">Pyramidal</span> column tracts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Vitamin B12 deficiency:</strong> Nutritional (vegetarians) <span class=\"customMeta\" data-dictid=\"5cc1ea37091692777195fbd0aa687b\">Pernicious</span> anemia, post-gastrectomy, <span class=\"customMeta\" data-dictid=\"8559a65a1116927771864c296ce496\">Diphyllobothrium</span> infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Weakness: <span class=\"customMeta\" data-dictid=\"a218fdbabf1692777185a2d48a9e1c\">Corticospinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> (CST)/Pyramidal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> and proprioception: <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> column <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement</li>\n<li>Ataxia: <strong>Romberg sign positive</strong></li>\n<li>DTR: Absent (Peripheral neuropathy), Babinski sign: Positive (CST involvement)</li>\n<li><strong>Dementia: reversible</strong> with therapy</li>\n<li><strong>Hyperpigmentation of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Vitamin B12 assay:</strong> <span class=\"customMeta\" data-dictid=\"bc09155adc169277719248f9543785\">Methyl</span> malonate/Homocysteine levels estimation</li>\n<li>Peripheral blood smear: may reveal <span class=\"customMeta\" data-dictid=\"04173aa3b71692777191ff88525398\">macrocytosis</span> with hypersegmented neutrophils</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>NOTE: SACD can occur without <span class=\"customMeta\" data-dictid=\"04173aa3b71692777191ff88525398\">macrocytosis</span> as well</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitamin B12 supplements</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hypocupric myelopathy:</strong> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> Cu2+ levels should be checked</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In hemiplegia caused by an ischemic stroke, which region of the internal capsule is impacted?", "options": [{"label": "A", "text": "Retrolentiform", "correct": false}, {"label": "B", "text": "Sublentiform", "correct": false}, {"label": "C", "text": "Anterior limb", "correct": false}, {"label": "D", "text": "Posterior limb", "correct": true}], "correct_answer": "D. Posterior limb", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1yTw9y6aDOJlwT4PfEA81745479589.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Lacunar <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> (affecting <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> branches) secondary to atherosclerotic occlusion/lipohyalinosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hypertension: Most common</strong></li>\n<li>Diabetes</li>\n<li>Atrial fibrillation</li>\n<li>Smoking</li>\n<li>Hyperlipidemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites &amp; manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior limb of internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pure motor hemiparesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genu of internal capsule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clumsy hand <span class=\"customMeta\" data-dictid=\"faa6bb18b11692777186c6a26198e2\">dysarthria</span> lacunar syndrome (facial weakness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cortical <span class=\"customMeta\" data-dictid=\"b32e60f29a16927771963de1f70fd5\">pontocerebellar</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I/L <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> + C/L hemiparesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventroposterolateral <span class=\"customMeta\" data-dictid=\"0c5f024f21169277720046ac004a34\">thalamus</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dejerine-Roussy syndrome</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior limb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Retrolentiform part</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sublentiform part</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Frontopontine fibres (Arnold's bundle)</li>\n<li>Corticorubral fibres</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Parietopontine,occipitopontine, and occipitotectal fibres</li>\n<li>Optic radiation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporopontine fibres</li>\n<li>Auditory radiation (fibres from the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">geniculate</span> body to the <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> cortex)</li>\n<li>Thalamic fibres to the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> and amygdala.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following causes the slowing of conduction in multiple sclerosis?", "options": [{"label": "A", "text": "Gliosis", "correct": false}, {"label": "B", "text": "Loss of myelin sheath", "correct": true}, {"label": "C", "text": "Defect at node of Ranvier", "correct": false}, {"label": "D", "text": "Leaky Na + channel", "correct": false}], "correct_answer": "B. Loss of myelin sheath", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Y7PFi6rzA2Ftf4mSCWiX1746449621.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lesion at which level produces incongruous homonymous hemianopia with Wernicke's pupil?", "options": [{"label": "A", "text": "Optic tract", "correct": true}, {"label": "B", "text": "Visual cortex", "correct": false}, {"label": "C", "text": "Optic radiation", "correct": false}, {"label": "D", "text": "Optic nerve", "correct": false}], "correct_answer": "A. Optic tract", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\"&gt;Optic&lt;/span&g\n<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman is brought to the OPD with complaints of behavioural change, a history of multiple falls, urinary incontinence, and dementia. What is your diagnosis?", "options": [{"label": "A", "text": "Normal pressure hydrocephalus", "correct": true}, {"label": "B", "text": "Frontotemporal dementia", "correct": false}, {"label": "C", "text": "Parkinson disease", "correct": false}, {"label": "D", "text": "Creutzfeldt-Jakob disease", "correct": false}], "correct_answer": "A. Normal pressure hydrocephalus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3Nd8qB4wUvIkblqvyu4o1746510398.png", "https://image.prepladder.com/content/psCfZn4gMasHySOuhbOS1746510398.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Normal Pressure <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">Hydrocephalus</span> (NPH)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>NPH is often <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> but can result from prior injuries affecting <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) dynamics, such as <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> hemorrhage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gait disturbance</strong>: Progressive difficulties in walking</li>\n<li><strong>Urinary issues</strong>: Urgency or incontinence</li>\n<li><strong>Cognitive impairment</strong>: Decline in cognitive functions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ventriculomegaly is typically seen</li>\n<li><strong>Evans ratio</strong>: the ratio of the maximum <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> of <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> horns to inner table <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> of <strong>more than 0.31 </strong>is often used for evaluation but has low <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy.</li>\n<li>An <strong>acute <span class=\"customMeta\" data-dictid=\"3d75814381169277718350f5548cc1\">callosal</span> angle </strong>(less than 90°) on <span class=\"customMeta\" data-dictid=\"dad5b2152216927771851a3d10cd41\">coronal</span> MR images is another measurement used, also with limited accuracy.</li>\n<li>A<strong> disproportionately enlarged <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space hydrocephalus</strong> is seen having <span class=\"customMeta\" data-dictid=\"8501c4040a1692777201eb9e7ea8f6\">ventriculomegaly</span> combined with sulcal <span class=\"customMeta\" data-dictid=\"dc0035cd191692777187b9b8b2af69\">effacement</span> at the <span class=\"customMeta\" data-dictid=\"47effe8b551692777201331142edf5\">vertex</span> and scattered enlarged sulci.</li>\n<li>CSF flow study shows hyper-dynamism with a streak of flow <span class=\"customMeta\" data-dictid=\"3ea4fc34801692777202b98af71861\">void</span> through cerebral aqueduct.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of aphasia is seen in the lesions of the posterior part of the superior temporal gyrus?", "options": [{"label": "A", "text": "Fluent", "correct": true}, {"label": "B", "text": "Non-fluent", "correct": false}, {"label": "C", "text": "Anomic", "correct": false}, {"label": "D", "text": "Conduction", "correct": false}], "correct_answer": "A. Fluent", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Wernicke's Aphasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Broca's <span class=\"customMeta\" data-dictid=\"9b5386bf6216927771812526afb5e6\">Aphasia</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Global Aphasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Conduction <span class=\"customMeta\" data-dictid=\"9b5386bf6216927771812526afb5e6\">Aphasia</span> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Speech Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluent</strong>, but paraphasic and circumlocutious, <span class=\"customMeta\" data-dictid=\"3c07f956e61692777190be7ce53d88\">jargon</span> speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nonfluent</strong>, labored, dysarthric, telegraphic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nonfluent, severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluent, but many phonemic paraphasias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Comprehension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired for spoken and written words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intact, except for syntactically complex sentences</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intact for spoken language, impaired for reading aloud</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Repetition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired, with phonemic paraphasias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Naming</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired, leading to neologisms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired, with phonemic paraphasias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Writing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired, with phonemic paraphasias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Motor Output (Facial and Limb)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often unremarkable (rare mild <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> flattening)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> weakness, hemiparesis, buccofacial apraxia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right hemiplegia, hemisensory loss</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varies depending on <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause (Common Lesions)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior part of superior <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> gyrus</strong>, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> gyrus</strong>, superior <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves entire <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> distribution</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arcuate fasciculus</strong>, <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> branches</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe agitation, paranoia, possible right hemianopia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> weakness, hemiparesis, emotional distress</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right hemiplegia, hemisensory loss, <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> hemianopia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No significant associated features</p>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Harrison’s Principles of Internal Medicine, 21st Edition, Page 196,197</li><li>↳ https://www.ncbi.nlm.nih.gov/books/NBK441951/</li><li>↳ https://link.springer.com/referenceworkentry/10.1007/978-0-387-79948-3_856</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male was brought to the emergency room with a history of RTA. GCS progressively declines over hours and axial T2 MRI shows multiple small hypointense lesions at the corticomedullary junction and basal ganglia. What is the diagnosis?", "options": [{"label": "A", "text": "Diffuse axonal injury", "correct": true}, {"label": "B", "text": "Extensive subarachnoid haemorrhage", "correct": false}, {"label": "C", "text": "Hypoxic cerebral injury", "correct": false}, {"label": "D", "text": "Multiple haemorrhagic contusion", "correct": false}], "correct_answer": "A. Diffuse axonal injury", "question_images": ["https://image.prepladder.com/content/tkw3i5GtgaN31KpeAFMn1746792977.png"], "explanation_images": ["https://image.prepladder.com/content/4MXWHw01wm7twIMoUWrv1746793091.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Visual field testing of a patient revealed the following type of loss. Where is the likely site of lesion in the optic pathway?", "options": [{"label": "A", "text": "Frontal visual field", "correct": false}, {"label": "B", "text": "Occipital lobe", "correct": true}, {"label": "C", "text": "Optic radiation", "correct": false}, {"label": "D", "text": "Optic chiasma", "correct": false}], "correct_answer": "B. Occipital lobe", "question_images": ["https://image.prepladder.com/content/wkWIthvjJUaPpFfKn6ak1746793412.png"], "explanation_images": ["https://image.prepladder.com/content/VfXZEfetmmIq7F5VpNOW1746793477.png", "https://image.prepladder.com/content/rc1uXYhGolmu8yQm7rCS1746793497.png", "https://image.prepladder.com/content/iGvkdjnEfuBrTM3Y7FbW1746793507.png", "https://image.prepladder.com/content/SPf6YkVXhANEMinK9jjp1746793531.png", "https://image.prepladder.com/content/XmnSWm46dbztN7C8mv9Y1746793541.png", "https://image.prepladder.com/content/ohuYAjdKivkLOawVZOdh1746793594.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Visual Pathway Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/rc1uXYhGolmu8yQm7rCS1746793497.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Anopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Chiasma</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"307\" src=\"https://image.prepladder.com/content/iGvkdjnEfuBrTM3Y7FbW1746793507.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Bitemporal Hemianopia</strong></p>\n<p><strong>(Heteronymous Hemianopia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Optic Tract</strong></li>\n<li><strong>Lateral Geniculate Body (LGB Lesion)</strong></li>\n<li><strong>Optic Radiation </strong><strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + Contralateral Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"149\" src=\"https://image.prepladder.com/content/SPf6YkVXhANEMinK9jjp1746793531.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Homonymous Hemianopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">Cortex</span> without the involvement of tip</strong></p>\n<p><strong>(Post. Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + Contralateral Nasal Fibers except for <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> representation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/XmnSWm46dbztN7C8mv9Y1746793541.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Homonymous <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">Hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">Macular</span> Sparing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tip of Visual Cortex</strong></p>\n<p><strong>(Middle Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Macular Representation of Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> and Contralateral Nasal Fibers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/ohuYAjdKivkLOawVZOdh1746793594.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Macular <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">Homonymous</span> Hemianopia</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable cause for a 22-year-old man who has a high-grade fever, a purpuric rash, and a CSF sample showing gram-negative diplococci?", "options": [{"label": "A", "text": "Neisseria meningitidis", "correct": true}, {"label": "B", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "C", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "D", "text": "E.coli", "correct": false}], "correct_answer": "A. Neisseria meningitidis", "question_images": ["https://image.prepladder.com/content/gt4axtk4XUEElIB9mN4I1747981967.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Consciousness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased level of consciousness occurs in &gt;75% of cases, ranging from <span class=\"customMeta\" data-dictid=\"7f737d5d2f1692777191ac675cbf29\">lethargy</span> to coma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kernig's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive when <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> extension of the knee elicits pain; indicative of meningeal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brudzinski's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive when <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of the neck results in <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of the hips and knees; also indicative of meningeal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pupils</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May present as dilated and poorly <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> due to increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure (ICP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posturing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Possible <span class=\"customMeta\" data-dictid=\"b992edcc081692777186b24fecb86f\">decerebrate posturing</span> as a sign of severe CNS dysfunction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs of Increased ICP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Includes elevated CSF opening pressure (&gt;180 mmH2O), papilledema, and potential cerebral <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> (1–8% incidence).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Additional Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nausea, vomiting, photophobia; seizures in 15–40% (focal or generalized).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Meningococcemia Rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erythematous <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> rash</strong> that quickly becomes petechial, commonly on the trunk and lower extremities.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old former pilot visits a neurologist, accompanied by his wife, exhibiting symptoms of rapidly advancing dementia, myoclonus, ataxia, and visual impairments. The provided FLAIR MRI scans can assist in confirming the diagnosis. What is the probable diagnosis?", "options": [{"label": "A", "text": "Alzheimer's disease", "correct": false}, {"label": "B", "text": "Vascular dementia", "correct": false}, {"label": "C", "text": "Sporadic CJD", "correct": false}, {"label": "D", "text": "Variant CJD", "correct": true}], "correct_answer": "D. Variant CJD", "question_images": ["https://image.prepladder.com/content/Y4IIFGXNlHbjWhonAWxP1747036610.png"], "explanation_images": ["https://image.prepladder.com/content/XPtNNaFTejm4kPR8p0Vp1748163525.png", "https://image.prepladder.com/content/IjTdCue4nlXImfhGyG3X1747036633.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Creutzfeldt-Jakob disease (CJD) findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Electroencephalography (EEG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Periodic sharp wave complexes (PSWC)</li>\n<li>These can be either lateralized in earlier stages or generalized in later stages.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dirzius, Edgaras &amp; Balnytė, Renata &amp; Steibliene, Vesta &amp; Gleizniene, Rymante &amp; Gudinaviciene, Inga &amp; Radziunas, Andrius &amp; Petrikonis, Kestutis.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Electroencephalography-at-week-18-Legend-periodic-sharp-wave-complexes-in-frontal_fig2_310735862\" data-tags=\"\" height=\"5856\" src=\"https://image.prepladder.com/content/XPtNNaFTejm4kPR8p0Vp1748163525.png\" width=\"6738\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>MRI findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DWI or FLAIR MRI has a sensitivity of 98% and <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> of 93%</li>\n<li>DWI: Increased intensity in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia, thalamus, and cortex</li>\n<li><strong>Cortical ribboning</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Pract Neurol\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Practneurol-2016-001571f02.jpg\" data-tags=\"\" height=\"574\" src=\"https://image.prepladder.com/content/IjTdCue4nlXImfhGyG3X1747036633.png\" width=\"448\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Hockey stick or <span class=\"customMeta\" data-dictid=\"b36e8ba0101692777196f1b3621e90\">pulvinar</span> sign </strong>is seen in <strong>variant</strong>, infectious, or <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> CJD</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was asked to copy the face of a clock and his drawing is shown below. What is the correct term to be used here?", "options": [{"label": "A", "text": "Confabulation", "correct": false}, {"label": "B", "text": "Hemispatial neglect", "correct": true}, {"label": "C", "text": "Kinetic apraxia", "correct": false}, {"label": "D", "text": "Asterixis", "correct": false}], "correct_answer": "B. Hemispatial neglect", "question_images": ["https://image.prepladder.com/content/IO2ioJUck4IQvKy6TcB91748163624.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who is 66 years old and has a history of chronic hypertension, arrives at the emergency room with changes in mental state and high blood pressure measuring 210/110 mm Hg. A brain CT scan shows bleeding within the brain tissue. The typical location of this bleeding in similar cases is?", "options": [{"label": "A", "text": "Putamen", "correct": true}, {"label": "B", "text": "Thalamus", "correct": false}, {"label": "C", "text": "Pons", "correct": false}, {"label": "D", "text": "Cerebellum", "correct": false}], "correct_answer": "A. Putamen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cerebral <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">Amyloid</span> </strong></p>\n<p><strong>Angiopathy (CAA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Berry Aneurysm Rupture </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Hypertensive Crisis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Venous Sinus Thrombosis </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Elderly (&gt;60 years)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Younger</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Older, with chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Younger, hypercoagulable states</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hemorrhage Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> haemorrhages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Subarachnoid, single-event</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Deep (e.g., <strong>putamen</strong>, thalamus)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hemorrhagic infarction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hemorrhage Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cortical-subcortical regions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Subarachnoid space</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Deep brain structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Venous infarction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lobar haemorrhages, microbleeds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Single, <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> bleed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Deep hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Venous <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acute neurological symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Thunderclap headache</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Often no symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Seizures, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acute neurological presentation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sudden, thunderclap headache</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acute, with chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acute, gradual progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Spares deep structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Focal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Deep brain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Venous infarction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman presents with weakness in right arm for 6 hours. The weakness gradually became lesser and later resolved. She is a known case of diabetes and hypertension and is obese. Which of the following is the probable diagnosis of this case?", "options": [{"label": "A", "text": "Compressive neuropathy", "correct": false}, {"label": "B", "text": "Transient ischaemic attack", "correct": true}, {"label": "C", "text": "Ischaemic stroke", "correct": false}, {"label": "D", "text": "Diabetic neuropathy", "correct": false}], "correct_answer": "B. Transient ischaemic attack", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 60 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BP ≥ 140/90</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> without weakness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilateral weakness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 points</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10–59 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 60 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 points</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of diabetes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:409px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stroke Risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 90</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0–3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.2%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3.1%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4–5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4.1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5.9%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9.8%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6–7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8.1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>11.7%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>17.8%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about tremors are true? PD is characterized by resting tremor Tremor consist of alternate contraction of agonist and antagonist muscle in an oscillating rhythmic manner Essential tremor is an uncommon movement disorder. Normal individuals can have physiologic tremors that manifest as mild high frequency, postural or action tremors", "options": [{"label": "A", "text": "1,2,3 only", "correct": false}, {"label": "B", "text": "2,3,4 only", "correct": false}, {"label": "C", "text": "1,2,4 only", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. 1,2,4 only", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Exacerbating Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Alleviating Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resting Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Parkinson's disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occurs at rest</li>\n<li>Pill-rolling movement</li>\n<li>Asymmetrical</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emotional stress</li>\n<li>Fatigue</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Voluntary movement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Action Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cerebellar disorders</li>\n<li>Multiple sclerosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tremor occurs with voluntary movement</li>\n<li>Intention <span class=\"customMeta\" data-dictid=\"bb6d2476421692777200c2af1ac0c8\">tremor</span> (worsens near target)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Movement initiation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Postural Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Essential tremor</li>\n<li>Physiologic tremor</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tremor when maintaining <span class=\"customMeta\" data-dictid=\"115643fed616927771961316effc71\">posture</span> against gravity</li>\n<li>Fine or <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> oscillations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anxiety</li>\n<li>Fatigue</li>\n<li>Caffeine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcohol</li>\n<li>Beta-blockers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intention Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cerebellar damage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases in <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> as the target is approached</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Goal-directed movements</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physiologic Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal individuals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fine, rapid, low-amplitude tremor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anxiety</li>\n<li>Caffeine</li>\n<li>Hyperthyroidism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rest</li>\n<li>Sleep</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Essential <span class=\"customMeta\" data-dictid=\"bb6d2476421692777200c2af1ac0c8\">Tremor</span> (Most Common Tremors)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unknown (often familial)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bilateral, symmetric</li>\n<li>Affects hands, head, voice</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stress</li>\n<li>Fatigue</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcohol</li>\n<li>Beta-blockers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dystonic Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dystonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Irregular tremor</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> postures</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Movement or sustained posture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sensory tricks (geste antagonists)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug-induced Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lithium</li>\n<li>Valproate</li>\n<li>SSRIs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symmetric, postural, or action tremor</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Drug use</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dose reduction or discontinuation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psychogenic Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Functional neurologic disorder</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden onset</li>\n<li>Inconsistent tremor</li>\n<li>Disappears with distraction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Psychological stress</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distraction</li>\n<li>Psychotherapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most important pathophysiological mechanism for Berry aneurysm?", "options": [{"label": "A", "text": "Endothelial injury of vessel due to HTN", "correct": false}, {"label": "B", "text": "Muscle intimal elastic lamina layer defect", "correct": true}, {"label": "C", "text": "Endothelial layer defect", "correct": false}, {"label": "D", "text": "Adventitia defect", "correct": false}], "correct_answer": "B. Muscle intimal elastic lamina layer defect", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Berry Aneurysm</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Saccular <span class=\"customMeta\" data-dictid=\"9573d4999216927771943e3f309d90\">outpouching</span> of <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> arterial wall</li>\n<li>Represents 90% of cerebral aneurysms</li>\n<li>Primary location: Circle of Willis</li>\n<li>Most common sites:\n\t\t\t\t<ul>\n<li>Anterior communicating/anterior cerebral junction</li>\n<li>Posterior communicating/internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> junction</li>\n<li>Middle cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> bifurcation</li>\n<li>Basilar apex</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiological Mechanisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structural Changes:</strong></p>\n<ul>\n<li><strong>Most important-</strong> Internal <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> disruption</li>\n<li>Media layer thinning</li>\n<li>Adventitial layer remodeling</li>\n</ul>\n<p><strong>Molecular Mechanisms:</strong></p>\n<ul>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"a993f205b0169277719284faad4c87\">mediator</span> activation</li>\n<li>Matrix <span class=\"customMeta\" data-dictid=\"392e6d28d916927771923364b31e89\">metalloproteinase</span> upregulation</li>\n<li>Vessel wall <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> degradation</li>\n</ul>\n<p><strong>Hemodynamic Factors:</strong></p>\n<ul>\n<li>Wall <span class=\"customMeta\" data-dictid=\"1a9e83a309169277719859946ca445\">shear</span> stress elevation</li>\n<li>Flow-related endothelial injury</li>\n<li>Intramural stress distribution alterations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathological Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Mycotic:</strong></p>\n<ul>\n<li>Infectious arterial wall damage</li>\n<li>Distal vessel predilection</li>\n<li>Inflammatory cell infiltration</li>\n</ul>\n<p><strong>2. Arteriosclerotic:</strong></p>\n<ul>\n<li>Intimal hyperplasia</li>\n<li>Media degeneration</li>\n<li>Elastic fiber fragmentation</li>\n</ul>\n<p>3. Traumatic:</p>\n<ul>\n<li>Transmural disruption</li>\n<li>False <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> formation</li>\n<li>Adventitial hemorrhage</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rupture Risk Stratification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphological Criteria:</strong></p>\n<ul>\n<li>Size &gt;7mm: high risk</li>\n<li>Aspect ratio &gt;1.6</li>\n<li>Daughter <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> presence</li>\n<li>Wall irregularity</li>\n</ul>\n<p><strong>Hemodynamic Factors:</strong></p>\n<ul>\n<li>Systolic BP &gt;140 mmHg</li>\n<li>Flow pattern alterations</li>\n<li>Intrasaccular pressure gradients</li>\n</ul>\n<p><strong>Genetic Markers:</strong></p>\n<ul>\n<li>Collagen deficiency</li>\n<li>Elastic fiber abnormalities</li>\n<li>Matrix <span class=\"customMeta\" data-dictid=\"392e6d28d916927771923364b31e89\">metalloproteinase</span> polymorphisms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subarachnoid Hemorrhage:</strong></p>\n<ul>\n<li>Hunt-Hess grading scale correlation</li>\n<li>Fisher scale for CT findings</li>\n<li>Modified Rankin Scale outcomes</li>\n</ul>\n<p><strong>Mass Effect:</strong></p>\n<ul>\n<li>Cranial nerve <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> syndromes</li>\n<li>Brainstem <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> sequelae</li>\n<li>Hydrocephalus development</li>\n</ul>\n<p><strong>Thromboembolic Events:</strong></p>\n<ul>\n<li>Watershed <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> patterns</li>\n<li>Perforator <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> syndromes</li>\n<li>Distal <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> phenomena</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16 year old girl, who is taking antiepileptics, has had a seizure-free period of 6 months. She has no family history of epilepsy. Her EEG is now normal and she has a normal neurological exam and intelligence. What would be your advice?", "options": [{"label": "A", "text": "Stop the treatment and follow up", "correct": false}, {"label": "B", "text": "Gradually taper the drug and stop treatment", "correct": false}, {"label": "C", "text": "Continue treatment for another 2 years", "correct": true}, {"label": "D", "text": "Continue lifelong treatment with antiepileptics", "correct": false}], "correct_answer": "C. Continue treatment for another 2 years", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought with a 2-week history of not feeding well and excessive irritability. History of TB for sister is present and is taking treatment for it. In workup, LP was performed. Which of the following is likely to be found in CSF?", "options": [{"label": "A", "text": "Lymphocytosis, low sugar, and high protein", "correct": true}, {"label": "B", "text": "Lymphocytosis, high sugar, and high protein", "correct": false}, {"label": "C", "text": "Neutrophils, low sugar and low protein", "correct": false}, {"label": "D", "text": "Neutrophils, low sugar and high protein", "correct": false}], "correct_answer": "A. Lymphocytosis, low sugar, and high protein", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Lymphocytosis, low sugar and high\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In hypoglossal nerve injury , which of the following is seen?", "options": [{"label": "A", "text": "Tongue deviation to the contralateral side", "correct": false}, {"label": "B", "text": "Tongue deviation to the same side", "correct": true}, {"label": "C", "text": "Falling of the tongue", "correct": false}, {"label": "D", "text": "Inability in tongue protrusion", "correct": false}], "correct_answer": "B. Tongue deviation to the same side", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Tongue &lt;span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\"&gt;deviation&lt;/span&gt; to th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 24-year-old female patient who presents with fever, headache, ataxia, nausea, and vomiting for the past 3 days? The patient exhibits neck rigidity and hip and knee flexion upon passive flexion of the neck. A lumbar puncture was performed, and the CSF findings are provided below. Opening pressure – increased Color – cloudy white WBCs – 7000/µl; neutrophil predominant Sugar – 15 mg/dl CSF/serum glucose ratio – 0.2 Protein – 70 mg/dl Latex agglutination – positive Limulus lysate test – negative", "options": [{"label": "A", "text": "Bacterial meningitis", "correct": true}, {"label": "B", "text": "Tubercular meningitis", "correct": false}, {"label": "C", "text": "Viral meningitis", "correct": false}, {"label": "D", "text": "Fungal meningitis", "correct": false}], "correct_answer": "A. Bacterial meningitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wJKomL4ULKcyifbfKxEX1714034170.png"], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following type of hypersensitivity reactions is seen in myasthenia gravis?", "options": [{"label": "A", "text": "Type 1 hypersensitivity reaction", "correct": false}, {"label": "B", "text": "Type 2 hypersensitivity reaction", "correct": true}, {"label": "C", "text": "Type 3 hypersensitivity reaction", "correct": false}, {"label": "D", "text": "Type 4 hypersensitivity reaction", "correct": false}], "correct_answer": "B. Type 2 hypersensitivity reaction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\"&gt;Type 2&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\"&gt;hypersensitivity&lt;/span&g\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"5\">\n<p style=\"text-align:center\"><strong>Types of <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">Hypersensitivity</span> Reactions</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Type 1</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Type 2</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Type 3</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Type 4</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Immune reaction</strong></p>\n</td>\n<td>\n<p>Anaphylactic</p>\n</td>\n<td>\n<p>Cytotoxic</p>\n</td>\n<td>\n<p>Immune complex</p>\n</td>\n<td>\n<p>T-Cell dependent </p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Typical manifestations</strong></p>\n</td>\n<td>\n<ul>\n<li>Anaphylaxis</li>\n<li>Asthma</li>\n<li>Atopic dermatitis</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Transfusion reactions</li>\n<li>Rh incompatibility</li>\n<li>Hemolytic anemia</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Arthus reaction</li>\n<li>Serum sickness</li>\n<li>Glomerulo-nephritis</li>\n<li>Rheumatoid arthritis</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Tuberculin test</li>\n<li>Granuloma formation in TB and leprosy</li>\n<li>Contact dermatitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not one of the key clinical features used to diagnose Lewy body dementia?", "options": [{"label": "A", "text": "Fluctuating cognition", "correct": false}, {"label": "B", "text": "Recurrent visual hallucinations", "correct": false}, {"label": "C", "text": "REM sleep behaviour disorder", "correct": false}, {"label": "D", "text": "Orthostatic hypotension", "correct": true}], "correct_answer": "D. Orthostatic hypotension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\"&gt;Orthostatic&lt;/span&gt; h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient experiencing repeated inflammation of the optic nerve in both eyes along with widespread inflammation of the spinal cord, and exhibiting visual acuity of 6/60 in the right eye and 6/18 in the left eye, with only a partial response to steroid treatment?", "options": [{"label": "A", "text": "Neuromyelitis optica", "correct": true}, {"label": "B", "text": "Subacute combined degeneration of spinal cord", "correct": false}, {"label": "C", "text": "Posterior cerebral artery stroke", "correct": false}, {"label": "D", "text": "Neurosyphilis", "correct": false}], "correct_answer": "A. Neuromyelitis optica", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4PLPt67KU7NLBs2Ha2X21714044602.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"8baf9699801692777193208f36c4c4\"&gt;Neuromyelitis&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old was brought ro OPD with rapidly progressing dementia and myoclonus. Below is the EEG of the patient. What is the likely diagnosis?", "options": [{"label": "A", "text": "Hepatic encephalopathy", "correct": false}, {"label": "B", "text": "Creuzfeldt-Jakob disease", "correct": true}, {"label": "C", "text": "Generalized tonic clonic seizures", "correct": false}, {"label": "D", "text": "Herpes simplex encephalitis", "correct": false}], "correct_answer": "B. Creuzfeldt-Jakob disease", "question_images": ["https://image.prepladder.com/content/I6ViEKGhWOVsF4tnHtM61694692155.png"], "explanation_images": ["https://image.prepladder.com/content/uv2plmialUIdzaLa44IU1714044966.png"], "explanation": "<p>Correct Option B - Creuzfeldt-Jak\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about juvenile myoclonic epilepsy is false? Polygenic inheritance Lamotrigine helps in controlling myoclonic jerks Benzodiazepines alone can control myoclonic jerks Valproate should be avoided", "options": [{"label": "A", "text": "1,2 &amp;amp; 3 are correct", "correct": true}, {"label": "B", "text": "1&amp;amp;3 are correct", "correct": false}, {"label": "C", "text": "2&amp;amp; 4 are correct", "correct": false}, {"label": "D", "text": "1,2,3 and 4 are correct", "correct": false}], "correct_answer": "A. 1,2 &amp; 3 are correct", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Subacute Sclerosing Panencephalitis is a complication of which of the following conditions?", "options": [{"label": "A", "text": "Mumps", "correct": false}, {"label": "B", "text": "Measles", "correct": true}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "RSV", "correct": false}], "correct_answer": "B. Measles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B: Subacute &lt;span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\"&gt;Sclerosing&lt;/span&gt; Panencephalitis- \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lesion shown in the image given below.", "options": [{"label": "A", "text": "Port Wine stain", "correct": true}, {"label": "B", "text": "Melanoma", "correct": false}, {"label": "C", "text": "Molluscum contagiosum", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": false}], "correct_answer": "A. Port Wine stain", "question_images": ["https://image.prepladder.com/content/9Y0pV7Il7Ccg7fnNzh0K1687408740.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Port W\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are true about Brown Sequard Syndrome except", "options": [{"label": "A", "text": "I/L loss of vibration", "correct": false}, {"label": "B", "text": "I/L loss of joint position", "correct": false}, {"label": "C", "text": "C/L loss of pain", "correct": false}, {"label": "D", "text": "C/L loss of vibration", "correct": true}], "correct_answer": "D. C/L loss of vibration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D.\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent statements accurately describe tremors? PD is characterized by resting tremor Tremor consist of alternate contraction of agonist and antagonist muscle in an oscillating rhythmic manner Essential tremor is an uncommon movement disorder affecting 5% of the population Normal individuals can have physiologic tremors that manifest as mild high frequency, postural or action tremors", "options": [{"label": "A", "text": "1,2,3 only", "correct": false}, {"label": "B", "text": "2,3,4 only", "correct": false}, {"label": "C", "text": "1,2,4 only", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. 1,2,4 only", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 1,2,4 only: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 37-year-old man is brought to the emergency room by his son. He complains of being unable to move his left arm and leg. According to his son, the patient was reading a book half an hour ago when he realized he couldn't lift his left arm to pick up another book. As he tried to move away from the table, he noticed that his left leg also became very weak. Additionally, he experienced double vision. The patient has a history of hypertension and hyperlipidemia. His body temperature is 36.1°C (97°F), blood pressure is 165/100 mmHg, pulse is 85 beats/min, and he has a respiratory rate of 16 breaths/min. During the examination, it is observed that the patient has drooping of the right eyelid and his right eye is directed downwards and to the side. When requested to smile, there is a drooping of the left corner of the mouth. The strength of the left upper and lower limbs is rated as 3 out of 5, whereas the strength of the right upper and lower limbs is rated as 5 out of 5. Which region of his brain has experienced ischemia among the following options?", "options": [{"label": "A", "text": "Inner capsule", "correct": false}, {"label": "B", "text": "Medulla", "correct": false}, {"label": "C", "text": "Midbrain", "correct": true}, {"label": "D", "text": "Occipital lobe", "correct": false}], "correct_answer": "C. Midbrain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common cause of Berry aneurysm?", "options": [{"label": "A", "text": "Endothelial injury of vessel due to HTN", "correct": false}, {"label": "B", "text": "Muscle intimal elastic lamina layer defect", "correct": true}, {"label": "C", "text": "Endothelial layer defect", "correct": false}, {"label": "D", "text": "Adventitia defect", "correct": false}], "correct_answer": "B. Muscle intimal elastic lamina layer defect", "question_images": [], "explanation_images": [], "explanation": "<p> Correct Option B – Muscle &lt;span class=\"customMeta\" data-dictid=\"0c950b29361692777190aa5f42e76b\"&gt;intimal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\"&gt;elastic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\"&gt;lamina&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding Guillain-Barre syndrome?", "options": [{"label": "A", "text": "Ascending paralysis", "correct": false}, {"label": "B", "text": "Descending paralysis is seen", "correct": true}, {"label": "C", "text": "Plasmapheresis is a treatment method", "correct": false}, {"label": "D", "text": "Demyelinating disorder", "correct": false}], "correct_answer": "B. Descending paralysis is seen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\"&gt;Descending&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\"&gt;paralysis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding patients with trigeminal neuralgia?", "options": [{"label": "A", "text": "More common in females", "correct": false}, {"label": "B", "text": "Pain along V2 and V3 division of trigeminal nerve", "correct": false}, {"label": "C", "text": "Deep seated pain", "correct": true}, {"label": "D", "text": "No objective signs of sensory loss", "correct": false}], "correct_answer": "C. Deep seated pain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Deep-seated P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed form of Guillain-Barre syndrome among the options provided?", "options": [{"label": "A", "text": "Acute motor axonal neuropathy", "correct": false}, {"label": "B", "text": "Acute inflammatory demyelinating polyneuropathy", "correct": true}, {"label": "C", "text": "Acute motor sensory axonal neuropathy", "correct": false}, {"label": "D", "text": "Miller fisher syndrome", "correct": false}], "correct_answer": "B. Acute inflammatory demyelinating polyneuropathy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\"&gt;inflammatory&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"25cf8215eb1692777186f0ab76dc34\"&gt;demyelinating polyneuropathy&lt;/span&gt; (AIDP)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the consequence of thrombosis in the posterior inferior cerebellar artery?", "options": [{"label": "A", "text": "Lateral medullary syndrome", "correct": true}, {"label": "B", "text": "Weber syndrome", "correct": false}, {"label": "C", "text": "Medial medullary syndrome", "correct": false}, {"label": "D", "text": "Millard Gubler syndrome", "correct": false}], "correct_answer": "A. Lateral medullary syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\"&gt;Lateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\"&gt;medullary&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old female came complains of weakness, easy fatigability, double vision and drooping of the upper eyelids. On examination her deep tendon reflexes are normal. What is the pathogenesis of the condition in this case?", "options": [{"label": "A", "text": "Decreased acetylcholine release at the nerve endings", "correct": false}, {"label": "B", "text": "Decreased myosin", "correct": false}, {"label": "C", "text": "Absence of troponin C", "correct": false}, {"label": "D", "text": "Decreased synaptic transmission at the myoneural junction", "correct": true}], "correct_answer": "D. Decreased synaptic transmission at the myoneural junction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Decreased &lt;span class=\"customMeta\" data-dictid=\"5c4592475a1692777199991c761d11\"&gt;synaptic&lt;/span&gt; transmission at the &lt;span class=\"customMeta\" data-dictid=\"6e00e3eee21692777193dfa090411e\"&gt;myoneural&lt;/span&gt; ju\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Weber's syndrome is incorrect?", "options": [{"label": "A", "text": "Contralateral hemiplegia", "correct": false}, {"label": "B", "text": "Ipsilateral oculomotor nerve palsy", "correct": false}, {"label": "C", "text": "Contralateral parkinsonism", "correct": false}, {"label": "D", "text": "Ipsilateral paralysis of lower face", "correct": true}], "correct_answer": "D. Ipsilateral paralysis of lower face", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ipsilateral &lt;span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\"&gt;paralysis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the typical pattern observed in Brown-Sequard syndrome?", "options": [{"label": "A", "text": "Contralateral loss of joint sense and position", "correct": false}, {"label": "B", "text": "Contralateral loss of pain sensation", "correct": true}, {"label": "C", "text": "Ipsilateral loss of complete sensory functions", "correct": false}, {"label": "D", "text": "Contralateral motor functions", "correct": false}], "correct_answer": "B. Contralateral loss of pain sensation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What medication is employed for mass chemoprophylaxis in the case of meningococcal meningitis?", "options": [{"label": "A", "text": "Ciprofloxacin", "correct": true}, {"label": "B", "text": "Chloramphenicol", "correct": false}, {"label": "C", "text": "Tetracycline", "correct": false}, {"label": "D", "text": "Penicillin", "correct": false}], "correct_answer": "A. Ciprofloxacin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old, male with hypertension develops sudden onset weakness on the right side of the face &amp;amp; arm. His attender recalls history of headache, blurred vision in the patient which leads to the suspicion of increased ICP. Which is the most common cranial nerve involved in raised ICP?", "options": [{"label": "A", "text": "Abducens nerve", "correct": true}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Trigeminal nerve", "correct": false}, {"label": "D", "text": "Facial nerve", "correct": false}], "correct_answer": "A. Abducens nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"493415137f1692777180adce8b5447\"&gt;Abducens&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended method for preventing meningococcal meningitis during pregnancy?", "options": [{"label": "A", "text": "Ceftriaxone", "correct": true}, {"label": "B", "text": "Rifampicin", "correct": false}, {"label": "C", "text": "Ciprofloxacin", "correct": false}, {"label": "D", "text": "Penicillin G", "correct": false}], "correct_answer": "A. Ceftriaxone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following symptoms is absent in Horner syndrome?", "options": [{"label": "A", "text": "Mydriasis", "correct": true}, {"label": "B", "text": "Ptosis", "correct": false}, {"label": "C", "text": "Anhidrosis", "correct": false}, {"label": "D", "text": "Enophthalmos", "correct": false}], "correct_answer": "A. Mydriasis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 43-year-old patient comes to the OPD with complains tingling sensation in the hands and feet. Reversible dementia is seen in?", "options": [{"label": "A", "text": "SACD", "correct": true}, {"label": "B", "text": "AD", "correct": false}, {"label": "C", "text": "CJD", "correct": false}, {"label": "D", "text": "Pick's disease", "correct": false}], "correct_answer": "A. SACD", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - SACD\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below is NOT accurate regarding Parkinson's disease?", "options": [{"label": "A", "text": "Manganese can cause secondary Parkinsonism", "correct": false}, {"label": "B", "text": "Usage of Carbidopa leads to on and off phenomenon", "correct": true}, {"label": "C", "text": "Slight tremor in the hand or foot followed by jaw", "correct": false}, {"label": "D", "text": "Cog wheel rigidity or lead pipe rigidity is seen", "correct": false}], "correct_answer": "B. Usage of Carbidopa leads to on and off phenomenon", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Usage of &lt;span class=\"customMeta\" data-dictid=\"fdef17b2781692777183c601c1c5eb\"&gt;Carbidopa&lt;/span&gt; leads to on and off ph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As an intern in the neurology ward of the Department of Internal Medicine, you encounter a 48-year-old female patient who has been admitted due to muscle weakness. After conducting investigations and examinations, it is found that her nerve conduction shows a decremental response , but she displays signs of flaccidity. Based on these findings, what possible diagnosis would you consider?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "GBS", "correct": false}, {"label": "C", "text": "Transverse myelitis", "correct": false}, {"label": "D", "text": "Traumatic neuritis", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\"&gt;Myasthenia&lt;/span&gt; grav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Extensor Reflex on pinching gastrocnemius muscle is called?", "options": [{"label": "A", "text": "Gower Sign", "correct": false}, {"label": "B", "text": "Homan Sign", "correct": false}, {"label": "C", "text": "Oppenheim Sign", "correct": false}, {"label": "D", "text": "Gordon Sign", "correct": true}], "correct_answer": "D. Gordon Sign", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Gordon Sig\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Sign</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Associated Condition</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gower Sign</p>\n</td>\n<td>\n<p>Duchenne <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> dystrophy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Homan Sign</p>\n</td>\n<td>\n<p>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> (DVT)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oppenheim Sign</p>\n</td>\n<td>\n<p>Upper <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> dysfunction</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gordon Sign</p>\n</td>\n<td>\n<p>Hypertrophy of calf muscles due to muscle weakness</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Tigroid white matter on MR imaging is seen in which of the following conditions?", "options": [{"label": "A", "text": "Pantothenate kinase deficiency", "correct": false}, {"label": "B", "text": "Pelizaeus-Merzbacher disease", "correct": true}, {"label": "C", "text": "Neuroferritinopathy", "correct": false}, {"label": "D", "text": "Aceruloplasminemia", "correct": false}], "correct_answer": "B. Pelizaeus-Merzbacher disease", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old man was brought to the OPD with complaints of multiple hyperpigmented skin macules which started in his childhood. These fibromas near the eyelid have increased in size causing visual disturbance. Identify the disease shown in the below image.", "options": [{"label": "A", "text": "Facial nerve palsy", "correct": false}, {"label": "B", "text": "Plexiform neurofibromatosis", "correct": true}, {"label": "C", "text": "Masticator space abscess", "correct": false}, {"label": "D", "text": "Fibrous dysplasia", "correct": false}], "correct_answer": "B. Plexiform neurofibromatosis", "question_images": ["https://image.prepladder.com/content/5hb7VT5ibffnnrUqgm0d1691498130.PNG"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"946db798c6169277719544d7b31041\"&gt;Plexiform&lt;/span&gt; neu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of a backache for 10 days, has now presented with sudden onset difficulty in micturition and defaecation. There was no history of a cough or fever previously. What is the diagnosis?", "options": [{"label": "A", "text": "Pott's Spine", "correct": false}, {"label": "B", "text": "Gullian Barre Syndrome", "correct": false}, {"label": "C", "text": "Cauda Equina Syndrome", "correct": true}, {"label": "D", "text": "Multiple Sclerosis", "correct": false}], "correct_answer": "C. Cauda Equina Syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"657533bf1d16927771839f7875a8eb\"&gt;Cauda&lt;/span&gt; Equina S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with left-sided facial paralysis and weakness for the past 1 hour. Her blood pressure is 160/100 mmHg and CT appears normal. What would be your next step?", "options": [{"label": "A", "text": "Nothing, since CT was normal", "correct": false}, {"label": "B", "text": "Start on aspirin + clopidogrel", "correct": false}, {"label": "C", "text": "Intravenous thrombolysis", "correct": true}, {"label": "D", "text": "Advice BP control", "correct": false}], "correct_answer": "C. Intravenous thrombolysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\"&gt;Intravenous&lt;/span&gt; th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient walks with a stomping gait. When asked to close his eyes and walk, he is unable to do so. Which of the following tracts is probably affected?", "options": [{"label": "A", "text": "Spinocerebellar tract", "correct": false}, {"label": "B", "text": "Posterior column tract", "correct": true}, {"label": "C", "text": "Vestibulospinal tract", "correct": false}, {"label": "D", "text": "Rubrospinal tract", "correct": false}], "correct_answer": "B. Posterior column tract", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\"&gt;Posterior&lt;/span&gt; colu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the sagittal section of the brain given below, if the coloured area is affected, which of the following is not seen?", "options": [{"label": "A", "text": "Urinary incontinence", "correct": false}, {"label": "B", "text": "Gait apraxia", "correct": false}, {"label": "C", "text": "Perianal anesthesia", "correct": true}, {"label": "D", "text": "Fecal incontinence", "correct": false}], "correct_answer": "C. Perianal anesthesia", "question_images": ["https://image.prepladder.com/content/3DVaIJ5qj4NU6aSZ7VEX1687936426.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\"&gt;Perianal&lt;/span&gt; anesth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old girl, who is taking antiepileptics, has had a seizure-free period of 6 months. She has no family history of epilepsy. Her EEG is now normal and she has a normal neurological exam and intelligence. What would your advice be?", "options": [{"label": "A", "text": "Stop the treatment and follow up", "correct": false}, {"label": "B", "text": "Gradually taper the drug and stop treatment", "correct": false}, {"label": "C", "text": "Continue treatment for another 2 years", "correct": true}, {"label": "D", "text": "Continue lifelong treatment with antiepileptics", "correct": false}], "correct_answer": "C. Continue treatment for another 2 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Continue treatment for another 2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 123 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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The symptoms began 2 months after she suffered a stroke. On examination, she has hyperesthesia and allodynia on the right side. The clinician suspected it to be due to lacunar infarct. What could be the likely site of infarct causing her present symptoms?", "options": [{"label": "A", "text": "Ventroposterolateral thalamus", "correct": true}, {"label": "B", "text": "Posterior limb of internal capsule", "correct": false}, {"label": "C", "text": "Genu of internal capsule", "correct": false}, {"label": "D", "text": "Cortical pontocerebellar tract", "correct": false}], "correct_answer": "A. Ventroposterolateral thalamus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lacunar infarct</strong> of <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> branches of <strong>PCA (P1 segment)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemianesthesia affecting one half of body (initially) <strong>[Hemisensory loss]</strong></li>\n<li>Later causing <strong>burning pain</strong> sensation (during recovery)</li>\n<li>O/E: Hyperaesthesia, <span class=\"customMeta\" data-dictid=\"59858cff5516927771819ae5126f84\">allodynia</span> may be present on the affected side</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carbamazepine, Gabapentin, TCAs (Tricyclic antidepressants)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lacunar <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> (affecting <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> branches) secondary to atherosclerotic occlusion/lipohyalinosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypertension: Most common</strong></li>\n<li>Diabetes</li>\n<li>Atrial fibrillation</li>\n<li>Smoking</li>\n<li>Hyperlipidemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites &amp; manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Posterior limb of internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> </strong><strong>(Option B)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pure motor hemiparesis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Genu of internal <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> </strong><strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clumsy hand <span class=\"customMeta\" data-dictid=\"faa6bb18b11692777186c6a26198e2\">dysarthria</span> lacunar syndrome (facial weakness)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cortical <span class=\"customMeta\" data-dictid=\"b32e60f29a16927771963de1f70fd5\">pontocerebellar</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> </strong><strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>I/L <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> + C/L hemiparesis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ventroposterolateral <span class=\"customMeta\" data-dictid=\"0c5f024f21169277720046ac004a34\">thalamus</span> </strong><strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dejerine-Roussy syndrome</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly patient presented with a history of slowing of movements, frequent falls and forgetfulness. MRI done is as shown below. Which among the following is not a feature of this condition?", "options": [{"label": "A", "text": "Defective downward gaze", "correct": false}, {"label": "B", "text": "Bradykinesia and tremors", "correct": true}, {"label": "C", "text": "Poor response to levodopa", "correct": false}, {"label": "D", "text": "Gunslinger’s gait", "correct": false}], "correct_answer": "B. Bradykinesia and tremors", "question_images": ["https://image.prepladder.com/notes/GnPoWVN3ky3QqV7D5jhd1744361515.png"], "explanation_images": ["https://image.prepladder.com/notes/O2qtKniwCnITRNPvCZfO1744361541.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progressive <span class=\"customMeta\" data-dictid=\"5ef5f7d035169277719997649dc97a\">supranuclear</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> [PSP]</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early onset postural instability</strong> - H/O frequent falls + Dementia</li>\n<li><strong>Tremors - absent </strong><strong>(Option B)</strong></li>\n<li><strong>Defective downward gaze</strong> <strong>(Option A) </strong>+ extended <span class=\"customMeta\" data-dictid=\"115643fed616927771961316effc71\">posture</span> of body</li>\n<li>Dystonia: <span class=\"customMeta\" data-dictid=\"885fe5e0df1692777196089bd62500\">Procerus</span> sign (forehead) + <strong>Gunslinger’s gait</strong> (flexion at elbow &amp; <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> at upper limb) <strong>(Option D)</strong></li>\n<li><strong>Poor response to levodopa</strong><strong> (Option C)</strong></li>\n<li><strong>MRI: Hummingbird sign</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lewy body <span class=\"customMeta\" data-dictid=\"41cc5ad93c169277718553c6b948a3\">dementia</span> [LBD]</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parkinsonian features + <strong>Visual <span class=\"customMeta\" data-dictid=\"e5f22a787616927771880e1f38d8e6\">hallucination</span> + early Dementia</strong></li>\n<li>Associated <strong>REM sleep disorder</strong> may be present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multiple <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> [MSA]</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>MSA-A: </strong>Autonomic <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> + <strong>(orthostatic hypotension)</strong></li>\n<li><strong>MSA-C: </strong>Cerebellar symptoms + ; <strong>MRI- Hot cross <span class=\"customMeta\" data-dictid=\"eeb0ec7e661692777183f957a8794b\">bun</span> sign</strong> (Pons)\n\t\t\t\t<figure class=\"caption_element\"><img alt=\" Hummingbird sign\" data-author=\"Moreira, Ana Sofia &amp; Castro, Miguel &amp; Grande, Pablo &amp; Brito, Jorge &amp; Ventosa, Ana &amp; Patricio, Henrique &amp; Santos, Bruno &amp; Afonso, Graça &amp; Dinis, Mónica.\" data-hash=\"9230\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Hummingbird-Sign-T1W-weighted-sagittal-MRI-of-the-brain-trough-the-brainstem-showing_fig24_314917629\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/O2qtKniwCnITRNPvCZfO1744361541.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticobasal syndrome [CBS]</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dystonia</strong> + <strong>myoclonus</strong> + <strong>alien limb phenomena</strong> present alone with other <span class=\"customMeta\" data-dictid=\"af42cffef41692777194ceaa162eeb\">parkinsonian</span> features\n\t\t\t\t<figure class=\"caption_element\"><img alt=\" Hot cross &lt;span class=\" custommeta\"=\"\" data-dictid=\"eeb0ec7e661692777183f957a8794b\"/>bun sign\" data-author=\"Moreira, Ana Sofia &amp; Castro, Miguel &amp; Grande, Pablo &amp; Gameiro, Ana &amp; Bahia Soares, Carla &amp; Costa, Yessica &amp; Silva, Luís &amp; Saraiva, José &amp; Dinis, Mónica.\" data-hash=\"9232\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Hot-Cross-Bun-Sign-Head-T2W-MRI-though-the-pons-showing-a-hyperintense-pontine-cross_fig2_314914201\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/2EPLrNdg8OTYMWmfFSuA1744361572.png\" /&gt;\n\t\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following clinical signs of upper motor neuron lesion is described correctly ?", "options": [{"label": "A", "text": "Gordon’s sign - A stroke beneath and in front of the lateral malleolus causing an extensor plantar response.Babinski’s sign - Lateral stroke of the sole resulting in flexion of all toes", "correct": false}, {"label": "B", "text": "Gordon’s sign - A stroke beneath and in front of the lateral malleolus causing an extensor plantar response.", "correct": false}, {"label": "C", "text": "Oppenheim’s sign - Apply pressure along the medial aspect of tibia causing an extensor plantar response", "correct": true}, {"label": "D", "text": "Chaddock’s sign - Squeeze the calf muscles to produce extensor plantar response.", "correct": false}], "correct_answer": "C. Oppenheim’s sign - Apply pressure along the medial aspect of tibia causing an extensor plantar response", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ds1fA1Hbnan7VmvmoBOi1744361334.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5 year old female child presented to the casualty with recurrent seizures and left sided hemiplegia. On physical examination, a reddish skin lesion was found since birth over the right side of her forehead involving the right eye, nose and cheek. On CT imaging of the brain, the following picture was seen. What is the probable diagnosis?", "options": [{"label": "A", "text": "Von Hippel Lindau syndrome", "correct": false}, {"label": "B", "text": "Sturge Weber syndrome", "correct": true}, {"label": "C", "text": "Neurofibromatosis", "correct": false}, {"label": "D", "text": "Ataxia telangiectasia", "correct": false}], "correct_answer": "B. Sturge Weber syndrome", "question_images": ["https://image.prepladder.com/notes/1WMZdUilmc1clKxBhWRy1744361134.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15 year old adolescent male patient came with his parents with complaints of neuropsychiatric symptoms such as tremors and an irritable mood. On physical examination, hepatomegaly and the following ophthalmological finding is seen. What is the probable diagnosis and gene involved in this patient?", "options": [{"label": "A", "text": "Wilson’s disease and ATP7B gene", "correct": true}, {"label": "B", "text": "Hemochromatosis and HFE gene", "correct": false}, {"label": "C", "text": "Gilbert syndrome and UGT1A1 gene", "correct": false}, {"label": "D", "text": "Classical galactosemia and GALT gene", "correct": false}], "correct_answer": "A. Wilson’s disease and ATP7B gene", "question_images": ["https://image.prepladder.com/notes/9zWXjQz8TNuTQ9r0y0vU1744361075.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wilson’s disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wilson's disease is caused by mutations in the ATP7B gene, leading to <strong>defective <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> excretion</strong> and increased <strong>copper accumulation</strong> in organs such as the <strong>liver, brain, and eyes</strong>, resulting in <span class=\"customMeta\" data-dictid=\"c00796544416927771883205a5eb12\">hepatolenticular</span> degeneration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hepatic</strong>: Jaundice, hepatomegaly, ascites; <strong>chronic liver disease may develop by age 40</strong>.</li>\n<li><strong>Neurological</strong>: Dysarthria, rigidity, tremors, uncoordinated handwriting.</li>\n<li><strong>Psychiatric</strong>: Personality changes such as <span class=\"customMeta\" data-dictid=\"31383b73d01692777190c6880a580b\">irritable</span> mood, depression and anxiety.</li>\n<li><strong>Ocular</strong>: <strong>Kayser-Fleischer rings</strong><strong> </strong>(copper deposits in the <strong>Descemet’s membrane</strong> of cornea) and <strong>sunflower</strong> cataracts.</li>\n<li><strong>Other</strong>: Delayed puberty, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> dysfunction, skeletal issues (osteoporosis, rickets), <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Biochemical</strong>: <strong>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> copper</strong> and <strong>ceruloplasmin</strong>, elevated <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> transaminases, aminoaciduria, <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia.</li>\n<li><strong>Diagnostic Tests</strong>:<strong> </strong>Increased <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> excretion; liver <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for <strong>hepatic <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> measurement (values &gt;200</strong></li>\n</ul>\n<p><strong>μg/g dry weight</strong> is <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> of Wilson’s disease).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Copper Chelation</strong>: <strong>D-penicillamine </strong>enhances <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> excretion. Alternatives include<strong> trientine hydrochloride.</strong></li>\n<li><strong>Zinc Therapy</strong>: Reduces <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> in the gut mainly useful for <span class=\"customMeta\" data-dictid=\"de809764741692777196fbafdae4e5\">presymptomatic</span> patients and during pregnancy.</li>\n<li><strong>Liver Transplantation</strong>: Considered in advanced cases or when medical therapy fails.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 year old male patient was brought to the casualty with a history of road traffic accident and sustained multiple injuries. On primary assessment, he was disoriented and complained of his worst and most painful headache he ever had. On CT brain imaging, the following image was seen. What is the most probable diagnosis in this patient?", "options": [{"label": "A", "text": "Intracerebral hemorrhage", "correct": false}, {"label": "B", "text": "Subdural hemorrhage", "correct": false}, {"label": "C", "text": "Subarachnoid hemorrhage", "correct": true}, {"label": "D", "text": "Extradural hemorrhage", "correct": false}], "correct_answer": "C. Subarachnoid hemorrhage", "question_images": ["https://image.prepladder.com/notes/fILBYAg6WrHecq6VyHV01744361007.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subarachnoid haemorrhage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common cause is <strong>head injury</strong>.</li>\n<li>Most common non-traumatic cause is due to<strong> <span class=\"customMeta\" data-dictid=\"df4e8e3ae81692777198a0513bc88c\">saccular</span> (berry) aneurysms</strong>, often at the <span class=\"customMeta\" data-dictid=\"9698e03b20169277718451fdb9d984\">circle of Willis</span> - most commonly <strong>anterior <span class=\"customMeta\" data-dictid=\"8c3efbee661692777184685e54c75e\">communicating</span> artery</strong>.</li>\n<li>Other causes include non-aneurysmal (perimesencephalic) haemorrhages, <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> malformations and vertebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> dissection.</li>\n<li>Increased risk in cases of <strong>polycystic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</strong>, and <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue disorders (e.g., <strong>Ehlers-Danlos syndrome</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden, severe \"<strong>thunderclap</strong>\" headache (often <strong>occipital</strong>), lasting hours to days. Often occurs during physical exertion or straining.</li>\n<li><strong>Signs of</strong> <strong>raised ICP</strong> - vomiting, raised blood pressure, neck stiffness/pain, potential loss of consciousness, <span class=\"customMeta\" data-dictid=\"46e2a1c298169277719583f46ff587\">photophobia</span> and neck <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> (which may develop over time).</li>\n<li>Focal neurological signs may be present if associated <span class=\"customMeta\" data-dictid=\"c7f167b8df1692777190bcd90fe428\">intracerebral</span> haematoma occurs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CT brain and <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> are essential for diagnosis.</li>\n<li>CT can confirm SAH, but negative results do not exclude it (small blood volumes may not be detected).</li>\n<li><strong>Lumbar puncture</strong> should be performed 12 hours post-symptom onset to detect <strong>xanthochromia</strong>.</li>\n<li>If SAH is confirmed, cerebral <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">angiography</span> is necessary to plan for treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nimodipine</strong> (30–60 mg IV for <strong>5–14 days</strong>, followed by 360 mg orally for 7 days) is used to <strong>prevent delayed ischemia.</strong></li>\n<li><strong>Aneurysms</strong> may be treated with <strong>endovascular coiling</strong> or <strong>surgical clipping</strong> to reduce <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</li>\n<li>Management of complications includes <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> for obstructive hydrocephalus, vasodilators for delayed cerebral ischemia, and fluid restriction for hyponatremia.</li>\n<li>Other supportive measures for immobility-related complications (e.g., chest infection, <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> thrombosis) may be necessary.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75 year old male patient came to the OPD with complaints of recent onset stooping, broad based abnormal gait, short-term memory loss and urge incontinence. On radiological investigation, the following image is obtained. What is the probable diagnosis?", "options": [{"label": "A", "text": "Parkinson’s disease", "correct": false}, {"label": "B", "text": "Alzheimer’s disease", "correct": false}, {"label": "C", "text": "Normal pressure hydrocephalus", "correct": true}, {"label": "D", "text": "Idiopathic intracranial hypertension", "correct": false}], "correct_answer": "C. Normal pressure hydrocephalus", "question_images": ["https://image.prepladder.com/notes/7IZGl9wyseKbs1lvOIlN1744360950.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Idiopathic <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hypertension</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It usually affects <strong>young <span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\">obese</span> women</strong>. Its exact cause is uncertain, but <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> may impair <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> reabsorption, while certain medications like<strong> tetracycline</strong> and <strong>vitamin A</strong> are associated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients typically present with<strong> headaches, diplopia</strong>, and <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> visual disturbances.</li>\n<li>Physical signs include <strong>papilloedema</strong> and possible <strong>sixth <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsy</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Brain <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> to <strong>rule out structural causes</strong>.</li>\n<li>Lumbar puncture, revealing <strong>elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> pressure &gt; 30 cmH2O.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Weight loss</strong> might be beneficial.</li>\n<li>Medications such as<strong> acetazolamide</strong> or <strong>topiramate</strong> may lower <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure.</li>\n<li><strong>Repeated <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> punctures</strong> can alleviate headaches, but if vision is threatened, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> options like <strong>optic <span class=\"customMeta\" data-dictid=\"782b2a963516927771936bac7aff14\">nerve sheath</span> fenestration</strong> or a lumbo-peritoneal <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">shunt</span> may be necessary.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13 year old male patient presented with complaints of poor scholastic performance, history of recurrent seizures since infancy and the following incidental finding on his back. What does the incidental finding denote and probable diagnosis of this patient?", "options": [{"label": "A", "text": "Neurofibroma and Neurofibromatosis", "correct": false}, {"label": "B", "text": "Adenoma sebaceum and Tuberous sclerosis", "correct": false}, {"label": "C", "text": "Shagreen patch and Tuberous sclerosis", "correct": true}, {"label": "D", "text": "Cafe-au-lait spots and Neurofibromatosis", "correct": false}], "correct_answer": "C. Shagreen patch and Tuberous sclerosis", "question_images": ["https://image.prepladder.com/notes/XnyGQ9C22LM3wGuXS9p21744360659.png"], "explanation_images": ["https://image.prepladder.com/notes/xGNHDN1IfPp9BAmvoLtL1744360714.png", "https://image.prepladder.com/notes/tbrOdp9m7bKkRbf9063U1744360748.png", "https://image.prepladder.com/notes/npa9DvvAARDHXKWV72rE1744360790.png", "https://image.prepladder.com/notes/F60FRWPMowjhMyJAzCUW1744360837.png", "https://image.prepladder.com/notes/otOn46BBsSb30RI3C7fy1744360879.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tuberous <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> (BOURNEVILLE DISEASE)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is an autosomal dominant disorder.</li>\n<li>Genes involved are <strong>TSC1</strong> in <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>9</strong> producing <strong>hamartin</strong> protein and <strong>TSC2</strong> is on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>16</strong> producing <strong>tuberin protein</strong>.</li>\n<li>Both these proteins play a role in cell growth and cell division. Mutations lead to <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of mTOR <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> signalling giving rise to various tumours.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Classical <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> of <strong>seizures </strong>(epilepsy), low IQ, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> angiofibromas (<strong>adenoma sebaceum</strong>)-<strong> EPILOIA</strong></li>\n<li>Other skin manifestations include <span class=\"customMeta\" data-dictid=\"3312dd2c3416927771983551a7aae0\">shagreen</span> patches, hypomelanotic macules (<strong>Ash leaf macules</strong>), <span class=\"customMeta\" data-dictid=\"071b6e63e416927771957247e84890\">periungual</span> fibromas (<strong>Koenen tumours</strong>)</li>\n<li>Associated with <strong>renal angiomyolipomas</strong>, <strong>cardiac rhabdomyomas</strong> (in children)</li>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"3e782ca1981692777199a69e89b274\">subependymal</span> nodules, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> tubers and <strong>subependymal giant cell astrocytomas</strong> (SEGAs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anticonvulsants for seizures</li>\n<li><strong>mTOR inhibitors</strong> (sirolimus or everolimus) for SEGAs and <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> reduction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis on the basis of the MRI image given below?", "options": [{"label": "A", "text": "Vestibular schwannoma", "correct": true}, {"label": "B", "text": "Pneumocephalus", "correct": false}, {"label": "C", "text": "Craniopharyngioma", "correct": false}, {"label": "D", "text": "Prion disease", "correct": false}], "correct_answer": "A. Vestibular schwannoma", "question_images": ["https://image.prepladder.com/notes/7Ih55L7jwg6aEVGcYezN1744360157.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis on the basis of the CT image given below?", "options": [{"label": "A", "text": "Pantothenate kinase-associated neurodegeneration", "correct": true}, {"label": "B", "text": "Pneumocephalus", "correct": false}, {"label": "C", "text": "Craniopharyngioma", "correct": false}, {"label": "D", "text": "Prion disease", "correct": false}], "correct_answer": "A. Pantothenate kinase-associated neurodegeneration", "question_images": ["https://image.prepladder.com/notes/nezQIzSyKCrseFZsdjIR1744359992.png"], "explanation_images": ["https://image.prepladder.com/notes/OobaxIqsAGpsnsdzKN2W1744360032.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a CT finding of Pneumocephalus?", "options": [{"label": "A", "text": "Mount Fuji Sign", "correct": false}, {"label": "B", "text": "Air Bubble Sign", "correct": false}, {"label": "C", "text": "Peaking Sign", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/1oeBQ3UrRHHHcF8ui7aV1744359787.png", "https://image.prepladder.com/notes/5rhUgF6KTPdroG0lFL3v1744359829.png", "https://image.prepladder.com/notes/A6ZoTAsaYj2tisP5kyww1744359879.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Observation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mount Fuji Sign</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accumulation of air in the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> region, separating the <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">tips</span> of the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> lobes in a <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> patient.</p>\n<figure class=\"caption_element\"><img alt=\"Peaking Sign\" data-author=\"Choudhary G, Sattouf M, Ranchod A\" data-hash=\"9181\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/mount-fuji-sign-1\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1oeBQ3UrRHHHcF8ui7aV1744359787.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Air Bubble Sign</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, round areas of low <span class=\"customMeta\" data-dictid=\"22818451b71692777182237914a233\">attenuation</span> (dark regions) representing air pockets within <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid spaces.</p>\n<figure class=\"caption_element\"><img alt=\"Air Bubble Sign\" data-author=\"O'Donnell C\" data-hash=\"9182\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/tension-pneumocranium-post-fess-perforation-of-ethmoidal-air-cells?case_id=tension-pneumocranium-post-fess-perforation-of-ethmoidal-air-cells&amp;lang=us\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/5rhUgF6KTPdroG0lFL3v1744359829.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peaking Sign</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lack of separation between the <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">tips</span> of the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> lobes; appears flattened or peaked, indicating increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure.</p>\n<figure class=\"caption_element\"><img alt=\"Mount Fuji Sign\" data-author=\"Gokmen, Ibrahim &amp; Keskin, Suat &amp; Kıresi, Demet &amp; Erdoğan, Hasan. \" data-hash=\"9183\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Mount-fuji-sign-tension-pneumocephalus-Axial-non-contrast-brain-CT-image-demonstrates_fig1_274781297\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/A6ZoTAsaYj2tisP5kyww1744359879.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Describe the lesion given in the MRI below:", "options": [{"label": "A", "text": "Cystic", "correct": false}, {"label": "B", "text": "Heterogenous", "correct": false}, {"label": "C", "text": "Homogenous", "correct": false}, {"label": "D", "text": "Both A and B", "correct": true}], "correct_answer": "D. Both A and B", "question_images": ["https://image.prepladder.com/notes/vOJxAPsPZfwQZzeTGTuK1744359683.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is false on findings of Creutzfeldt-Jakob disease?", "options": [{"label": "A", "text": "Periodic sharp wave complexes on EEG", "correct": false}, {"label": "B", "text": "Cortical ribboning in MRI", "correct": false}, {"label": "C", "text": "Increased intensity in the basal ganglia", "correct": false}, {"label": "D", "text": "All prion diseases are characterized by spongiform changes", "correct": true}], "correct_answer": "D. All prion diseases are characterized by spongiform changes", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/O9oD0uw20eZNt5LiuIel1744359493.png", "https://image.prepladder.com/notes/5Xg1Ffn38kw954TpiJxb1744359556.png", "https://image.prepladder.com/notes/7wQUP4eNUPL0RhhGUbdK1744359589.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Electroencephalography (EEG)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Periodic sharp wave complexes (PSWC) <strong>(Option A ruled out)</strong></li>\n<li>These can be either lateralized in earlier stages or generalized in later stages.\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"Periodic sharp wave complex\" data-author=\"Dirzius, Edgaras &amp; Balnytė, Renata &amp; Steibliene, Vesta &amp; Gleizniene, Rymante &amp; Gudinaviciene, Inga &amp; Radziunas, Andrius &amp; Petrikonis, Kestutis.\" data-hash=\"9171\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Electroencephalography-at-week-18-Legend-periodic-sharp-wave-complexes-in-frontal_fig2_310735862\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/O9oD0uw20eZNt5LiuIel1744359493.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MRI findings</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased intensity in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> <span class=\"customMeta\" data-dictid=\"f2804c808516927771887dda93e56c\">ganglia</span> <strong>(Option C ruled out)</strong></li>\n<li><strong>Cortical ribboning</strong> <strong>(Option B ruled out)</strong>\n<figure class=\"caption_element\"><img alt=\"Cortical ribboning\" data-author=\"Pract Neurol\" data-hash=\"9172\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Creutzfeldt%E2%80%93Jakob_disease\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/5Xg1Ffn38kw954TpiJxb1744359556.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the ER after a fall, initially conscious but rapidly deteriorates following a brief lucid interval. The CT image is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Epidural hematoma", "correct": true}, {"label": "B", "text": "Extradural hematoma", "correct": false}, {"label": "C", "text": "Subdural hematoma", "correct": false}, {"label": "D", "text": "Intracerebral hematoma", "correct": false}], "correct_answer": "A. Epidural hematoma", "question_images": ["https://image.prepladder.com/notes/G2ONVhIszKIfWb2kMNjj1744359331.png"], "explanation_images": ["https://image.prepladder.com/notes/JrTbqyuDuO9wOjTVPkuT1744359427.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subdural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> (Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Biconvex or lens-shaped mass due to the limited ability of blood to expand within the fixed <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> of the <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> to the <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> sutures</li>\n<li>Does not cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines.\n\t\t\t\t<figure class=\"caption_element\"><img alt=\" &lt;span class=\" custommeta\"=\"\" data-dictid=\"6de01005f61692777187a3003970c7\"/>Epidural hematoma\" data-author=\"James Heilman, MD\" data-hash=\"9169\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Epidural_hematoma\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ErSJ0X0GBCltkgjCMq5X1744359369.png\" /&gt;\n\t\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically <span class=\"customMeta\" data-dictid=\"c22cf6658416927771856f7516a87e\">crescentic</span> in configuration, extending over the cerebral <span class=\"customMeta\" data-dictid=\"70cc36bc1a1692777185d6cfa6e6b9\">convexity</span> due to the lack of <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> constraints in the <span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\">subdural</span> space.\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"Subdural hematoma\" data-author=\"James Heilman, MD\" data-hash=\"9170\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/JrTbqyuDuO9wOjTVPkuT1744359427.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the MRI finding (shown below) , Which of the following criteria and corresponding treatment used in this condition?", "options": [{"label": "A", "text": "Brighton’s criteria, IV Steroids", "correct": false}, {"label": "B", "text": "Brighton’s criteria, IV Immunoglobulin", "correct": false}, {"label": "C", "text": "McDonald’s criteria, IV Steroids", "correct": true}, {"label": "D", "text": "McDonald’s criteria, IV Immunoglobulin", "correct": false}], "correct_answer": "C. McDonald’s criteria, IV Steroids", "question_images": ["https://image.prepladder.com/notes/pZlhBKB05dUm95qsm7VR1744358956.png"], "explanation_images": ["https://image.prepladder.com/notes/nFN3LpzjzPsBq2iUXEas1744359052.png", "https://image.prepladder.com/notes/KohSBoWpPsc5F7yJ3gnN1744359097.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic neurological disorder characterized by inflammation, <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> and <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> with lesions <strong>disseminated over time and space</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune cause:</p>\n<ul>\n<li><strong>Triggering antigen: <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">Myelin</span> basic protein</strong></li>\n<li>Antibodies target: Oligodendrocytes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>U/L <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> neuritis: Positive <strong>Uhthoff sign</strong> (blurring of vision on heat exposure)</li>\n<li>Sensory: Positive <strong>Lhermitte sign</strong> (Flexion at neck → Paraesthesia /shock-like sensation across the spine/back)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Relapsing MS: Most common type</strong>, usually females, associated with Vit-D deficiency, <span class=\"customMeta\" data-dictid=\"e4f6b2922d16927771865030175a86\">EBV</span> infection</li>\n<li><strong>Primary progressive MS:</strong> Relatively late onset</li>\n<li><strong>Secondary progressive MS:</strong> Least common<img alt=\"Types of Multiplke sclerosis\" data-author=\"\" data-hash=\"9166\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"332\" src=\"https://image.prepladder.com/notes/nFN3LpzjzPsBq2iUXEas1744359052.png\" width=\"332\"/></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scoring scale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Extended disability scoring scale (EDSS)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Criteria:<strong> McDonald’s criteria </strong><strong>(Option C)</strong></li>\n<li>MRI: <strong>Dawson’s fingers</strong> (demyelination over <span class=\"customMeta\" data-dictid=\"a71c8cfa8216927771955861218d80\">periventricular</span> areas); lesions dissemination over time &amp; space seen.</li>\n<li><strong>CSF: <span class=\"customMeta\" data-dictid=\"754705a861169277719425d87c6742\">Oligoclonal</span> bands +</strong>\n<figure class=\"caption_element\"><img alt=\"Dawson’s fingers\" data-author=\"Raz E, Yu Y, Saber M\" data-hash=\"9167\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/dawson-fingers\" data-tags=\"April2025\" height=\"329\" src=\"https://image.prepladder.com/notes/KohSBoWpPsc5F7yJ3gnN1744359097.png\" width=\"378\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute: IV Methylprednisolone</strong> <strong>(Option C)</strong></li>\n<li><strong>Disease modifying drugs:</strong> <strong>Ocrelizumab (anti-CD20) &gt; Natalizumab</strong> &gt;&gt; Mitoxantrone.</li>\n<li>Other drugs:<strong> </strong>\n<ul>\n<li><strong>IFN-β:</strong> least side effects and hence more preferred in chronic disease</li>\n<li><strong>Fingolimod:</strong> SIP-1 Modulator</li>\n<li><strong>Gatiramer acetate:</strong> <span class=\"customMeta\" data-dictid=\"287fd897ad1692777196f583338128\">Polypeptide</span> drug</li>\n<li><strong>Dimethyl fumarate:</strong> <span class=\"customMeta\" data-dictid=\"3fd7ed192816927771903b14cd8262\">Krebs cycle</span> metabolite</li>\n<li><strong>Miscellaneous :</strong> Daclizumab, Almetuzumab, Mitoxantrone</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male presents to the emergency department with a sudden onset of right-sided weakness and difficulty speaking. His symptoms resolved within 20 minutes. He has a history of hypertension, hyperlipidemia and smoking. On examination, he is neurologically intact. A CT scan of the brain shows no acute infarction. Which of the following best describes the pathophysiology of this condition?", "options": [{"label": "A", "text": "Small intracerebral hemorrhage with rapid clot reabsorption", "correct": false}, {"label": "B", "text": "Embolic occlusion with reperfusion before permanent infarction", "correct": true}, {"label": "C", "text": "Permanent neuronal death without immediate infarction on imaging", "correct": false}, {"label": "D", "text": "Decreased cerebral blood flow due to chronic atherosclerosis", "correct": false}], "correct_answer": "B. Embolic occlusion with reperfusion before permanent infarction", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:610px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 60 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BP ≥ 140/90</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> without weakness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral weakness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 points</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10–59 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 60 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 points</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of diabetes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:409px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stroke Risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Day 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Day 7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Day 90</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">0–3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1.2%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">3.1%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">4–5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">4.1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">5.9%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">9.8%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">6–7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">8.1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">11.7%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">17.8%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 year old female who delivered a male baby via C-section owing to eclampsia developed a sudden onset headache, seizures, visual disturbances and altered sensorium 2 days following delivery. MRI showed the following (shown below). What is the likely diagnosis? (CADASIL - Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy)", "options": [{"label": "A", "text": "Reversible cerebral vasoconstriction syndrome (RCVS)", "correct": false}, {"label": "B", "text": "CADASIL", "correct": false}, {"label": "C", "text": "Postpartum transient ischemic attack", "correct": false}, {"label": "D", "text": "Posterior reversible encephalopathy syndrome (PRES)", "correct": true}], "correct_answer": "D. Posterior reversible encephalopathy syndrome (PRES)", "question_images": ["https://image.prepladder.com/notes/VjDF4uzdgyS3mWvQORXk1744358121.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Introduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurological disorder characterized by <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> involvement resulting in sudden onset neurological manifestations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperperfusion state → Cerebral edema</p>\n<ul>\n<li><strong>Pre-eclampsia /Eclampsia in the <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> period</strong></li>\n<li>Uncontrolled hypertension</li>\n<li>Drugs: Sympathomimetics (Amphetamine), Cytotoxic (anti-cancer)</li>\n<li>Renal: AKI, <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> syndrome</li>\n<li>Autoimmune: SLE, APLA syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually<strong> manifests within a week in the <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> phase</strong></li>\n<li><strong>Sudden onset</strong> headache, seizures.</li>\n<li>Visual disturbances, altered <span class=\"customMeta\" data-dictid=\"3da14bba581692777192def3cc48d4\">mentation</span> and other <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits</li>\n<li>Rarely can present with ischaemic symptoms (if present for long duration)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>MRI: Hyperintensities + over <span class=\"customMeta\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\">occipital</span> lobe</strong> (and hence the name posterior)\n\t\t\t\t<figure class=\"caption_element\"><img alt=\" Hyperintensities over the &lt;span class=\" custommeta\"=\"\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\"/>occipital lobe\" data-author=\"Rashmi Chawla, Daniel Smith and Paul E Marik\" data-hash=\"9162\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.m.wikipedia.org/wiki/File:Posterior_reversible_encephalopathy_syndrome_MRI.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/gFcgGm8mmxqDAAKxhVb41744358205.png\" /&gt;\n\t\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anti-hypertensives: first step</strong> is to control BP (Target MAP: 130 mmHg)</li>\n<li>Anti-epileptics: if seizures +</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Good prognosis, only supportive care required</li>\n<li><strong>Manifestations are reversible</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reversible cerebral <span class=\"customMeta\" data-dictid=\"3f0b42b17016927772014c586d44b7\">vasoconstriction</span> syndrome (RCVS): </strong><strong>(Option A)</strong></p>\n<ul>\n<li><strong>Presentation: sudden onset severe headache</strong> (similar to SAH)</li>\n<li><strong>Ischemic/hemorrhagic stroke</strong>-like presentation</li>\n<li>Severe new-onset <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> is usually present</li>\n<li><strong>Angiography: </strong>Non-inflammatory <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> changes involving all lobes (resembles vasculitis)</li>\n<li>Treatment: <strong>Oral CCBs</strong>; recurrence-rare</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following statements is/are false regarding CADASIL disorder? 1) Autosomal Dominant inheritance 2) Predominantly causes Large-vessel stroke 3) Characteristic symptom is Migraine with aura 4) Notch-3 gene is involved", "options": [{"label": "A", "text": "Only 2", "correct": true}, {"label": "B", "text": "1,3", "correct": false}, {"label": "C", "text": "1,2", "correct": false}, {"label": "D", "text": "2,3", "correct": false}], "correct_answer": "A. Only 2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inherited disorder characterized by <strong>small-vessel strokes </strong><strong>(Statement-2)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etio- pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Notch-3 gene </strong><strong>(Statement-4)</strong></li>\n<li>Autosomal <span class=\"customMeta\" data-dictid=\"18e7ddb7841692777186f7e78b2206\">Dominant inheritance</span> <strong>(Statement-1)</strong></li>\n<li>Notch-3 gene regulates <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">Epidermal</span> growth factor (EGF)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age: <strong>4th-5th decade</strong></li>\n<li>Small-vessel stroke</li>\n<li>Progressive dementia</li>\n<li><strong>Migraine with aura: characteristic feature </strong><strong>(Statement-3)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MRI: Extensive symmetric <span class=\"customMeta\" data-dictid=\"faffdfe705169277720242bf7ee9b5\">white matter</span> changes over <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> lobe</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient presented with stroke-like symptoms. Cerebral angiography done revealed the following finding. Which among the following is false regarding this condition?", "options": [{"label": "A", "text": "Involves occlusion of predominantly large arteries", "correct": false}, {"label": "B", "text": "Associated with vascular inflammation", "correct": true}, {"label": "C", "text": "Anticoagulation is contraindicated", "correct": false}, {"label": "D", "text": "More common in young adults", "correct": false}], "correct_answer": "B. Associated with vascular inflammation", "question_images": ["https://image.prepladder.com/notes/kNIm4JJpIsejcOjah75q1744358006.png"], "explanation_images": ["https://image.prepladder.com/notes/A2FArkdrzYjsqIiM2zaV1744358048.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Isolated <strong>chronic, non-inflammatory </strong><strong>(Option B) </strong><strong>usually bilateral</strong> <span class=\"customMeta\" data-dictid=\"929584f4881692777201f5248a021d\">vasculopathy</span> of undetermined <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> characterized by progressive narrowing of <strong>large arteries </strong><strong>(Option A)</strong> - <strong>distal part of internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (ICA)</strong>, <strong>stem of</strong> middle cerebral <strong>(MCA)</strong> and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cerebral artery<strong> (ACA)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Genetic: </strong>MYMY genes involved</li>\n<li><strong>Drugs: </strong>Phenylpropanolamine, <strong>Cocaine, Methamphetamine</strong></li>\n<li><strong>Idiopathic:</strong> exact cause unknown</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of large arteries leads to <strong>development of collaterals</strong> usually involving <span class=\"customMeta\" data-dictid=\"cba0c766911692777191b4bcb68f08\">lenticulostriate</span> branches - gives rise to “Puff of smoke” appearance on angiography.</li>\n<li><strong>Vascular <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> is absent</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More commonly affects <strong>Younger adults </strong><strong>(Option C)</strong>, usually <strong>Asians</strong>.</li>\n<li>Can present with <strong>both Ischaemic</strong> - secondary to <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> (pediatric age group) <strong>and Hemorrhagic</strong> - secondary to burst of collaterals (adult age group) <strong>stroke-like presentation</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cerebral angiography: “Puff of smoke”</strong> appearance\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"Puff of smoke\" data-author=\"Dixon A, Deng F, Elfeky M\" data-hash=\"9160\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/puff-of-smoke-sign\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/A2FArkdrzYjsqIiM2zaV1744358048.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Alternate radiological investigations:\n\t\t\t\t<ul>\n<li>MR Angiography</li>\n<li>Transcranial doppler</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Management:</strong></p>\n<ul>\n<li>Aspirin 50-100mg: for maintenance</li>\n<li><strong>Anticoagulation: is usually contraindicated </strong><strong>(Option C)</strong> as risk of collaterals <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> can occur.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Surgical Management:</strong></p>\n<ul>\n<li>Revascularization procedures usually using <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> may be beneficial.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 year old woman presents with a headache, seizures and focal neurological deficits. She has a history of oral contraceptive use. MRI venography reveals a filling defect in the cerebral venous sinus as shown in picture below. What is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Endovascular thrombolysis", "correct": false}, {"label": "B", "text": "Heparin anticoagulation", "correct": true}, {"label": "C", "text": "Oral warfarin immediately", "correct": false}, {"label": "D", "text": "Blood pressure management for hypotension", "correct": false}], "correct_answer": "B. Heparin anticoagulation", "question_images": ["https://image.prepladder.com/notes/ThGTD3fJWgE2pLHO87EM1744357866.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:665px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cerebral <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> (CVT)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CVT is a rare condition caused by a <span class=\"customMeta\" data-dictid=\"40d68b98721692777183c42090e023\">blood clot</span> in the cerebral veins or <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> sinuses, obstructing <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> within the brain.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes:</strong></p>\n\t\t\t \n\n\t\t\t<p>CVT can be <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by:</p>\n<ul>\n<li><strong>Dehydration</strong></li>\n<li><strong>Pregnancy</strong></li>\n<li>Behçet's disease</li>\n<li>Thrombophilia</li>\n<li>Hypotension</li>\n<li><strong>Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> use</strong></li>\n<li>Local causes: <span class=\"customMeta\" data-dictid=\"e23ca9914316927771948eba43a1e9\">Paranasal</span> sinusitis, meningitis, <span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\">subdural</span> empyema, head and eye trauma, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> infections, <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media, and mastoiditis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation:</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Symptoms depend on the affected <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> and often include:</li>\n<li><strong>Raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure</strong></li>\n<li><strong>Seizures</strong></li>\n<li><strong>Focal neurological deficits</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis:</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>MR venography</strong> is the primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tool for CVT, revealing a <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the affected <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> or sinus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Anticoagulation:</strong> <strong>Heparin </strong>followed by <strong>warfarin </strong>is the main treatment, even in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> hemorrhage.</li>\n<li><strong>Endovascular Thrombolysis:</strong> May be recommended in some cases.</li>\n<li><strong>Antibiotics</strong>: Required for infections, especially when caused by <strong>Staphylococcus aureus</strong> (seen in ~10% of CVT cases, particularly in <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis).</li>\n<li>Comprehensive Management: Includes treating <strong>underlying causes</strong> and<strong> managing complications </strong>like persistent raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> Thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cavernous <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> Thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: <span class=\"customMeta\" data-dictid=\"4edef7912e1692777196cb0f66e35d\">Proptosis</span> (eye protrusion), <span class=\"customMeta\" data-dictid=\"e18c2053271692777194e62a208e01\">ptosis</span> (drooping eyelid), headache, <span class=\"customMeta\" data-dictid=\"2cc1b4ff2216927771940a80e764a2\">ophthalmoplegia</span> (eye muscle weakness), papilloedema (optic disc swelling), <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> sensation in <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve's first division.</li>\n<li>Patients are usually <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> and may show <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> involvement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">Sagittal</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> Thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: Headaches, papilloedema, seizures, can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hypertension.</li>\n<li>Involvement of both hemispheres may lead to progressive motor and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transverse <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> Thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: Hemiparesis, seizures, papilloedema, and potential involvement of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves 9, 10, and 11 if it extends to the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cortical <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> Thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> deficits such as aphasia, <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> (depending on the affected area), and epilepsy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As an intern in the medicine ward, you are asked to guide the nursing staff about the various supportive care measures to improve the outcome of stroke patients. Which among the following will you not advise?", "options": [{"label": "A", "text": "Start nasogastric feeding if risk of aspiration is present.", "correct": false}, {"label": "B", "text": "Urinary catheterisation is recommended for routine bladder care.", "correct": true}, {"label": "C", "text": "Pneumatic compression stockings are indicated to prevent deep vein thrombosis.", "correct": false}, {"label": "D", "text": "Give antipyretics to patients with fever to prevent infarct expansion.", "correct": false}], "correct_answer": "B. Urinary catheterisation is recommended for routine bladder care.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:681px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supportive measures to improve stroke outcome </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Airway</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perform bedside screening for <span class=\"customMeta\" data-dictid=\"2749f813cb16927771864616f3317f\">dysphagia</span> and <strong>keep patients nil per oral</strong>, if <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> is unsafe or <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> occurs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.Breathing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Check <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate and <strong>give oxygen</strong> if <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> &lt; 95%.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3.Circulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Check<strong> <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> perfusion</strong>, pulse and blood pressure.</li>\n<li>Treat abnormalities with <strong>fluid replacement</strong>, antiarrhythmics and <span class=\"customMeta\" data-dictid=\"d44f29df6116927771902150f69464\">inotropic</span> drugs as appropriate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. Hydration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If signs of dehydration, give fluids parenterally or by <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5.Nutrition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assess nutritional status and provide supplements if needed.</li>\n<li>If<strong> dysphagia</strong> persists for <strong>&gt;48 hrs</strong>, start <strong>feeding via <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube</strong> instead of oral. Consider other routes for essential medications if <span class=\"customMeta\" data-dictid=\"2749f813cb16927771864616f3317f\">dysphagia</span> is present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6.Glycemic control</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Check blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and treat when levels are <strong>≥ 200 mg/dl</strong> by <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> or glucose/potassium/insulin combination.</li>\n<li>Monitor closely to <strong>avoid hypoglycemia</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7.Temperature</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Look for fever, investigate and treat underlying cause</li>\n<li><strong>Control with antipyretics</strong>, as raised brain temperature may increase <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> volume. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. Infection control</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Avoid routine catheterisation</strong> to prevent UTIs.</li>\n<li><strong>Chest <span class=\"customMeta\" data-dictid=\"1f210719c116927771959b3083cb18\">physiotherapy</span> </strong>to avoid lung infections.</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> by <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> if required. <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9.Pressure areas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Provide<strong> pressure-relieving mattresses</strong> like water-bed, air beds.</li>\n<li><strong>Pneumatic <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> stockings</strong> and <strong>anticoagulation </strong>with <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> to reduce risk of deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis. <strong>(Option C ruled out)</strong></li>\n<li><strong>Regular frequent mobilization</strong> of patients along with<strong> physiotherapy</strong> for immobile joints like shoulders,etc.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10.Bowel and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> care</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Check for <strong>constipation</strong> and<strong> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention</strong>; treat these appropriately.</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> catheterisation unless the patient is in <strong>acute <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> </strong>or<strong> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> incontinence</strong> is<strong> threatening pressure areas</strong>.</li>\n<li>Appropriate dietary changes and <strong>stool softeners</strong> for constipation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>11.Psychological care</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maintain a positive attitude and provide appropriate information regarding treatment options and prognosis.</li>\n<li><strong>Antidepressants</strong> and <strong>anti-anxiety</strong> medications if indicated.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 year old male presents with acute onset right-sided weakness and slurred speech for the past 2 hours. His blood pressure is 180/110 mmHg, and a non-contrast CT scan of the brain shows no evidence of hemorrhage. His medical history includes atrial fibrillation, for which he is on warfarin, and a recent gastrointestinal bleed 10 days ago. Which of the following is a contraindication to thrombolysis with rtPA in this patient?", "options": [{"label": "A", "text": "Symptom onset within 2 hours", "correct": false}, {"label": "B", "text": "Blood pressure of 180/110 mmHg", "correct": false}, {"label": "C", "text": "Recent gastrointestinal bleed", "correct": true}, {"label": "D", "text": "Absence of hemorrhage on CT", "correct": false}], "correct_answer": "C. Recent gastrointestinal bleed", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications and contraindications for thrombolysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications for rtPA in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"bef027ba821692777190cb424e9554\">Ischemic Stroke</span> (AIS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clinical Diagnosis of Stroke: </strong>The patient presents with clinical features of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> stroke, confirmed by a neurological examination.</li>\n<li><strong>No Evidence of Haemorrhage on Imaging</strong>: A non-contrast <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> must exclude hemorrhagic stroke before administering rtPA. <strong>(Option D ruled out) </strong></li>\n<li><strong>Time Window:</strong> Administer within 3 hours of symptom onset (FDA); in some regions, the window is extended to 4.5 hours with restrictions. <strong>(Option A ruled out) </strong></li>\n<li><strong>Age</strong>: The patient must be 18 years or older.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications for rtPA in AIS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Conditions Increasing <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">Bleeding</span> Risk:</strong> Active internal bleeding, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> diathesis, recent head trauma (within 3 months), recent <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hemorrhage, <span class=\"customMeta\" data-dictid=\"e79ce088c716927771923a3bad7ab7\">major surgery</span> in the last 14 days, <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in the past 21 days, recent myocardial infarction. <strong>(Option C)</strong></li>\n<li><strong>Uncontrolled Hypertension:</strong> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">Blood pressure</span> &gt;185/110 mmHg despite treatment increases the risk of hemorrhagic complications. <strong>(Option B ruled out) </strong></li>\n<li><strong>Large <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">Infarct</span> Core:</strong> <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> revealing significant <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> in more than one-third of the <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> territory is contraindicated due to the risk of <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and limited benefit.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Points to Consider</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Use of <span class=\"customMeta\" data-dictid=\"9259c6f2981692777181fadef25e02\">Antithrombotic</span> Agents: </strong>Concomitant use of anticoagulants requires careful evaluation to avoid increasing <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</li>\n<li><strong>Advanced Imaging:</strong> Techniques like CT <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may help identify patients eligible for rtPA beyond the standard time window, even up to 24 hours in some cases, though this approach remains investigational.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68 year old male presents to the emergency department 2 hours after sudden onset of left sided weakness and slurred speech. His blood pressure is 180/100 mmHg, and a non-contrast CT scan shows no hemorrhage. His past medical history includes hypertension and type 2 diabetes and he is not on any anticoagulants. What is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Intravenous recombinant tissue plasminogen activator (rtPA)", "correct": true}, {"label": "B", "text": "Antiplatelet therapy with aspirin", "correct": false}, {"label": "C", "text": "Initiation of anticoagulation therapy", "correct": false}, {"label": "D", "text": "Immediate blood pressure reduction to &amp;lt;140/90 mmHg", "correct": false}], "correct_answer": "A. Intravenous recombinant tissue plasminogen activator (rtPA)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"11\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Major trauma, surgery, or head trauma within 3 weeks</li>\n<li>Prior hemorrhagic stroke</li>\n<li>Ischemic stroke within the prior 6 months</li>\n<li>Central nervous system neoplasm</li>\n<li>Gastrointestinal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> within one month</li>\n<li>Active bleeding</li>\n</ul>\n</td>\n<td rowspan=\"11\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cancer</li>\n<li>Age &gt; 75–80</li>\n<li>Transient ischemic attack within 6 months</li>\n<li>Oral <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> therapy</li>\n<li>Noncompressible punctures</li>\n<li>Traumatic resuscitation</li>\n<li>Refractory hypertension</li>\n<li>Advanced liver disease</li>\n<li>Infective endocarditis</li>\n<li>Active <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> ulcer</li>\n<li>Pregnancy or within one week postpartum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:722px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment for stroke- ischemic stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate Medical Support</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stabilize the patient by managing airway, breathing, and <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> <strong>(ABCs)</strong>.</li>\n<li><strong>Manage blood pressure</strong>: Permissive <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> is allowed to maintain cerebral perfusion, but reduce BP if &gt;220/120 mmHg ( reduce BP if &gt;185/110 mmHg- for rtPA). <strong>Avoid overly aggressive reduction</strong>. <strong>(Option D ruled out) </strong></li>\n<li>Control fever and hyperglycemia.</li>\n<li>Treat <span class=\"customMeta\" data-dictid=\"0ab8536ded1692777184e946b21fa2\">cerebral edema</span> with <span class=\"customMeta\" data-dictid=\"67ba030b801692777191d63dce44b4\">mannitol</span> or <span class=\"customMeta\" data-dictid=\"e3b6f640d316927771880233de1d2b\">hemicraniectomy</span> if severe.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Restoring Blood Flow: <span class=\"customMeta\" data-dictid=\"7e7b9c1b1816927772000af22608df\">Thrombolysis</span> &amp; Thrombectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Intravenous <span class=\"customMeta\" data-dictid=\"7e7b9c1b1816927772000af22608df\">Thrombolysis</span> (rtPA): Effective within 4.5 hours</strong> of symptom onset.</li>\n<li><strong>Endovascular Thrombectomy:</strong> Best for large vessel occlusions, ideally<strong> within 6 hours</strong>; can be extended <strong>up to 24 hours </strong>using advanced imaging.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preventing Future Strokes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Antiplatelet Therapy:</strong>\n<ul>\n<li><strong>Aspirin </strong>for secondary prevention, delayed 24 hours post-rtPA or given immediately if rtPA not used. <strong>(Option B ruled out) </strong></li>\n<li><strong>Clopidogrel </strong>or ticagrelor may be combined with <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> for short-term use.</li>\n</ul>\n</li>\n<li><strong>Anticoagulation:</strong> Recommended for <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> but avoided in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> stroke unless cardioembolic source is confirmed after rtPA. <strong>(Option C ruled out) </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early intervention with physical, occupational, and speech therapy helps maximize recovery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50 year old male patient came to the emergency room with complaints of headache, blurring of vision, altered sensorium, slurring of speech and left sided hemiparesis for 2 hours. He is a known case of diabetes mellitus, hypertension with irregular compliance. His vitals and CT image are given below. What is the most appropriate statement regarding management of this patient? BP - 190/110 mm Hg PR - 92/min SpO2 - 98%", "options": [{"label": "A", "text": "The head end of the patient bed should be flat to prevent coning of the brain.", "correct": false}, {"label": "B", "text": "Blood pressure of the patient should be reduced to &amp;lt;140/90 with nicardipine.", "correct": true}, {"label": "C", "text": "Immediate intravenous thrombolysis with rtPA is recommended since the patient is in the window period.", "correct": false}, {"label": "D", "text": "Heparin should be started immediately to prevent further brain anoxia.", "correct": false}], "correct_answer": "B. Blood pressure of the patient should be reduced to &lt;140/90 with nicardipine.", "question_images": ["https://image.prepladder.com/notes/A5bQo0xQ7a9vo7ibprMh1744357714.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Haemorrhagic stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accounts for ~10% of all strokes</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> in Asians and blacks.</li>\n<li>Most common cause - <strong>head trauma</strong></li>\n<li>Other important causes - <strong>hypertension, coagulopathy</strong>, <span class=\"customMeta\" data-dictid=\"504306528f1692777199a0b2437267\">sympathomimetic</span> drugs (<strong>cocaine, methamphetamine</strong>), and cerebral <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> <span class=\"customMeta\" data-dictid=\"6d7e26ca0216927771818c9c03bf9f\">angiopathy</span> (CAA).</li>\n<li>Risk factors: Advanced age, <strong>heavy alcohol use, low-dose aspirin</strong> in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> individuals.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abrupt onset of <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurologic deficit, may worsen over 30–90 minutes.</li>\n<li>Signs of <strong>raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure (ICP)</strong> such as headache, vomiting, altered sensorium, blurring of vision/diplopia,etc</li>\n<li>Larger haemorrhages can result in drowsiness, <span class=\"customMeta\" data-dictid=\"4aa0c051dd16927771993f76e966b0\">stupor</span> or even coma.</li>\n<li>Specific presentations based on haemorrhage location:\n\t\t\t\t<ul>\n<li><strong>Putamen</strong>: <strong>ipsilateral</strong> <strong>hemiparesis</strong>, slurred speech.</li>\n<li><strong>Thalamus</strong>: <strong>contralateral hemiplegia</strong>, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> deficits, possible aphasia.</li>\n<li><strong>Pontine</strong>: deep coma, <strong>quadriplegia</strong>, <strong>pinpoint pupil</strong>s.</li>\n<li><strong>Cerebellar</strong>: <strong>occipital headache, ataxia</strong>, vomiting.</li>\n<li><strong>Lobar</strong>: <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> headaches, varying neurologic deficits depending on the <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> affected.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT scan</strong> for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of haemorrhage.</li>\n<li>Routine blood tests to assess <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count, <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> time, partial <span class=\"customMeta\" data-dictid=\"9b51982d06169277720063c9420fbb\">thromboplastin</span> time, and international normalized ratio <strong>(INR)</strong>.</li>\n<li><strong>MRI </strong>may help in identifying underlying causes like <strong>arteriovenous malformations (AVMs</strong>).</li>\n<li>Angiography if <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> is uncertain; <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> is generally avoided due to risk of herniation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute Management</strong>: Assess airway, breathing and <strong>control blood pressure</strong>.</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> if elevated with <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of head end of patient bed, administering osmotic agents like <strong>mannitol</strong>, <strong>hypertonic saline</strong>, <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> drainage.</li>\n<li>Correct <span class=\"customMeta\" data-dictid=\"09376c06ef16927771848108fd8f70\">coagulopathy</span> (e.g.,<strong> <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> complex concentrates for <span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\">vitamin K</span> antagonists</strong>).</li>\n<li>Prevention focused on <strong>controlling hypertension</strong> and avoiding illicit drugs.</li>\n<li>Surgical intervention for cerebellar haemorrhage &gt;3 cm, or if there is significant deterioration.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 year old male presents to the emergency department with a sudden onset of right sided weakness, slurred speech and facial drooping for the past hour. His vital signs are stable and his blood glucose level is within normal range. The attending physician suspects a stroke. What is the most appropriate initial imaging study to confirm the diagnosis and determine the type of stroke?", "options": [{"label": "A", "text": "Magnetic Resonance Imaging (MRI)", "correct": false}, {"label": "B", "text": "Non-contrast Computed Tomography (CT)", "correct": true}, {"label": "C", "text": "CT Angiography (CTA)", "correct": false}, {"label": "D", "text": "Carotid Duplex Ultrasonography", "correct": false}], "correct_answer": "B. Non-contrast Computed Tomography (CT)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Workup for stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Assessment and Stabilization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Upon arrival, ensure the <strong>ABCs </strong>(Airway, Breathing, Circulation) are stable.</li>\n<li><strong>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels </strong>should be checked quickly to address <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> or hyperglycemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Determining Stroke Type: <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> is Key</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <strong>non-contrast CT scan</strong> is the primary <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> for differentiating between ischemic and hemorrhagic strokes.</li>\n<li>Clinical features may suggest stroke type, but <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> is essential for confirmation as <strong>no clinical finding can definitively <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between the two.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Further Investigations: Uncovering the Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Detailed History and Physical Exam:</strong> Consider risk factors (hypertension, diabetes, smoking, atrial fibrillation, etc.) and perform a neurological exam to localize the affected brain area.</li>\n<li><strong>Laboratory Tests</strong><strong>:</strong> Perform CBC, electrolytes, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, blood glucose, <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> profile, <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> studies, ESR, and <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> (to detect arrhythmias and signs of recent MI).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visualizing the Cerebral Vasculature: <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> (CTA)</strong>: Assesses cerebral <span class=\"customMeta\" data-dictid=\"5e9945f4ca169277720145ab886b00\">vasculature</span> and identifies blockages/stenosis, but is<strong> performed after non-contrast CT has ruled out hemorrhage</strong> (not for stroke type differentiation).<strong> (Option C ruled out)</strong></li>\n<li><strong>CT <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> Imaging</strong>: Assesses blood flow, identifying <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> and ischemic penumbra.</li>\n<li><strong>MRI:</strong> Provides more detail but takes longer than CT and is not as widely available, thus not the first <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> choice for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> stroke evaluation.<strong> (Option A ruled out)</strong></li>\n<li><strong>MRA:</strong> Offers detailed images of blood vessels, similar to CTA.</li>\n<li><strong>Cerebral Angiography:</strong> <strong>Gold standard for vessel evaluation</strong>, used when other techniques are inconclusive or before <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> intervention.</li>\n<li><strong>Ultrasound Techniques</strong>:<strong> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> Duplex Ultrasonography</strong><strong> </strong>assesses <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> but is not a first-line <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> modality;<strong> <span class=\"customMeta\" data-dictid=\"53d1321235169277720009a5ac7833\">Transcranial</span> <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> (TCD) </strong>measures <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> <span class=\"customMeta\" data-dictid=\"12c4510e191692777201c23ec126a3\">velocity</span> in <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> arteries. <strong>(Option D ruled out) </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tailoring Investigations Based on Stroke Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ischemic Stroke</strong>: Focuses on identifying the source of the <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> (cardioembolic, artery-to-artery embolic, small vessel disease).</li>\n<li><strong>Hemorrhagic Stroke:</strong> Investigations focus on identifying causes of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (e.g., hypertension, aneurysm, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> malformation).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 Y/O woman presents to the emergency department with sudden-onset slurred speech and right-sided facial weakness that resolved after 30 minutes. She has a history of hypertension and type 2 diabetes mellitus. Her blood pressure on arrival is 160/95 mmHg. She is otherwise stable and has no residual neurological deficits on examination. Based on the ABCD2 score, what is the total score for this patient, and how would her risk of stroke be classified?", "options": [{"label": "A", "text": "Score 3, low risk", "correct": false}, {"label": "B", "text": "Score 4, moderate risk", "correct": false}, {"label": "C", "text": "Score 5, moderate risk", "correct": false}, {"label": "D", "text": "Score 6, high risk", "correct": true}], "correct_answer": "D. Score 6, high risk", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:470px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>≥ 60 years = <strong>1 point</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg = <strong>1 point</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unilateral weakness = <strong>2 points</strong></li>\n<li>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> without weakness = <strong>1 point</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration of Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>≥ 60 minutes = <strong>2 points</strong></li>\n<li>10-59 minutes = <strong>1 point</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>History of diabetes = <strong>1 point</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:485px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 4 points</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low risk of stroke (1% risk of stroke within 2 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-5 points</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate risk of stroke (4% risk of stroke within 2 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 5 points</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk of stroke (8% risk of stroke within 2 days)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man with a history of poorly controlled hypertension presents to the emergency department after suddenly developing a severe headache, vomiting, and one-sided weakness. On examination, he is drowsy with a Glasgow Coma Scale (GCS) of 10. His blood pressure is 220/110 mmHg. CT of the patient is given below. Which of the following is the most likely underlying cause of this patient's hemorrhagic stroke?", "options": [{"label": "A", "text": "Ruptured saccular (berry) aneurysm", "correct": false}, {"label": "B", "text": "Charcot-Bouchard microaneurysm rupture", "correct": true}, {"label": "C", "text": "Dural sinus thrombosis", "correct": false}, {"label": "D", "text": "Arteriovenous malformation (AVM)", "correct": false}], "correct_answer": "B. Charcot-Bouchard microaneurysm rupture", "question_images": ["https://image.prepladder.com/notes/ZfN0CLN7VhDFJXZeoptn1744357343.png"], "explanation_images": ["https://image.prepladder.com/notes/VvAbgtPm0rIyhixwJjVt1744357619.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intracerebral <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (ICH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subarachnoid <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (SAH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long standing <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> produces <strong>degeneration of media, breakage of the <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> lamina</strong>, and <span class=\"customMeta\" data-dictid=\"c3bbd691781692777203582ec44b8c\">fragmentation</span> of smooth muscles of arteries.</li>\n<li><strong>Charcot-Bouchard aneurysms: </strong>Lipohyalinosis, <span class=\"customMeta\" data-dictid=\"43b1f01822169277720222a3b354dd\">fibrinoid</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the subendothelium, microaneurysms, and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> dilatations are seen in the arterioles.</li>\n<li><strong>Common sites</strong> of <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> <span class=\"customMeta\" data-dictid=\"c7f167b8df1692777190bcd90fe428\">intracerebral</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> are the small <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> arteries originating from <span class=\"customMeta\" data-dictid=\"cf3585c06f1692777182cba3cb4c97\">basilar</span> arteries or the anterior, middle, or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cerebral arteries.</li>\n<li>Hypertensive change causes <strong>non-lobar <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (ICH).</strong></li>\n</ul>\n<ul>\n<li><strong>Beta 40 Cerebral <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> <span class=\"customMeta\" data-dictid=\"6d7e26ca0216927771818c9c03bf9f\">angiopathy</span> (CAA) </strong>is an important cause of <strong>primary <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> intracerebral</strong> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in older adults.\n\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"Intracerebral &lt;span class=\" custommeta\"=\"\" data-dictid=\"4642acfc0c16927771880b34fa5174\"/>Hemorrhage (ICH)\" data-author=\"Jones J, Amer M, Geetha Virupakshappa A\" data-hash=\"9155\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/intracerebral-haemorrhage\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/GdlmaOyzTOhhdVKelipJ1744357571.png\" /&gt;\n\t\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ruptured <span class=\"customMeta\" data-dictid=\"92ff33318a16927771828d959514b8\">berry</span> <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> (Option A ruled out)</strong></li>\n<li>Arteriovenous malformation <strong>(Option D ruled out)</strong></li>\n<li>Vasculitis</li>\n<li>Cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> dissection</li>\n<li>Dural <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis <strong>(Option C ruled out)</strong></li>\n<li>Pituitary apoplexy</li>\n<li>The risk factors are hypertension, oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> pills, substance abuse, and pregnancy.\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"Subarachnoid hemorrhage\" data-author=\"James Heilman, MD \" data-hash=\"9156\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subarachnoid_hemorrhage#/media/File:SubarachnoidP.png\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/VvAbgtPm0rIyhixwJjVt1744357619.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old right-handed male is brought to the emergency department with sudden onset of right-sided weakness and difficulty speaking. On examination, he has weakness in the right arm and face, with mild weakness in the right leg. He is also unable to speak fluently but can understand spoken language. His gaze is deviated to the left, and he has a right homonymous hemianopia. Which of the following is the most likely location of the thrombus causing this patient's symptoms?", "options": [{"label": "A", "text": "Anterior Cerebral Artery (ACA) thrombosis", "correct": false}, {"label": "B", "text": "Middle Cerebral Artery (MCA) thrombosis", "correct": true}, {"label": "C", "text": "Posterior Cerebral Artery (PCA) thrombosis", "correct": false}, {"label": "D", "text": "Basilar Artery thrombosis", "correct": false}], "correct_answer": "B. Middle Cerebral Artery (MCA) thrombosis", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Location Clinical Features</li><li>↳ Location</li><li>↳ Location</li><li>↳ Location</li><li>↳ Clinical Features</li><li>↳ Clinical Features</li><li>↳ Clinical Features</li><li>↳ Middle Cerebral Artery (MCA) Thrombosis Most common artery involved in stroke. Contralateral hemiparesis and hemisensory loss: More prominent in the face and upper limb than the lower limb. Dysarthria caused by both dominant and non dominant hemispheres. Broca’s aphasia (expressive) in the superior division infarct. Wernicke’s aphasia (receptive) in the inferior division infarct. Neglect Homonymous hemianopia : Loss of vision in the same visual field of both eyes. Gaze preference towards the side of the lesion.</li><li>↳ Middle Cerebral Artery (MCA) Thrombosis</li><li>↳ Middle Cerebral Artery (MCA) Thrombosis</li><li>↳ Middle Cerebral Artery (MCA) Thrombosis</li><li>↳ Most common artery involved in stroke. Contralateral hemiparesis and hemisensory loss: More prominent in the face and upper limb than the lower limb. Dysarthria caused by both dominant and non dominant hemispheres. Broca’s aphasia (expressive) in the superior division infarct. Wernicke’s aphasia (receptive) in the inferior division infarct. Neglect Homonymous hemianopia : Loss of vision in the same visual field of both eyes. Gaze preference towards the side of the lesion.</li><li>↳ Most common artery involved in stroke. Contralateral hemiparesis and hemisensory loss: More prominent in the face and upper limb than the lower limb. Dysarthria caused by both dominant and non dominant hemispheres. Broca’s aphasia (expressive) in the superior division infarct. Wernicke’s aphasia (receptive) in the inferior division infarct. Neglect Homonymous hemianopia : Loss of vision in the same visual field of both eyes. Gaze preference towards the side of the lesion.</li><li>↳ Most common artery involved in stroke.</li><li>↳ Most common artery involved in stroke.</li><li>↳ Contralateral hemiparesis and hemisensory loss: More prominent in the face and upper limb than the lower limb.</li><li>↳ Contralateral hemiparesis and hemisensory loss:</li><li>↳ Dysarthria caused by both dominant and non dominant hemispheres.</li><li>↳ Dysarthria</li><li>↳ Broca’s aphasia (expressive) in the superior division infarct.</li><li>↳ Broca’s aphasia</li><li>↳ Wernicke’s aphasia (receptive) in the inferior division infarct.</li><li>↳ Wernicke’s aphasia</li><li>↳ Neglect</li><li>↳ Homonymous hemianopia : Loss of vision in the same visual field of both eyes.</li><li>↳ Homonymous hemianopia</li><li>↳ Gaze preference towards the side of the lesion.</li><li>↳ Gaze preference</li><li>↳ Anterior Cerebral Artery (ACA) Thrombosis (Option A ruled out) Contralateral hemiparesis and sensory loss: More pronounced in the lower limb than the upper limb. Urinary incontinence: Due to involvement of the medial frontal micturition centers. Behavioral or personality changes: Due to involvement of the prefrontal cortex (apathy, disinhibition). Abulia (lack of will) and apraxia. Upper extremity and face are spared.</li><li>↳ Anterior Cerebral Artery (ACA) Thrombosis (Option A ruled out)</li><li>↳ Anterior Cerebral Artery (ACA) Thrombosis</li><li>↳ Anterior Cerebral Artery (ACA) Thrombosis</li><li>↳ (Option A ruled out)</li><li>↳ (Option A ruled out)</li><li>↳ Contralateral hemiparesis and sensory loss: More pronounced in the lower limb than the upper limb. Urinary incontinence: Due to involvement of the medial frontal micturition centers. Behavioral or personality changes: Due to involvement of the prefrontal cortex (apathy, disinhibition). Abulia (lack of will) and apraxia. Upper extremity and face are spared.</li><li>↳ Contralateral hemiparesis and sensory loss: More pronounced in the lower limb than the upper limb. Urinary incontinence: Due to involvement of the medial frontal micturition centers. Behavioral or personality changes: Due to involvement of the prefrontal cortex (apathy, disinhibition). Abulia (lack of will) and apraxia. Upper extremity and face are spared.</li><li>↳ Contralateral hemiparesis and sensory loss: More pronounced in the lower limb than the upper limb.</li><li>↳ Contralateral hemiparesis and sensory loss:</li><li>↳ Urinary incontinence: Due to involvement of the medial frontal micturition centers.</li><li>↳ Urinary incontinence:</li><li>↳ Behavioral or personality changes: Due to involvement of the prefrontal cortex (apathy, disinhibition).</li><li>↳ Behavioral or personality changes:</li><li>↳ Abulia (lack of will) and apraxia.</li><li>↳ Upper extremity and face are spared.</li><li>↳ Posterior Cerebral Artery (PCA) Thrombosis (Option C ruled out) Contralateral homonymous hemianopia with macular sparing (due to collateral blood supply from MCA). Visual agnosia (inability to recognize objects). Alexia without agraphia: Inability to read without difficulty writing (if the dominant hemisphere is involved). Contralateral sensory loss or thalamic pain syndrome: Due to infarction in the thalamus (Dejerine-Roussy syndrome). Memory impairment: If the temporal lobe is affected.</li><li>↳ Posterior Cerebral Artery (PCA) Thrombosis (Option C ruled out)</li><li>↳ Posterior Cerebral Artery (PCA) Thrombosis</li><li>↳ Posterior Cerebral Artery (PCA) Thrombosis</li><li>↳ (Option C ruled out)</li><li>↳ (Option C ruled out)</li><li>↳ Contralateral homonymous hemianopia with macular sparing (due to collateral blood supply from MCA). Visual agnosia (inability to recognize objects). Alexia without agraphia: Inability to read without difficulty writing (if the dominant hemisphere is involved). Contralateral sensory loss or thalamic pain syndrome: Due to infarction in the thalamus (Dejerine-Roussy syndrome). Memory impairment: If the temporal lobe is affected.</li><li>↳ Contralateral homonymous hemianopia with macular sparing (due to collateral blood supply from MCA). Visual agnosia (inability to recognize objects). Alexia without agraphia: Inability to read without difficulty writing (if the dominant hemisphere is involved). Contralateral sensory loss or thalamic pain syndrome: Due to infarction in the thalamus (Dejerine-Roussy syndrome). Memory impairment: If the temporal lobe is affected.</li><li>↳ Contralateral homonymous hemianopia with macular sparing (due to collateral blood supply from MCA).</li><li>↳ Contralateral homonymous hemianopia</li><li>↳ Visual agnosia (inability to recognize objects).</li><li>↳ Visual agnosia</li><li>↳ Alexia without agraphia: Inability to read without difficulty writing (if the dominant hemisphere is involved).</li><li>↳ Alexia without agraphia:</li><li>↳ Contralateral sensory loss or thalamic pain syndrome: Due to infarction in the thalamus (Dejerine-Roussy syndrome).</li><li>↳ Contralateral sensory loss or thalamic pain syndrome:</li><li>↳ Memory impairment: If the temporal lobe is affected.</li><li>↳ Memory impairment:</li><li>↳ Vertebrobasilar Artery Thrombosis (Option D ruled out) The clinical presentation includes ataxia, vertigo, headache, vomiting, oropharyngeal dysfunction, visual field deficits, and abnormal oculomotor findings. Patterns of clinical presentation vary depending on the location and the infarction pattern of embolism or atherosclerosis.</li><li>↳ Vertebrobasilar Artery Thrombosis (Option D ruled out)</li><li>↳ Vertebrobasilar Artery Thrombosis</li><li>↳ Vertebrobasilar Artery Thrombosis</li><li>↳ (Option D ruled out)</li><li>↳ (Option D ruled out)</li><li>↳ The clinical presentation includes ataxia, vertigo, headache, vomiting, oropharyngeal dysfunction, visual field deficits, and abnormal oculomotor findings. Patterns of clinical presentation vary depending on the location and the infarction pattern of embolism or atherosclerosis.</li><li>↳ The clinical presentation includes ataxia, vertigo, headache, vomiting, oropharyngeal dysfunction, visual field deficits, and abnormal oculomotor findings. Patterns of clinical presentation vary depending on the location and the infarction pattern of embolism or atherosclerosis.</li><li>↳ The clinical presentation includes ataxia, vertigo, headache, vomiting, oropharyngeal dysfunction, visual field deficits, and abnormal oculomotor findings.</li><li>↳ ataxia, vertigo, headache, vomiting, oropharyngeal dysfunction, visual field deficits,</li><li>↳ Patterns of clinical presentation vary depending on the location and the infarction pattern of embolism or atherosclerosis.</li><li>↳ Cerebellar Infarction Patients may present with ataxia, nausea, vomiting, headache, dysarthria, and vertigo symptoms.</li><li>↳ Cerebellar Infarction</li><li>↳ Cerebellar Infarction</li><li>↳ Cerebellar Infarction</li><li>↳ Patients may present with ataxia, nausea, vomiting, headache, dysarthria, and vertigo symptoms.</li><li>↳ Patients may present with ataxia, nausea, vomiting, headache, dysarthria, and vertigo symptoms.</li><li>↳ Patients may present with ataxia, nausea, vomiting, headache, dysarthria, and vertigo symptoms.</li><li>↳ ataxia, nausea, vomiting, headache, dysarthria, and vertigo symptoms.</li><li>↳ Lacunar Infarction Lacunar infarcts result from the occlusion of small perforating or penetrating arteries. Infarcts are smaller than 1 centimeter in diameter. Present with a pure motor or sensory loss, sensorimotor deficit or ataxic-hemiparesis.</li><li>↳ Lacunar Infarction</li><li>↳ Lacunar Infarction</li><li>↳ Lacunar Infarction</li><li>↳ Lacunar infarcts result from the occlusion of small perforating or penetrating arteries. Infarcts are smaller than 1 centimeter in diameter. Present with a pure motor or sensory loss, sensorimotor deficit or ataxic-hemiparesis.</li><li>↳ Lacunar infarcts result from the occlusion of small perforating or penetrating arteries. Infarcts are smaller than 1 centimeter in diameter. Present with a pure motor or sensory loss, sensorimotor deficit or ataxic-hemiparesis.</li><li>↳ Lacunar infarcts result from the occlusion of small perforating or penetrating arteries.</li><li>↳ Infarcts are smaller than 1 centimeter in diameter.</li><li>↳ smaller than 1 centimeter in diameter.</li><li>↳ Present with a pure motor or sensory loss, sensorimotor deficit or ataxic-hemiparesis.</li><li>↳ pure motor or sensory loss, sensorimotor deficit or ataxic-hemiparesis.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle Cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (MCA) Thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most common <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> involved in stroke.</strong></li>\n<li><strong>Contralateral <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> and hemisensory loss:</strong> More prominent in the face and <span class=\"customMeta\" data-dictid=\"0bc1ae5070169277720193a2852d9c\">upper limb</span> than the lower limb.</li>\n<li><strong>Dysarthria</strong> caused by both dominant and <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> dominant hemispheres.</li>\n<li><strong>Broca’s aphasia</strong> (expressive) in the superior division infarct.</li>\n<li><strong>Wernicke’s <span class=\"customMeta\" data-dictid=\"9b5386bf6216927771812526afb5e6\">aphasia</span> </strong>(receptive) in the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> division infarct.</li>\n<li>Neglect</li>\n<li><strong>Homonymous hemianopia</strong>: Loss of vision in the same <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> of both eyes.</li>\n<li><strong>Gaze preference</strong> towards the side of the lesion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (ACA) Thrombosis</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Contralateral <span class=\"customMeta\" data-dictid=\"a44e1953c0169277718871c814bee5\">hemiparesis</span> and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss:</strong> More pronounced in the <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> than the upper limb.</li>\n<li><strong>Urinary incontinence:</strong> Due to involvement of the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> <span class=\"customMeta\" data-dictid=\"c9ea308a4d169277719266a39f4872\">micturition</span> centers.</li>\n<li><strong>Behavioral or personality changes: </strong>Due to involvement of the <span class=\"customMeta\" data-dictid=\"25bc983c6716927771967f68667610\">prefrontal</span> <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> (apathy, disinhibition).</li>\n<li>Abulia (lack of will) and apraxia.</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> and face are spared.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (PCA) Thrombosis</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Contralateral <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">hemianopia</span> </strong>with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> sparing (due to <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> blood supply from MCA).</li>\n<li><strong>Visual <span class=\"customMeta\" data-dictid=\"dc587844e316927771804707aa177f\">agnosia</span> </strong>(inability to recognize objects).</li>\n<li><strong>Alexia without agraphia: </strong>Inability to read without difficulty writing (if the <span class=\"customMeta\" data-dictid=\"f2451b14d1169277718689ec5309d4\">dominant hemisphere</span> is involved).</li>\n<li><strong>Contralateral <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss or thalamic pain syndrome:</strong> Due to <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in the <span class=\"customMeta\" data-dictid=\"0c5f024f21169277720046ac004a34\">thalamus</span> (Dejerine-Roussy syndrome).</li>\n<li><strong>Memory impairment:</strong> If the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> is affected.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertebrobasilar <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> Thrombosis </strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The clinical presentation includes <strong>ataxia, vertigo, headache, vomiting, <span class=\"customMeta\" data-dictid=\"b1a011ab5416927771949dde193e3a\">oropharyngeal</span> dysfunction, <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> deficits, </strong>and <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"ae7e8fa7d31692777194e3d4325f6b\">oculomotor</span> findings.</li>\n<li>Patterns of clinical presentation vary depending on the location and the <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> pattern of <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> or atherosclerosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cerebellar Infarction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients may present with <strong>ataxia, nausea, vomiting, headache, dysarthria, and <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> symptoms.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lacunar Infarction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lacunar infarcts result from the <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> of small perforating or <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> arteries.</li>\n<li>Infarcts are <strong>smaller than 1 <span class=\"customMeta\" data-dictid=\"f5f71ed4861692777184bf78350040\">centimeter</span> in diameter. </strong></li>\n<li>Present with a<strong> pure motor or <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss, <span class=\"customMeta\" data-dictid=\"068d6642471692777198d89a1be687\">sensorimotor</span> deficit or ataxic-hemiparesis.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients presenting with acute ischemic stroke, MRI or CT imaging of a lesion greater than which size is most indicative of a stroke due to large artery atherosclerotic origin?", "options": [{"label": "A", "text": "&amp;gt; 2.0 cm", "correct": false}, {"label": "B", "text": "&amp;gt; 2.5 cm", "correct": false}, {"label": "C", "text": "&amp;gt; 3.0 cm", "correct": false}, {"label": "D", "text": "&amp;gt; 1.5 cm", "correct": true}], "correct_answer": "D. &gt; 1.5 cm", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardioembolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Comprises patients with arterial blockages likely caused by an <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> originating in the heart.</li>\n<li>At least <strong>1 <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> source of an <span class=\"customMeta\" data-dictid=\"cd7b88eaf5169277718749baf505bd\">embolus</span> </strong>must be identified to consider a possible or probable diagnosis of cardioembolic stroke.</li>\n<li>Evidence of a <strong>previous <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> ischemic attack (TIA) or stroke in more than 1 <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> territory</strong> or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> embolisms supports a <span class=\"customMeta\" data-dictid=\"dd729c897216927771845c2b95f211\">clinical diagnosis</span> of <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> stroke.</li>\n<li>A stroke occurring in a patient with a <strong>medium-risk <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> source of <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> </strong>and no other apparent cause of stroke is categorized as a possible cardioembolic stroke.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Large <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> atherosclerosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients will exhibit clinical and brain <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> findings indicating either <strong>significant (&gt; 50%) narrowing or complete <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> of a major brain <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or branch <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> artery, </strong>likely due to atherosclerosis.</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> history, TIAs in the same <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> territory, a <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> bruit, or weakened pulses.</li>\n<li>Lesions in the cortex, cerebellum, brainstem, or <span class=\"customMeta\" data-dictid=\"c4960c2ad8169277719913d61ad2a9\">subcortical</span> hemispheric infarctions <strong>&gt; 1.5 cm in <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> </strong>observed on CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> indicate potential large <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> atherosclerotic origin.</li>\n<li><strong>Duplex <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or <span class=\"customMeta\" data-dictid=\"baea202dec1692777182a0723c23ea\">arteriography</span> demonstrating more than 50% <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> </strong>of a relevant <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> or <span class=\"customMeta\" data-dictid=\"ae83c0cf40169277718732a723c610\">extracranial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> is <strong>necessary</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Small vessel occlusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients with strokes commonly classified as <strong>lacunar infarcts in other systems.</strong></li>\n<li>Patients should present with 1 of the typical clinical lacunar syndromes and should not exhibit signs of cerebral <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> dysfunction.</li>\n<li>Patients should have normal <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> findings</li>\n<li>Brainstem or <span class=\"customMeta\" data-dictid=\"c4960c2ad8169277719913d61ad2a9\">subcortical</span> <span class=\"customMeta\" data-dictid=\"d702dfe10816927771881b37be4e4a\">hemisphere</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with a <strong>diameter of &lt;1.5 cm.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stroke of undetermined etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patient with <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> and <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> of 50%.</li>\n<li>Traditional lacunar syndrome and <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> of 50%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stroke of other determined etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients with uncommon stroke causes, such as <strong>nonatherosclerotic vasculopathies, hypercoagulable states, or hematologic disorders. </strong></li>\n<li>Patients in this category should <strong>exhibit clinical symptoms and CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> findings</strong> indicative of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> ischemic stroke, regardless of the size or location of the lesion.</li>\n<li>Diagnostic tests, such as blood tests or arteriography, should reveal 1 of these unusual stroke causes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 39 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 21 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following drugs is used to prevent delayed ischemia in the acute phase of subarachnoid hemorrhage?", "options": [{"label": "A", "text": "Nifedipine", "correct": false}, {"label": "B", "text": "Amlodipine", "correct": false}, {"label": "C", "text": "Nimodipine", "correct": true}, {"label": "D", "text": "Felodipine", "correct": false}], "correct_answer": "C. Nimodipine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nimodipine</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>30–60 mg IV for 5–14 days, followed by 360 mg orally for 7 days.</li>\n<li>Prevents delayed <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> in the <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> phase of SAH.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aneurysm Management</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endovascular coiling</li>\n<li>Surgical clipping</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arteriovenous <span class=\"customMeta\" data-dictid=\"88900fc4c61692777191a66457050a\">malformation</span> Management</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical removal.</li>\n<li>Ligation of <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> or draining blood vessels.</li>\n<li>Injection of material to <span class=\"customMeta\" data-dictid=\"76d49f7565169277719462f3e985bb\">occlude</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> or draining veins.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complications Treatment</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obstructive hydrocephalus: May need <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">shunt</span> drainage.</li>\n<li>Delayed cerebral ischaemia (vasospasm): Treated with vasodilators.</li>\n<li>Hyponatraemia: Managed by fluid restriction.</li>\n<li>Systemic complications (immobility): Manage chest infections and <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> thrombosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the emergency department with progressive weakness in his arms and legs over the past three months. On examination, he has hyperreflexia in the upper and lower extremities and bilateral weakness is noted with poorly localized, burning pain and spared sensation in the perineal and sacral areas. Based on the presentation, which of the following conditions is most likely responsible for this patient's symptoms?", "options": [{"label": "A", "text": "Extradural compression", "correct": false}, {"label": "B", "text": "Intradural compression", "correct": false}, {"label": "C", "text": "Foramen magnum syndrome", "correct": false}, {"label": "D", "text": "Intramedullary compression", "correct": true}], "correct_answer": "D. Intramedullary compression", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/63701NkBvRPeRpme6Wi81744390624.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intramedullary Tumors:</strong></p>\n<ul>\n<li style=\"text-align:center\">Ependymomas</li>\n<li style=\"text-align:center\">Astrocytomas</li>\n<li style=\"text-align:center\">Hemangioblastomas</li>\n</ul>\n<ul>\n<li style=\"text-align:center\"><strong>Abscesses</strong> (pyogenic or <span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\">tuberculous</span> abscesses) can create masses within the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord.</li>\n<li style=\"text-align:center\"><strong>Multiple sclerosis: </strong>Inflammatory demyelinating lesions may cause <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> effects.</li>\n</ul>\n<ul>\n<li style=\"text-align:center\"><strong>Trauma</strong></li>\n<li style=\"text-align:center\"><strong>Cystic lesions</strong>: Such as syringomyelia, where a <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> forms within the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Motor Symptoms: </strong>Weakness or <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> in the limbs, typically presenting as <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> weakness.</li>\n<li style=\"text-align:center\"><strong>Reflex Changes:</strong> <span class=\"customMeta\" data-dictid=\"0ae01203b4169277718914c4efe843\">Hyperreflexia</span> and <span class=\"customMeta\" data-dictid=\"86b057bddf1692777198e020fc1aad\">spasticity</span> below the level of the lesion.</li>\n<li style=\"text-align:center\"><strong>Pain: </strong>Poorly localized, <strong>burning pain</strong> and spared sensation in the <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> and sacral areas(sacral sparing).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>MRI of the Spine: The gold standard for identifying <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> lesions</strong>.</li>\n<li style=\"text-align:center\"><strong>CT Scan </strong></li>\n<li style=\"text-align:center\"><strong>Neurological Examination: </strong>Detailed assessment to identify the level and extent of dysfunction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with complaints of radicular pain on the lower back associated with loss of sensations over sacrum and urinary incontinence. There was weakness, started over lower limbs one month back and now weakness is present over upper limbs. What is the ideal imaging of choice to diagnose this condition?", "options": [{"label": "A", "text": "DWI", "correct": false}, {"label": "B", "text": "MRI", "correct": true}, {"label": "C", "text": "CT", "correct": false}, {"label": "D", "text": "X-ray", "correct": false}], "correct_answer": "B. MRI", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/IGQ9bBCSpVcUKdNyk5pO1744340114.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Intradural: Benign Neurofibroma</strong>; Slow onset of symptoms seen</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\"><strong>Extradural: <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> metastases</strong> from Breast/lung/Prostate cancer; Relatively rapid onset of manifestations seen</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">Radicular (root) pain along the nerve root involved</li>\n<li style=\"text-align:center\"><strong>Early sacral <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss</strong></li>\n<li style=\"text-align:center\"><strong>Ascending <span class=\"customMeta\" data-dictid=\"1ce806f0111692777198eedf1b5824\">spastic</span> paralysis</strong> starting from lower limbs</li>\n<li style=\"text-align:center\"><strong>Bladder involvement - early </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is the least likely manifestation in this spinal cord lesion (as shown below)?", "options": [{"label": "A", "text": "I/L loss of vibration sense at the same level", "correct": false}, {"label": "B", "text": "C/L loss of pain at the same level", "correct": true}, {"label": "C", "text": "I/L loss of vibration sense 2 segments below the level of lesion", "correct": false}, {"label": "D", "text": "C/L loss of pain 2 segments below the level of lesion", "correct": false}], "correct_answer": "B. C/L loss of pain at the same level", "question_images": ["https://image.prepladder.com/notes/84QQKtCZKjn8waQk6SN71744337426.png"], "explanation_images": ["https://image.prepladder.com/notes/uemcPh4zXxeVMgJAMqHZ1744337531.png", "https://image.prepladder.com/notes/84QQKtCZKjn8waQk6SN71744337426.png", "https://image.prepladder.com/notes/bCsaqEx6jtLfrYhVq7Vi1744337683.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ipsilateral (I/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contralateral (C/L)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>At the level of lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CST: LMN paralysis</li>\n<li>Dorsal column: Loss of <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> and proprioception</li>\n<li>Radicular pain +</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Below the level of lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CST: UMN paralysis</li>\n<li>Dorsal column: Loss of <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> and proprioception</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spinothalamic tract: Loss of Pain and Temperature</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 year old vegetarian female was referred to Neurology OPD with complaints of progressive weakness of lower limbs, numbness, difficulty walking and recent onset forgetfulness. On examination, there was B/L loss of vibration sense, Deep tendon reflexes - absent, Babinski-positive and Positive Romberg sign was noted. Peripheral blood smear done was normal. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Subacute combined degeneration of Spinal cord", "correct": true}, {"label": "B", "text": "Tabes dorsalis", "correct": false}, {"label": "C", "text": "Friedrich ataxia", "correct": false}, {"label": "D", "text": "Brown sequard syndrome", "correct": false}], "correct_answer": "A. Subacute combined degeneration of Spinal cord", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/HpNGp7JQEFmlRBWzl5it1744337315.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reversible <span class=\"customMeta\" data-dictid=\"429708823b1692777193bc84f81d9d\">myelopathy</span> mainly involving <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> column and <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">Pyramidal</span> column tracts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Vitamin B12 deficiency:</strong> Nutritional (vegetarians), <span class=\"customMeta\" data-dictid=\"5cc1ea37091692777195fbd0aa687b\">Pernicious</span> anemia, post-gastrectomy, <span class=\"customMeta\" data-dictid=\"8559a65a1116927771864c296ce496\">Diphyllobothrium</span> infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weakness: <span class=\"customMeta\" data-dictid=\"a218fdbabf1692777185a2d48a9e1c\">Corticospinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> (CST)/Pyramidal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> and proprioception: <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> column <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement</li>\n<li>Ataxia: <strong>Romberg sign positive</strong></li>\n<li>DTR: Absent (Peripheral neuropathy), Babinski sign: Positive (CST involvement)</li>\n<li><strong>Dementia: Reversible</strong> with therapy</li>\n<li><strong>Hyperpigmentation of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Vitamin B12 assay:</strong> <span class=\"customMeta\" data-dictid=\"bc09155adc169277719248f9543785\">Methyl</span> malonate/Homocysteine levels estimation</li>\n<li>Peripheral blood smear: May reveal <span class=\"customMeta\" data-dictid=\"04173aa3b71692777191ff88525398\">macrocytosis</span> with hypersegmented neutrophils</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>NOTE: SACD can occur without <span class=\"customMeta\" data-dictid=\"04173aa3b71692777191ff88525398\">macrocytosis</span> as well</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vitamin B12 supplementation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hypocupric myelopathy:</strong> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> Cu2+ levels should be checked</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman presents with sudden symmetrical onset of both lower extremity weakness, numbness, and urinary retention. She reports a history of a respiratory tract infection two weeks ago. Neurological examination reveals reduced muscle strength and sensory loss below the mid-thoracic region, along with hyperreflexia. MRI of the spine shows a focal area of increased T2 signal in the thoracic spinal cord without evidence of compression. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Multiple sclerosis", "correct": false}, {"label": "B", "text": "Guillain-Barré syndrome", "correct": false}, {"label": "C", "text": "Transverse myelitis", "correct": true}, {"label": "D", "text": "Amyotrophic lateral sclerosis", "correct": false}], "correct_answer": "C. Transverse myelitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Introduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acquired <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disorder of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etio- pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic: Most common</strong></li>\n<li><strong>Post-infectious:</strong> Usually Enterovirus, Herpes, HIV</li>\n<li><strong>Inflammatory/Autoimmune:</strong> Ankylosing spondylitis, APLA syndrome, Behcet disease, RA, Scleroderma</li>\n<li><strong>Multifocal <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> disorders:</strong> Multiple sclerosis, Neurosarcoidosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Motor: <strong>Sudden onset B/L</strong> usually <strong>symmetric rapid paralysis</strong> initially flaccidity, and later <span class=\"customMeta\" data-dictid=\"86b057bddf1692777198e020fc1aad\">spasticity</span> sets in.</li>\n<li>Sensory: Pain, Dysaesthesia, Paraesthesia</li>\n<li>Autonomic: <strong>Bowel/bladder disturbances +</strong>, <span class=\"customMeta\" data-dictid=\"960bd9fb3d1692777189abb8d8f4cf\">impotence</span> +</li>\n<li>Backache: Corresponding to the level of lesion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>T2-MRI: <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> <strong>Hyperintense signals</strong> within the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord</li>\n<li>CSF Analysis: To rule out other infectious/inflammatory etiology, <strong>elevated <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> index</strong> may be present</li>\n<li>Histopathology: <strong>Perivascular <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> of monocytes/lymphocytes</strong> + <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> +/- axonal injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First line: High dose IV Glucocorticoids</strong></li>\n<li>Plasmapheresis</li>\n<li>Other immunomodulators: Cyclophosphamide, Mycophenolate, Rituximab</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with sudden onset lower back pain and bilateral lower limb weakness. On examination, there is saddle anesthesia, knee jerk-intact and ankle jerk-absent. What is the most likely diagnosis and its corresponding onset of bladder involvement?", "options": [{"label": "A", "text": "Conus medullaris syndrome, Early bladder involvement", "correct": true}, {"label": "B", "text": "Cauda Equina Syndrome, Early bladder involvement", "correct": false}, {"label": "C", "text": "Conus medullaris syndrome, Late bladder involvement", "correct": false}, {"label": "D", "text": "Cauda Equina Syndrome, Late bladder involvement", "correct": false}], "correct_answer": "A. Conus medullaris syndrome, Early bladder involvement", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/SWSNxGEvK3jAzR8YZlF01744336950.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conus Medullaris syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cauda Equina syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve roots</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>S1-S5 (Purely sacral)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lumbar + Sacral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden and <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> symmetric</li>\n<li>Back Pain- more severe</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gradual and <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> asymmetric</li>\n<li>Pain- less severe</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radicular pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild-moderate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Knee jerk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Preserved</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Absent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ankle jerk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Absent</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Absent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> area: <span class=\"customMeta\" data-dictid=\"8b3b29ae5516927771987d1b16beb1\">Saddle</span> <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> +</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patchy loss along the lower limb: <span class=\"customMeta\" data-dictid=\"02f52172cf1692777197fe1be2e386\">Radicular</span> pattern distribution</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less marked, symmetric</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More marked, asymmetric</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bowel/bladder involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Frequent and early onset</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Late onset</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impotence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Present</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less frequent</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old male has a herniated disk that has damaged his L3-L5 nerve roots. Which of the following is least likely to be his clinical feature?", "options": [{"label": "A", "text": "Back pain", "correct": false}, {"label": "B", "text": "Saddle anesthesia", "correct": false}, {"label": "C", "text": "Brisk bulbocavernosus reflex", "correct": true}, {"label": "D", "text": "Impotence", "correct": false}], "correct_answer": "C. Brisk bulbocavernosus reflex", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression and <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"64d06f977116927771936e3af9572f\">nerve roots</span> from the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord (typically L1-L5), often resulting from<strong> damage </strong>(secondary to trauma, tumors, <strong>herniated discs</strong>, or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> ) <strong>to L3-L5 nerve roots</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical features</p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Back pain and <span class=\"customMeta\" data-dictid=\"7d0efa92331692777198fe5107d019\">sciatica</span> <strong>(Option A ruled out)</strong></p>\n<p>- <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (retention or incontinence)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (retention or incontinence)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"8b3b29ae5516927771987d1b16beb1\">Saddle</span> <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> <strong>(Option B ruled out)</strong></p>\n<p>- Sexual <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (impotence in men). <strong>(Option D ruled out)</strong></p>\n<p>- Motor or <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> deficits in the legs, often asymmetric.</p>\n<p>- Lower <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> signs: areflexia, hypotonia, atrophy.</p>\n<p>- Decreased rectal tone.</p>\n<p>- Absent <span class=\"customMeta\" data-dictid=\"11bb11e24c1692777183b711f17f55\">bulbocavernosus</span> reflex<strong> </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Urgent <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> with <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> and <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> T1 and T2 sequences is the gold standard.</p>\n<p>- CT <span class=\"customMeta\" data-dictid=\"248ceb598e16927771939575621aba\">myelogram</span> for patients contraindicated for MRI.</p>\n<p>- <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> scan to check post-void <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> volume for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> (laminectomy, discectomy, or sequestrectomy) with early neurosurgical or <span class=\"customMeta\" data-dictid=\"0b8eb98a3f16927771945b310aec42\">orthopedic</span> consultation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is wrong on conus medullaris?", "options": [{"label": "A", "text": "Tapered termination of spinal cord", "correct": false}, {"label": "B", "text": "Affects the sacral and single coccygeal segments", "correct": false}, {"label": "C", "text": "Bilateral saddle anesthesia", "correct": false}, {"label": "D", "text": "Loss of muscle strength on inner thighs", "correct": true}], "correct_answer": "D. Loss of muscle strength on inner thighs", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/1ApQdCBQV5IbEDLlkfj51744336796.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tapered <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord <strong>(Option A ruled out)</strong>, comprising the sacral and single <span class=\"customMeta\" data-dictid=\"3c3517ca0916927771844343d81474\">coccygeal</span> segments<strong> (Option B ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Conus medullaris\" data-author=\"Henry Vandyke Carter \" data-hash=\"9037\" data-license=\"Open access\" data-source=\"https://en.m.wikipedia.org/wiki/File:Gray1213.png\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/notes/1ApQdCBQV5IbEDLlkfj51744336796.png\" width=\"354\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"8b3b29ae5516927771987d1b16beb1\">saddle</span> <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> (S3–S5) <strong>(Option C ruled out)</strong> involving the perineum, inner thighs, and buttocks.</li>\n<li>Prominent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention, incontinence, and lax anal tone.</li>\n<li>Impotence is common due to the involvement of sacral segments.</li>\n<li><strong>Largely preserved muscle strength.</strong><strong>(Option D)</strong></li>\n<li>Absent <span class=\"customMeta\" data-dictid=\"11bb11e24c1692777183b711f17f55\">bulbocavernosus</span> <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (S2–S4) and anal <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (S4–S5).</li>\n<li>Typically minimal or absent pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with progressive weakness and sensory loss in her arms, along with muscle wasting in her hands. MRI reveals a large intramedullary spinal cord tumor, with an associated syrinx. What is the management?", "options": [{"label": "A", "text": "Tumor resection", "correct": true}, {"label": "B", "text": "Radiation therapy", "correct": false}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Decompression", "correct": false}], "correct_answer": "A. Tumor resection", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/dMfAfLLjgTpW74m8Aak61744336676.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MRI to detect <span class=\"customMeta\" data-dictid=\"76f83c41a816927771993ede18fc87\">syrinx</span> cavities, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord enlargement, assess Chiari malformation, and determine hydrocephalus.</p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chiari <span class=\"customMeta\" data-dictid=\"88900fc4c61692777191a66457050a\">malformation</span> treatment: <span class=\"customMeta\" data-dictid=\"ec0209653b1692777199b0723d791e\">Suboccipital</span> craniectomy, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> laminectomy, <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> placement.</li>\n<li>Hydrocephalus with Chiari: Shunting precedes <span class=\"customMeta\" data-dictid=\"76f83c41a816927771993ede18fc87\">syrinx</span> correction.</li>\n<li>Syrinx secondary to trauma/infection: <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">Decompression</span> and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> (shunt or fenestration).</li>\n<li style=\"text-align:center\">Syrinx due to <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord tumors: <strong>Tumor resection</strong> is preferred.\n\t\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Chiari formation\" data-author=\"Al Salam H, Knipe H, Gaillard F, et al\" data-hash=\"9036\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/cystic-spinal-cord-lesions\" data-tags=\"\" height=\"309\" src=\"https://image.prepladder.com/notes/dMfAfLLjgTpW74m8Aak61744336676.png\" width=\"274\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>Note: Patients with minimal symptoms do not require surgery and are monitored with clinical and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> follow-up.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about syringomyelia is wrong?", "options": [{"label": "A", "text": "A developmental cavity in the cervical cord", "correct": false}, {"label": "B", "text": "Symptoms begin in adolescence or early adulthood", "correct": false}, {"label": "C", "text": "The majority linked with Chiari type 2 malformation", "correct": true}, {"label": "D", "text": "Sensory loss in a cape distribution", "correct": false}], "correct_answer": "C. The majority linked with Chiari type 2 malformation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Dm5lpJ78Js0TJOWgCWWP1744336350.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A developmental <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> in the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cord <strong>(Option A ruled out)</strong> that can enlarge or remain asymptomatic.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"syringomyelia\" data-author=\"NA\" data-hash=\"9034\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"312\" src=\"https://image.prepladder.com/notes/Dm5lpJ78Js0TJOWgCWWP1744336350.png\" width=\"312\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Onset &amp; Progression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms begin in <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> or early adulthood <strong>(Option B ruled out)</strong>, progress irregularly, and may undergo <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> arrest.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common Association</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than half of cases are <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> with Chiari <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> malformations (cerebellar tonsils protrude through the <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> <span class=\"customMeta\" data-dictid=\"8b30f6b0351692777191c9482a965e\">magnum</span> and <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> canal). <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathophysiology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possibly related to <span class=\"customMeta\" data-dictid=\"f087a3103216927771903f59008962\">interference</span> with <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> flow, particularly due to Chiari malformations.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presentation</p>\n</td>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dissociated <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss (pain and temperature loss, touch and <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> spared)</strong>.</p>\n<p><strong>Areflexic weakness in upper limbs</strong>.</p>\n<p><strong>Suspended <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss in a cape distribution</strong> (nape, shoulders, upper arms, hands).<strong> (Option D ruled out) </strong></p>\n<p>Muscle <span class=\"customMeta\" data-dictid=\"9971eacaaf1692777202d2ece15a2a\">wasting</span> in neck, shoulders, arms, hands; absent/asymmetric reflexes in arms.</p>\n<p>As <span class=\"customMeta\" data-dictid=\"76f83c41a816927771993ede18fc87\">syrinx</span> expands: Spasticity, leg weakness, bladder/bowel dysfunction, Horner's syndrome.</p>\n<p><strong>Facial <span class=\"customMeta\" data-dictid=\"a6a2c6342d1692777193c3414d0cc8\">numbness</span> from <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> damage (C2 level or above)</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Syringomyelia of the &lt;span class=\" custommeta\"=\"\" data-dictid=\"d816ba952f1692777199fc69bd7c56\"/>spinal cord\" data-author=\"NA\" data-hash=\"9035\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"373\" src=\"https://image.prepladder.com/notes/cqGMDNcY4iGS75Se4iXe1744336455.png\" width=\"373\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Additional Symptoms</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chiari-associated symptoms: Cough-induced headache, neck, arm, or <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> pain.</p>\n<p>Syringobulbia: Palatal/vocal cord paralysis, dysarthria, nystagmus, vertigo, tongue weakness.</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which gene mutation is primarily associated with hyperkalemic periodic paralysis?", "options": [{"label": "A", "text": "KCNJ2", "correct": false}, {"label": "B", "text": "CACNA1S", "correct": false}, {"label": "C", "text": "SCN4A", "correct": true}, {"label": "D", "text": "RYR1", "correct": false}], "correct_answer": "C. SCN4A", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old female is admitted to the ICU following a subarachnoid hemorrhage. On examination, she is stuporous, exhibits intermittent reflex posturing and has severe motor deficits. Her Glasgow Coma Scale (GCS) score is 8. What is her grade of subarachnoid hemorrhage according to both the Hunt-Hess scale and the World Federation of Neurosurgical Societies (WFNS) scale?", "options": [{"label": "A", "text": "Hunt-Hess Grade 2, WFNS Grade 2", "correct": false}, {"label": "B", "text": "Hunt-Hess Grade 3, WFNS Grade 3", "correct": false}, {"label": "C", "text": "Hunt-Hess Grade 4, WFNS Grade 4", "correct": true}, {"label": "D", "text": "Hunt-Hess Grade 4, WFNS Grade 3", "correct": false}], "correct_answer": "C. Hunt-Hess Grade 4, WFNS Grade 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grading Scales for <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">Subarachnoid</span> Hemorrhage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GRADE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HUNT-HESS SCALE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WORLD FEDERATION OF NEUROSURGICAL SOCIETIES (WFNS) SCALE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild headache, normal mental status, no <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve or motor findings</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS score 15, no motor deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe headache, normal mental status, may have <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve deficit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS score 13–14, no motor deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Somnolent, <strong>confused</strong>, may have <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve or mild motor deficit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS score 13–14, with motor deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stupor</strong>, moderate to severe motor deficit, may have <strong>intermittent posturing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS score 7–12, with or without motor deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coma, <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> <span class=\"customMeta\" data-dictid=\"3bb2ac8bfb1692777196679581acb3\">posturing</span> or flaccid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS score 3–6, with or without motor deficits</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents to the emergency department with a sudden, severe headache described as the \"worst of their life.\" A non-contrast head CT scan is performed but returns negative. Despite this, the suspicion of subarachnoid hemorrhage (SAH) remains high. What is the most appropriate next step in the evaluation of this patient?", "options": [{"label": "A", "text": "Repeat the head CT scan in 24 hours", "correct": false}, {"label": "B", "text": "Lumbar puncture (LP) to assess for xanthochromia", "correct": true}, {"label": "C", "text": "Immediate cerebral angiography", "correct": false}, {"label": "D", "text": "Perform a Time-of-Flight Magnetic Resonance Angiography (TOF-MRA)", "correct": false}], "correct_answer": "B. Lumbar puncture (LP) to assess for xanthochromia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0VGpKWNKmlpXvRti6lYE1744336174.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:725px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vasospasm Prediction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The extent and location of blood on the <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> help locate the aneurysm, explain neurologic deficits, and predict <span class=\"customMeta\" data-dictid=\"88758385011692777201c7fff08b99\">vasospasm</span> risk.</li>\n<li>Large clots (&gt;5 × 3 mm) in <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns or blood layers &gt;1 mm in cerebral fissures indicate higher <span class=\"customMeta\" data-dictid=\"88758385011692777201c7fff08b99\">vasospasm</span> risk, particularly in <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> and <span class=\"customMeta\" data-dictid=\"f17a889c2e1692777180307821c3f9\">ACA</span> territories.</li>\n<li>CT scans are less predictive of <span class=\"customMeta\" data-dictid=\"88758385011692777201c7fff08b99\">vasospasm</span> in vertebral, basilar, or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cerebral arteries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Implications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Electrolytes: Close monitoring (daily or twice daily) of electrolytes, especially during the first 2 weeks due to the <strong>risk of hyponatremia</strong>.</li>\n<li>ECG Changes: SAH can cause ST-segment and T-wave changes similar to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> ischemia, with prolonged QRS, increased QT interval, and T-wave abnormalities.\n\t\t\t\t<ul>\n<li>Catecholamine Surge: SAH can lead to myocardial injury due to excessive <span class=\"customMeta\" data-dictid=\"69ccfc60d016927771837a12cdddb2\">catecholamine</span> release, causing <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> cardiomyopathy.</li>\n<li>Echocardiography Findings: Shows regional wall motion abnormalities corresponding to <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> nerve distribution, sparing the <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> apex.</li>\n<li>Troponin Elevation: Common but typically asymptomatic.</li>\n<li>Ventricular Dysrhythmias: Rare</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old woman is brought to the emergency department with a sudden onset of severe headache, described as \"the worst headache of her life.\" She was unresponsive at home, and, on arrival, was stuporous, with a Glasgow Coma Scale score of 10. A CT scan confirms a subarachnoid hemorrhage (SAH). On the fourth day of her hospitalisation, she becomes increasingly drowsy, and her speech slows down. A repeat CT scan reveals no new haemorrhage or infarct. Her serum sodium level is 125 mEq/L. What is the most likely cause of this patient's deterioration?", "options": [{"label": "A", "text": "Rebleeding of the aneurysm", "correct": false}, {"label": "B", "text": "Subacute hydrocephalus", "correct": false}, {"label": "C", "text": "Delayed cerebral ischemia (DCI)", "correct": false}, {"label": "D", "text": "Hyponatremia due to cerebral salt-wasting syndrome", "correct": true}], "correct_answer": "D. Hyponatremia due to cerebral salt-wasting syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:702px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subarachnoid hemorrhage- Delayed neurological deficits</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rerupture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Incidence: ~30% in the first month, with peak in the first 7 days.</li>\n<li><strong>Mortality rate: 50%.</strong></li>\n<li>Prevention: Early treatment eliminates risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hydrocephalus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute Hydrocephalus</strong>: Causes stupor/coma; managed by external <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> drain.</li>\n<li><strong>Subacute Hydrocephalus:</strong> Develops over days/weeks; causes drowsiness, slowed thinking, and incontinence.\n\t\t\t\t<ul>\n<li>Diagnosed via CT, CTA, TCD ultrasound, or <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">x-ray</span> angiography. <strong>(Option B ruled out)</strong></li>\n</ul>\n</li>\n<li><strong>Chronic Hydrocephalus</strong>: Weeks/months after SAH, with symptoms like <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> difficulty, incontinence, or cognitive impairment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed <span class=\"customMeta\" data-dictid=\"1d859d0b0416927771841b2915a839\">Cerebral Ischemia</span> (DCI)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cause: <strong>Vasospasm of arteries </strong>at the brain’s base, causing <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (~30% of patients).</li>\n<li><strong>Onset: 4–14 days after <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (peaks at 7 days).</strong></li>\n<li>Mechanism: <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">Triggered</span> by blood clots/ <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> products. More surrounding blood increases <span class=\"customMeta\" data-dictid=\"88758385011692777201c7fff08b99\">vasospasm</span> risk.</li>\n<li>Symptoms<strong>: Sudden <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> deficits, mental decline, fluctuating symptoms</strong>.</li>\n<li>Detection: <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> angiography, TCD ultrasound, or CTA.</li>\n<li>Treatment: <strong>CSF drainage, mannitol/ <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">hypertonic</span> saline, hemicraniectomy, moderate hypothermia.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyponatremia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Onset: Occurs in the<strong> first 2 weeks post-SAH </strong>due to <span class=\"customMeta\" data-dictid=\"0c980450d716927771939598e3bf30\">natriuresis</span> and volume <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> (hyponatremia + hypovolemia).</li>\n<li>Cause: Involves atrial and brain <span class=\"customMeta\" data-dictid=\"bd16654d3e169277719371077d7a8c\">natriuretic</span> peptides (cerebral salt-wasting syndrome).</li>\n<li>Treatment: <strong>Resolves in 1–2 weeks. Free-water restriction is avoided to reduce stroke risk.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents to the emergency department with a sudden, severe headache described as \"the worst headache of her life.\" She also reports vomiting. Imaging confirms a subarachnoid haemorrhage (SAH) due to a rupture of aneurysm at the posterior communicating artery and internal carotid junction. Which of the following clinical features is most likely associated with this scenario?", "options": [{"label": "A", "text": "6th cranial nerve palsy", "correct": false}, {"label": "B", "text": "Visual field defects", "correct": false}, {"label": "C", "text": "3rd cranial nerve palsy", "correct": true}, {"label": "D", "text": "Occipital pain", "correct": false}], "correct_answer": "C. 3rd cranial nerve palsy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:736px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subarachnoid hemorrhage- Clinical features and features based on location of bleed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unruptured Aneurysms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> but may cause <strong>cranial nerve or brain <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> (mass effect).</strong></li>\n<li>Prodromal Symptoms:\n\t\t\t\t<ul>\n<li><strong>Third <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">Cranial</span> Nerve Palsy:</strong> Seen with an expanding <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> at the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"8c3efbee661692777184685e54c75e\">communicating</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> and internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> junction. Symptoms include pupillary dilation, <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> light <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> loss, and eye pain.\n\t\t\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Third &lt;span class=\" custommeta\"=\"\" data-dictid=\"6b7b5460171692777185e6e2475f8c\"/>Cranial Nerve\" data-author=\"NA\" data-hash=\"9032\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"361\" src=\"https://image.prepladder.com/notes/0H16GJl9IG0DiaELM7xX1744336055.png\" width=\"361\" /&gt;\n\t\t\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Sixth Nerve Palsy:</strong> May suggest an <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> in the <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> sinus.<strong> (Option A ruled out)</strong></li>\n<li><strong>Visual Field Defects</strong>: May occur with an <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> in the supraclinoid <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> or <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (ACA).<strong> (Option B ruled out)</strong></li>\n<li><strong>Occipital/ <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> Pain:</strong> Seen with <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> or <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> cerebellar <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> aneurysms. <strong> (Option D ruled out)</strong></li>\n<li><strong>Eye/Temple Pain: </strong>Expanding middle cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (MCA) aneurysms can cause pain in or behind the eye and temple.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ruptured Aneurysms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sudden <span class=\"customMeta\" data-dictid=\"4d44b4af771692777189fb3f01cb77\">ICP</span> increase:</strong> Occurs at the moment of rupture, often causing <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> loss of consciousness in nearly 50% of patients.</li>\n<li><strong>Headache</strong>:\n\t\t\t\t<ul>\n<li>Excruciating headaches may precede before the rupture, but most patients report severe headache after regaining consciousness.</li>\n<li>The primary symptom is a sudden severe headache during exertion, often described as <strong>\"the worst headache of my life\".</strong></li>\n<li>Some cases may present with moderate headache or changes in usual headache patterns.</li>\n<li><strong>Additional Symptoms:</strong> Generalized headache with neck <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> is common.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Focal Neurologic Deficits:</strong>\n<ul>\n<li>May occur if the <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> bleeds into the brain or <span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\">subdural</span> space, causing a hematoma.</li>\n<li>Deficits include:<strong> Hemiparesis, aphasia, mental slowness (abulia).</strong></li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Severe Cases: 10% of patients may<strong> lose consciousness</strong> for several days due to significant bleeding.</li>\n<li><strong>Sentinel Bleeds:</strong> Small, earlier ruptures causing unexplained headache can precede major SAH, <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> <strong>imminent hemorrhage.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old female presents to the ER with a sudden onset of the \"worst headache of her life.\" A CT scan confirms a subarachnoid haemorrhage (SAH). After stabilization, further imaging reveals an aneurysm in the posterior circulation. Her relatives informed her that she had a past history of autosomal dominant polycystic kidney disease (ADPKD). Which of the following is most strongly associated with an increased risk of rupture of this aneurysm? A) Aneurysm size of 3 cm B) Location in the posterior circulation C) Hypertension D) Age over 60 years E) History of autosomal dominant polycystic kidney disease (ADPKD)", "options": [{"label": "A", "text": "All except E", "correct": false}, {"label": "B", "text": "All except B", "correct": false}, {"label": "C", "text": "All except B and E", "correct": false}, {"label": "D", "text": "All the above", "correct": true}], "correct_answer": "D. All the above", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:162px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subarachnoid hemorrhage</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subarachnoid <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">Hemorrhage</span> (SAH): Blood accumulation in the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space.</li>\n<li>Causes: Often due to <strong>aneurysm <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> (~85%) </strong>or <strong>trauma</strong>.</li>\n<li><strong>Non-traumatic SAH</strong> is most commonly caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of a <strong>saccular aneurysm</strong>.</li>\n</ul>\n<ul>\n<li>Clinical Impact: High mortality and morbidity; often presents with a sudden, severe headache <strong>(worst headache of life).</strong></li>\n</ul>\n<ul>\n<li>Complications: Seizures, vasospasm, hydrocephalus, and delayed <span class=\"customMeta\" data-dictid=\"1d859d0b0416927771841b2915a839\">cerebral ischemia</span> (DCI).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology:</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Age/ Gender: Most of the SAH occurs between age of 40-60, mean <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> age 50-55 and slightly more prevalent in females.</li>\n<li>Risk Factors: Smoking and history of ruptured aneurysms increase SAH risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology:</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Aneurysmal SAH (aSAH):</strong>\n<ul>\n<li>Risk Factors: <strong>Hypertension</strong>, <strong>smoking</strong>, family history, <strong>alcohol </strong>use, <strong>sympathomimetic drugs</strong>, and <strong>estrogen deficiency</strong>.</li>\n<li>Rupture Risk: <strong>(Option D)</strong>\n<ul>\n<li>Age &gt;60</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> aneurysms</li>\n<li>Atherosclerosis</li>\n<li>Aneurysm size\n\t\t\t\t\t\t<ul>\n<li>Aneurysms &lt;10 mm: ~0.1% annual <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk.</li>\n<li>Aneurysms ≥10 mm: 0.5–1% annual <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk.</li>\n<li>Giant aneurysms (&gt;2.5 cm): ~6% <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk in first year.</li>\n</ul>\n</li>\n<li>Family history</li>\n<li>Previous SAH</li>\n<li>ADPKD</li>\n</ul>\n</li>\n</ul>\n</li>\n<li><strong>Nonaneurysmal SAH (NASAH):</strong>\n<ul>\n<li><strong>Perimesencephalic NASAH</strong>: <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> blood in perimesencephalic cisterns, normal angiography, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> course.</li>\n<li><strong>Occult Aneurysm</strong>: Small aneurysms missed on initial angiography, detectable on repeat imaging.</li>\n<li><strong>Vascular Malformations:</strong> Includes <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> malformations (AVM) and <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> fistulae. Treated with surgery or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> interventions.</li>\n<li><strong>Intracranial Arterial Dissection:</strong> Diagnosed by angiography, causes severe bleeding, treated with surgery or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> methods.</li>\n<li>Other Causes: <strong>Cocaine abuse,</strong> <strong>cerebral <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> angiopathy, cerebral <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> thrombosis, sickle cell disorders, moyamoya disease, cerebral vasculitis, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology:</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Hemodynamic Stress</strong>: Central to <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> formation, especially at arterial bifurcations.</li>\n<li><strong>Aneurysm Rupture:</strong> Causes neurological damage through <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of adjacent brain tissue and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> from <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow.\n\t\t\t\t<ul>\n<li>Mechanisms: <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">Hemodynamic</span> stress and <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (matrix <strong>metalloproteinase (MMP)-mediated <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> of <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> matrix) </strong>weaken the arterial wall, promoting <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> formation and rupture.</li>\n<li>Inflammatory Response: Macrophages and smooth muscle cells drive these degenerative processes.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20 Y/O female presents to the clinic with a history of intermittent muscle weakness, which often follows periods of rest after exercise. She also reports occasional episodes of palpitations. On examination, she has mild facial dysmorphism, including a broad forehead, a small jaw, and low-set ears. Her pulse is irregular, and an ECG shows frequent premature ventricular contractions (PVCs) with occasional runs of bidirectional ventricular tachycardia. Genetic testing reveals a mutation in the KCNJ2 gene. Which of the following best describes the underlying cause of this patient’s condition?", "options": [{"label": "A", "text": "Sodium channelopathy affecting the cardiac conduction system", "correct": false}, {"label": "B", "text": "Potassium channelopathy affecting skeletal muscle and cardiac conduction", "correct": true}, {"label": "C", "text": "Calcium channelopathy affecting cardiac muscle", "correct": false}, {"label": "D", "text": "Abnormal chloride transport in skeletal and cardiac muscle", "correct": false}], "correct_answer": "B. Potassium channelopathy affecting skeletal muscle and cardiac conduction", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/NR0nUiPtLoJkWSGKrq6D1744335876.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 19-year-old male presents to the emergency department with a sudden onset of generalized muscle weakness, particularly in his legs, after a day of strenuous exercise followed by a high-carbohydrate meal. He reports experiencing similar episodes of muscle weakness in the past, often triggered by exercise or large meals. His ECG shows U waves. What is the most appropriate first-line treatment for this patient’s acute presentation?", "options": [{"label": "A", "text": "Oral potassium supplementation", "correct": true}, {"label": "B", "text": "Intravenous potassium", "correct": false}, {"label": "C", "text": "Acetazolamide", "correct": false}, {"label": "D", "text": "Beta-blockers", "correct": false}], "correct_answer": "A. Oral potassium supplementation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18-year-old male presents to the emergency department with a sudden onset of severe muscle weakness, primarily in his legs, which started a few hours after consuming a large, carbohydrate-heavy meal following exercise. He reports similar episodes in the past, often triggered by large meals or after rest following physical activity. His vital signs are stable, and he has no respiratory involvement. Blood work reveals a serum potassium level of 2.3 mEq/L. What is the most likely underlying mechanism for this patient's condition?", "options": [{"label": "A", "text": "Sodium channel dysfunction causing an inability to generate action potentials", "correct": false}, {"label": "B", "text": "Potassium channel dysfunction leading to excessive potassium loss", "correct": false}, {"label": "C", "text": "Calcium or sodium channel mutations causing abnormal potassium influx into cells", "correct": true}, {"label": "D", "text": "Excessive release of acetylcholine at the neuromuscular junction", "correct": false}], "correct_answer": "C. Calcium or sodium channel mutations causing abnormal potassium influx into cells", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old male presents to the clinic with complaints of muscle stiffness, especially in his face and hands, following exposure to cold weather. He reports that his symptoms worsen with repeated movements and improve with rest. Upon examination, his muscles are stiff but not weak. His symptoms do not improve with warming .What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myotonic Dystrophy", "correct": false}, {"label": "B", "text": "Paramyotonia Congenita", "correct": true}, {"label": "C", "text": "Hypokalemic Periodic Paralysis", "correct": false}, {"label": "D", "text": "Becker Muscular Dystrophy", "correct": false}], "correct_answer": "B. Paramyotonia Congenita", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 21 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 30-year-old female presents to the OPD with a 3 cm breast lump in the upper medial quadrant . The lump has an uneven, bosselated surface , and the overlying skin is mildly ulcerated . Microscopic examination reveals the given findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Phyllodes tumor", "correct": true}, {"label": "B", "text": "Galactocele", "correct": false}, {"label": "C", "text": "Fibroadenoma", "correct": false}, {"label": "D", "text": "Paget's disease", "correct": false}], "correct_answer": "A. Phyllodes tumor", "question_images": ["https://image.prepladder.com/content/DOhXoukvwuwXNLuszAAc1741075420.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:344px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-50 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, large <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uneven, bosselated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stromal overgrowth, leaf-like pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> / mastectomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which patient has better prognosis in breast cancer?", "options": [{"label": "A", "text": "Her2+", "correct": false}, {"label": "B", "text": "Triple negative", "correct": false}, {"label": "C", "text": "Luminal B", "correct": false}, {"label": "D", "text": "Luminal A", "correct": true}], "correct_answer": "D. Luminal A", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\"&gt;Luminal&lt;/span&gt; A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with a lesion over his left ear. It slowly grew in size over the past 3 months, and he is a chronic smoker with 20 pack years. Vitals are within normal limits, and his physical examination is otherwise unremarkable. The histopathologic evaluation shows keratin pearls. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Nodular melanoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": false}, {"label": "C", "text": "Squamous cell carcinoma", "correct": true}, {"label": "D", "text": "Malignant melanom", "correct": false}], "correct_answer": "C. Squamous cell carcinoma", "question_images": ["https://image.prepladder.com/notes/ny3YuQd8BZWYNzZoNalS1747998668.png"], "explanation_images": ["https://image.prepladder.com/content/xu3zCu9U1C3eq68J0CnH1747024902.png", "https://image.prepladder.com/content/zBRLEgadyZkyIZikgLwu1747024902.png", "https://image.prepladder.com/content/LX9ySO0piJZJDepZVlgG1747024902.png", "https://image.prepladder.com/content/HxzHkGntrGsKPuhHutxZ1747024902.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Squamous cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a type of <strong>skin cancer</strong> that arises from the <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cells, which are the flat cells found in the epidermis, <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes &amp; tissues lining your organs. It is the second most common type of skin cancer after <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cell carcinoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High sunlight exposure</li>\n<li><strong>Arsenic </strong>exposure.</li>\n<li>Immunosuppression (organ transplant, HIV)</li>\n<li>Chronic lymphocytic leukemia</li>\n<li><strong>Human <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">papilloma</span> virus.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It commonly presents as papules, nodules, or plaques with <span class=\"customMeta\" data-dictid=\"7a14c26a7816927771904fb670c6da\">induration</span> and signs of <span class=\"customMeta\" data-dictid=\"4fcf84d1741692777195f8562d0ada\">photodamage</span> like crusting and scaling.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Dermanonymous\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Squamous_Cell_Carcinoma,_Right_Upper_Cheek.png\" data-tags=\"\" height=\"291\" src=\"https://image.prepladder.com/content/xu3zCu9U1C3eq68J0CnH1747024902.png\" width=\"387\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It involves <span class=\"customMeta\" data-dictid=\"27ac5e3413169277719548c1b36288\">physical examination</span> and biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reveals characteristic <span class=\"customMeta\" data-dictid=\"d0e68b82ed1692777190fa10f7d4ba\">keratin</span> pearls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primary treatment involves wide <strong>surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with margins. </strong></li>\n<li><strong>Mohs micrographic surgery (MMS)</strong> aids in <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> histopathological examination.</li>\n<li>Advanced cases may require <strong>radiation or chemotherapy.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old lady presented with a 1.5 cm pigmented lesion on her face that was growing rapidly in size and associated with itching. The lesion is shown below. Which of the following is likely the diagnosis?", "options": [{"label": "A", "text": "Dysplastic nevus", "correct": false}, {"label": "B", "text": "Congenital melanocytic nevus", "correct": false}, {"label": "C", "text": "Acquired melanocytic nevus", "correct": false}, {"label": "D", "text": "Malignant melanoma", "correct": true}], "correct_answer": "D. Malignant melanoma", "question_images": ["https://image.prepladder.com/content/iUhO3Jr4DTx72m5fVEjD1747024520.png"], "explanation_images": ["https://image.prepladder.com/content/9W4uO3VA9rmvjzxlmOht1747024806.png", "https://image.prepladder.com/content/ztxq7udSu14sJaRKtZ1N1747024833.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Malignant melanoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Melanoma is a <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tumour arising from <strong>melanocytes at the epidermal-dermal junction.</strong> Though it is a rare skin cancer, it has a high mortality rate. It presents as a <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> that enlarges, ulcerates, or bleeds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positive family history.</li>\n<li>Fair skin.</li>\n<li>Genetics: <strong>CDKN2A </strong>(chromosome <strong>9p21</strong>), MC1R, and TYR genes.</li>\n<li>Nevus:\n\t\t\t\t<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"f23fb27bcf169277719237a433653d\">melanocytic</span> nevi.</li>\n<li>Junctional nevi.</li>\n<li>Atypical nevi.</li>\n<li>Dysplastic nevi.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(P</strong>neumonic<strong>: ABCDE)</strong></p>\n<ul>\n<li>Asymmetry: <strong>Irregular shapes.</strong></li>\n<li>Border:<strong> Irregular. </strong></li>\n<li>Colour: <strong>Various colours present or uneven distribution.</strong></li>\n<li>Diameter: <strong>&gt; 6 mm</strong>.</li>\n<li>Evolution:<strong> Changes in <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> over time</strong> (size, shape, itching, or bleeding)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical examination.</li>\n<li>Dermoscopy.</li>\n<li>Biopsy.</li>\n<li>Immunohistochemistry: The markers are <strong>S-100, HMB-45</strong> (the most specific), <strong>Melan-A</strong> (MART-1), and <strong>MITF.</strong></li>\n<li>CT scan.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (with margins measured before <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and determined by Breslow depth, <span class=\"customMeta\" data-dictid=\"f08132bdfb16927771986a66c5d7b6\">sentinel</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> indicated for tumours with a depth of &gt;1.0 mm).</li>\n<li>If the tumour is aggressive:\n\t\t\t\t<ul>\n<li>Immunotherapy.</li>\n<li>Chemotherapy.</li>\n<li>Targeted therapy.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Interferon-𝛼</strong> is the only <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> treatment that has documented beneficial effects on overall survival.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common primary source of metastasis to the brain is:", "options": [{"label": "A", "text": "Thyroid", "correct": false}, {"label": "B", "text": "Lung", "correct": true}, {"label": "C", "text": "Liver", "correct": false}, {"label": "D", "text": "Breast", "correct": false}], "correct_answer": "B. Lung", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A factory worker working in a plastic pipe factory presented to the OPD with weight loss and right upper quadrant abdominal pain for 6 months duration. He had hepatomegaly. Further investigation revealed that most of the liver was replaced by a hemorrhagic tumour with extensive necrosis. What can be the likely diagnosis in this case?", "options": [{"label": "A", "text": "Cavernous hemangioma", "correct": false}, {"label": "B", "text": "Metastatic carcinoma of the liver", "correct": false}, {"label": "C", "text": "Angiosarcoma of the liver", "correct": true}, {"label": "D", "text": "Primary hepatocellular carcinoma", "correct": false}], "correct_answer": "C. Angiosarcoma of the liver", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hepatic Angiosarcoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is a <strong>high-grade <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> </strong>that arises from the endothelial cells lining blood vessels or <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> channels.</li>\n<li>It is the <strong>most common sarcoma</strong> arising in the liver, especially in those with significant exposure to <strong>Vinyl chloride.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Men and elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arsenic,</li>\n<li>Radiation,</li>\n<li>Thorium <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">dioxide</span> (Thorotrast)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It can spread through <strong>lymphatic and <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> routes</strong>, but due to the tumour's <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> nature, <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread (via blood vessels) is more common.</li>\n<li>The<strong> liver and lungs</strong> are common sites of metastasis, reflecting the tumour's aggressive nature</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It presents as a <strong>red-brown, indurated, and ulcerated skin lesion. </strong></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most commonly seen tumour in the retroperitoneal space?", "options": [{"label": "A", "text": "Liposarcoma", "correct": true}, {"label": "B", "text": "Rhabdomyosarcoma", "correct": false}, {"label": "C", "text": "Synovial sarcoma", "correct": false}, {"label": "D", "text": "Neurofibroma", "correct": false}], "correct_answer": "A. Liposarcoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely primary site of origin for metastatic liver adenocarcinoma with CK 7 (-), CK 20 (+), and CDX-1 (+) IHC markers?", "options": [{"label": "A", "text": "Colon carcinoma", "correct": true}, {"label": "B", "text": "Breast carcinoma", "correct": false}, {"label": "C", "text": "Pancreatic carcinoma", "correct": false}, {"label": "D", "text": "Ovarian carcinoma", "correct": false}], "correct_answer": "A. Colon carcinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CK7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CK20</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CDX1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colon cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Breast cancer (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic cancer (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ovarian cancer (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(+) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(-) ve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: A. Marjolin ulcer over the dorsum of foot measuring 3cm x 2cm 1. Excision biopsy B. 1.5 cm cervical lymph node in the neck 2. Core needle biopsy C. Soft tissue sarcoma over mid-thigh 3. USG guided FNAC D. Solitary thyroid nodule 4. Wedge biopsy", "options": [{"label": "A", "text": "A-1, B-2, C-3, D-4", "correct": false}, {"label": "B", "text": "A-4, B-1, C-2, D-3", "correct": true}, {"label": "C", "text": "A-3, B-2, C-1, D-4", "correct": false}, {"label": "D", "text": "A-4, B-3, C-2, D-1", "correct": false}], "correct_answer": "B. A-4, B-1, C-2, D-3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Marjolin <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> over the <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of foot measuring 3cm x 2cm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wedge <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> </strong>(removing a small wedge-shaped tissue sample from the nodule) is commonly performed on a <span class=\"customMeta\" data-dictid=\"770ac6263216927771911afa24094b\">Marjolin ulcer</span> (a <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation in a chronic non-healing wound).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1.5 cm <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> in the neck </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Excision <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> </strong>is commonly used to evaluate a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Soft tissue <span class=\"customMeta\" data-dictid=\"82068425041692777198fe3064c370\">sarcoma</span> over mid-thigh </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Core needle <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> </strong>involves obtaining a small cylindrical core of tissue from the <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> for <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> examination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Solitary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> nodule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>USG guided FNAC </strong>is used to evaluate a <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">nodule</span> by guiding a needle into the tumour to collect cells for cytological analysis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the meaning of neoadjuvant chemotherapy in the context of a 54-year-old woman diagnosed with stage 2A cervical cancer?", "options": [{"label": "A", "text": "Chemotherapy is given along with radiation.", "correct": false}, {"label": "B", "text": "Chemotherapy is given during surgery.", "correct": false}, {"label": "C", "text": "Chemotherapy is given before radical surgery to reduce the bulk of the tumour.", "correct": true}, {"label": "D", "text": "Chemotherapy is given after radical surgery for micrometastases.", "correct": false}], "correct_answer": "C. Chemotherapy is given before radical surgery to reduce the bulk of the tumour.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a known case of HTN came in with complaints of headaches for five days. All classical signs, increased metanephrine levels, and other investigations indicate pheochromocytoma. What is the best imaging modality for this patient?", "options": [{"label": "A", "text": "CECT Chest and Abdomen", "correct": false}, {"label": "B", "text": "Sestamibi scan", "correct": false}, {"label": "C", "text": "MIBG", "correct": true}, {"label": "D", "text": "USG", "correct": false}], "correct_answer": "C. MIBG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - MIBG\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents with redness and a Peau d'orange appearance involving more than 2/3 of her breast, without any palpable lump in the breast. On further evaluation, it is found that the skin involvement extends to the chest wall and is suggestive of inflammatory carcinoma . What is the appropriate TNM staging for this patient?", "options": [{"label": "A", "text": "T4a", "correct": false}, {"label": "B", "text": "T4b", "correct": false}, {"label": "C", "text": "T3", "correct": false}, {"label": "D", "text": "T4d", "correct": true}], "correct_answer": "D. T4d", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D - T4d</p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>T Category</strong></td>\n<td><strong>T Criteria</strong></td>\n</tr>\n<tr>\n<td>TX</td>\n<td>Primary tumor cannot be assessed</td>\n</tr>\n<tr>\n<td>T0</td>\n<td>No evidence of primary tumor</td>\n</tr>\n<tr>\n<td>Tis (DCIS)</td>\n<td>Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in situ</td>\n</tr>\n<tr>\n<td>Tis (Paget)</td>\n<td>Paget disease not associated with <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or DCIS</td>\n</tr>\n<tr>\n<td>T1a</td>\n<td>Tumor size ≤1 mm</td>\n</tr>\n<tr>\n<td>T1b</td>\n<td>Tumor size &gt;1 mm but ≤5 mm</td>\n</tr>\n<tr>\n<td>T1c</td>\n<td>Tumor size &gt;5 mm but ≤10 mm</td>\n</tr>\n<tr>\n<td>T1d</td>\n<td>Tumor size &gt;10 mm but ≤20 mm</td>\n</tr>\n<tr>\n<td>T2</td>\n<td>Tumor size &gt;20 mm but ≤50 mm</td>\n</tr>\n<tr>\n<td>T3</td>\n<td>Tumor size &gt;50mm</td>\n</tr>\n<tr>\n<td>T4a</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> invasion</td>\n</tr>\n<tr>\n<td>T4b</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"f446058fd81692777191e035c08229\">macroscopic</span> skin changes including <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> and/or satellite skin nodules and/or edema</td>\n</tr>\n<tr>\n<td>T4c</td>\n<td>Tumor with criteria of both T4a and T4b</td>\n</tr>\n<tr>\n<td>T4d</td>\n<td>Inflammatory carcinoma</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td><strong>T Category</strong></td>\n<td><strong>T Criteria</strong></td>\n</tr>\n<tr>\n<td>TX</td>\n<td>Primary tumor cannot be assessed</td>\n</tr>\n<tr>\n<td>T0</td>\n<td>No evidence of primary tumor</td>\n</tr>\n<tr>\n<td>Tis (DCIS)</td>\n<td>Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in situ</td>\n</tr>\n<tr>\n<td>Tis (Paget)</td>\n<td>Paget disease not associated with <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or DCIS</td>\n</tr>\n<tr>\n<td>T1a</td>\n<td>Tumor size ≤1 mm</td>\n</tr>\n<tr>\n<td>T1b</td>\n<td>Tumor size &gt;1 mm but ≤5 mm</td>\n</tr>\n<tr>\n<td>T1c</td>\n<td>Tumor size &gt;5 mm but ≤10 mm</td>\n</tr>\n<tr>\n<td>T1d</td>\n<td>Tumor size &gt;10 mm but ≤20 mm</td>\n</tr>\n<tr>\n<td>T2</td>\n<td>Tumor size &gt;20 mm but ≤50 mm</td>\n</tr>\n<tr>\n<td>T3</td>\n<td>Tumor size &gt;50mm</td>\n</tr>\n<tr>\n<td>T4a</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> invasion</td>\n</tr>\n<tr>\n<td>T4b</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"f446058fd81692777191e035c08229\">macroscopic</span> skin changes including <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> and/or satellite skin nodules and/or edema</td>\n</tr>\n<tr>\n<td>T4c</td>\n<td>Tumor with criteria of both T4a and T4b</td>\n</tr>\n<tr>\n<td>T4d</td>\n<td>Inflammatory carcinoma</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presents with a non-palpable lump in the breast. The biopsy and IHC results reveal Luminal A. What characteristics are included under Luminal A?", "options": [{"label": "A", "text": "ER positive, PR positive, Her2 neu positive", "correct": false}, {"label": "B", "text": "ER positive, PR positive, Her2 neu negative with low proliferation", "correct": true}, {"label": "C", "text": "ER positive, PR positive, Her2 neu negative with high proliferation", "correct": false}, {"label": "D", "text": "Triple-negative", "correct": false}], "correct_answer": "B. ER positive, PR positive, Her2 neu negative with low proliferation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ER Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>PR Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HER2 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ki-67 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminal A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally, it is low grade, has a better prognosis, and is responsive to hormonal therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminal B </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher grade, poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> compared to <span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\">Luminal</span> A, may require targeted HER2 therapy following status.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HER2-enriched</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aggressive, higher grade, poor prognosis, requires targeted HER2 therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Basal-like</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Includes triple-negative breast cancer (TNBC), highly aggressive, no targeted hormonal therapy.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Claudin-low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often associated with poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and aggressive behaviour, typically lacks response to hormonal therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a follow-up case of prostate cancer, what do we need to check?", "options": [{"label": "A", "text": "Alkaline phosphatase", "correct": false}, {"label": "B", "text": "PSA", "correct": true}, {"label": "C", "text": "Testosterone", "correct": false}, {"label": "D", "text": "Acid phosphatase", "correct": false}], "correct_answer": "B. PSA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance in <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> Cancer Follow-Up</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PSA (Prostate-Specific Antigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most important marker; rising levels indicate <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> or metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (ALP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marker for <strong>bone metastases</strong>, but not routinely used for follow-up</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acid <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (PAP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Older marker, now largely replaced by PSA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testosterone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Checked in hormone-sensitive cases on ADT to confirm <strong>castrate levels</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Spread of prostate cancer to lumbar vertebra is via?", "options": [{"label": "A", "text": "Arterial spread", "correct": false}, {"label": "B", "text": "Local spread", "correct": false}, {"label": "C", "text": "Lymphatic spread", "correct": false}, {"label": "D", "text": "Venous spread", "correct": true}], "correct_answer": "D. Venous spread", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism &amp; Common Sites</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct extension into the <strong>seminal vesicles, bladder, or rectum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obturator, internal &amp; external <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> nodes</strong> are commonly involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematogenous spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Via <strong>Batson’s <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> → <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> vertebrae, pelvis, femur, ribs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, usually occurs <strong>late</strong> in disease progression</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the T stage for this tumour in the oral cavity?", "options": [{"label": "A", "text": "T3", "correct": false}, {"label": "B", "text": "T4a", "correct": true}, {"label": "C", "text": "T2", "correct": false}, {"label": "D", "text": "T4b", "correct": false}], "correct_answer": "B. T4a", "question_images": ["https://image.prepladder.com/content/OEi4HNe2CzHH6OjWh2Fq1741855826.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Staging of Oral <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">Cavity</span> Cancer (AJCC 8th Edition):</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>T (Primary Tumor):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary tumor cannot be assessed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carcinoma in situ.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤2 cm, ≤5 mm depth of invasion (DOI).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor ≤2 cm, DOI &gt;5 mm and ≤10 mm; or tumor &gt;2 cm but ≤4 cm, and ≤10 mm DOI. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor &gt;4 cm; or any tumor &gt;10 mm DOI. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderately advanced local disease - Invades through <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> bone, deep/ <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, maxillary sinus, or skin of the face.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very advanced local disease - Invades masticator space, <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates, skull base, or encases internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>N (Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Nodes):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, ≤3 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>N2a: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> node, &gt;3 cm but ≤6 cm in greatest dimension.</li>\n<li>N2b: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> nodes, all ≤6 cm).</li>\n<li>N2c: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, all ≤6 cm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>N3a: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> &gt;6 cm in greatest dimension, ENE(-).</li>\n<li>N3b: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in any node(s) with clinically overt ENE(+).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>M (Distant Metastasis):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage <span class=\"customMeta\" data-dictid=\"d5b9840ce01692777188803b4c75b4\">Grouping</span> of oral cancer </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage 0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tis N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1 N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2 N0 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3 N0 M0 or T1-3 N1 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a N0-1 M0 or T1-4a N2 M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any T N3 M0 or T4b Any N M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage IVC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any T Any N M1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is preferred for lowering uric acid to prevent renal damage in tumor lysis syndrome ?", "options": [{"label": "A", "text": "Furosemide", "correct": false}, {"label": "B", "text": "Rasburicase", "correct": true}, {"label": "C", "text": "Corticosteroids", "correct": false}, {"label": "D", "text": "Febuxostat", "correct": false}], "correct_answer": "B. Rasburicase", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What category of malignancy do rodent ulcers belong to?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": true}, {"label": "C", "text": "Malignant Melanoma", "correct": false}, {"label": "D", "text": "Adenocarcinoma", "correct": false}], "correct_answer": "B. Basal cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cancers is the most common primary for brain metastasis ?", "options": [{"label": "A", "text": "Lung cancer", "correct": true}, {"label": "B", "text": "Head and neck cancer", "correct": false}, {"label": "C", "text": "Prostate cancer", "correct": false}, {"label": "D", "text": "Breast cancer", "correct": false}], "correct_answer": "A. Lung cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Lung\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is not seen in tumor lysis syndrome ?", "options": [{"label": "A", "text": "Hypophosphatemia", "correct": true}, {"label": "B", "text": "Hypocalcemia", "correct": false}, {"label": "C", "text": "Hyperuricemia", "correct": false}, {"label": "D", "text": "Hyperkalemia", "correct": false}], "correct_answer": "A. Hypophosphatemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hypophosph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cock's peculiar tumor is:", "options": [{"label": "A", "text": "Papilloma", "correct": false}, {"label": "B", "text": "Infected sebaceous cyst of scalp", "correct": true}, {"label": "C", "text": "Cylindroma", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": false}], "correct_answer": "B. Infected sebaceous cyst of scalp", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/F3PrEdZ2NRMcdWm9I2cN1714022567.png", "https://image.prepladder.com/content/2ypYCtp0OCw4wxo00R3T1714022589.png", "https://image.prepladder.com/content/YET1ObKySy8GphvVIw7Y1714022624.png", "https://image.prepladder.com/content/Scglx2KQRQxIZMSp9Wk31714022642.png"], "explanation": "<p>Correct Option B - Infected &lt;span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\"&gt;sebaceous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\"&gt;cyst&lt;/span&gt; of scalp: \n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cock’s peculiar tumor</strong></p>\n<ul>\n<li>Infected <span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\">sebaceous</span> <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> of scalp</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/2ypYCtp0OCw4wxo00R3T1714022589.png\" style=\"height:225px; width:200px\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pott’s puffy tumor</strong></p>\n<ul>\n<li>Osteomyelitis of skull bones</li>\n<li>MC skull bone involved – <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">Frontal</span> bone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/YET1ObKySy8GphvVIw7Y1714022624.png\" style=\"height:207px; width:200px\"/><img src=\"https://image.prepladder.com/content/Scglx2KQRQxIZMSp9Wk31714022642.png\" style=\"height:186px; width:200px\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Calculate: Anion gap Expected PaCO2 compensation", "options": [{"label": "A", "text": "AG=30, Expected PaCO2=25±2", "correct": true}, {"label": "B", "text": "AG=30, Expected PaCO2=30±2", "correct": false}, {"label": "C", "text": "AG=25, Expected PaCO2=25±2", "correct": false}, {"label": "D", "text": "AG=25, Expected PaCO2=30±2", "correct": false}], "correct_answer": "A. AG=30, Expected PaCO2=25±2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the acid base disorder with their respective etiology Condition Acid - base disorder 1. Ureterostomy a. High anion gap Metabolic acidosis 2. Opium poisoning b. Normal anion gap metabolic acidosis 3. Prolonged NG suction c. Respiratory acidosis 4. Salicylate poisoning d. Metabolic alkalosis", "options": [{"label": "A", "text": "1-b, 2-a, 3-c, 4-d", "correct": false}, {"label": "B", "text": "1-b , 2-c ,3-d, 4-a", "correct": true}, {"label": "C", "text": "1-c, 2-d, 3-a, 4-b", "correct": false}, {"label": "D", "text": "1-d, 2-b, 3-a, 4-c", "correct": false}], "correct_answer": "B. 1-b , 2-c ,3-d, 4-a", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:767px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Condition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acid - base disorder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reasoning </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Ureterostomy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Urine enters the bowel, where the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> reabsorbs <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> and exchanges it for bicarbonate. This leads to a net increase in <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> in body fluids, causing a decrease in the strong <span class=\"customMeta\" data-dictid=\"4b2f2a6d0a16927771902f60fa9ff7\">ion</span> difference. The loss of <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> also contributes to a normal <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> (NAGMA).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Opium poisoning</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Respiratory acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Opium <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> depresses the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> center, leading to <span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\">hypoventilation</span> and an increase in CO₂, causing <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Prolonged NG suction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Metabolic alkalosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">NG <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> removes stomach acid (HCl), causing a relative <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> of <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> and leading to <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> alkalosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Salicylate poisoning</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Salicylate <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> leads to accumulation of organic acids, causing a high <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old pregnant woman at 32 weeks gestation is brought to the emergency department with severe abdominal pain and vomiting for the past 24 hours. She appears distressed and is breathing rapidly. Her vitals show BP 110/70 mmHg, HR 112/min, and RR 28/min. Based on the Davenport diagram provided, which areas would best represent her likely acid-base status initially and after 12 hours of untreated progression?", "options": [{"label": "A", "text": "Initially: Area C, After 12 hours: Area E", "correct": true}, {"label": "B", "text": "Initially: Area D, After 12 hours: Area F", "correct": false}, {"label": "C", "text": "Initially: Area A, After 12 hours: Area B", "correct": false}, {"label": "D", "text": "Initially: Area F, After 12 hours: Area C", "correct": false}], "correct_answer": "A. Initially: Area C, After 12 hours: Area E", "question_images": ["https://image.prepladder.com/notes/s8w6oWYzh86Oos07MXha1744320108.png"], "explanation_images": ["https://image.prepladder.com/notes/s8w6oWYzh86Oos07MXha1744320108.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old alcoholic presents with severe abdominal pain. His ABG shows pH: 7.20 HCO3: 12 mEq/L Na+: 140 mEq/L Cl-: 98 mEq/L. Which of the following options correctly justifies the diagnosis?", "options": [{"label": "A", "text": "Delta ratio 0.4 - Pure NAGMA", "correct": false}, {"label": "B", "text": "Delta ratio 1.8 - Pure HAGMA", "correct": true}, {"label": "C", "text": "Delta ratio 0.6 - Mixed HAGMA and NAGMA", "correct": false}, {"label": "D", "text": "Delta ratio 2.2 - HAGMA with metabolic alkalosis", "correct": false}], "correct_answer": "B. Delta ratio 1.8 - Pure HAGMA", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old diabetic patient presents to emergency with nausea and vomiting for 2 days. His ABG shows: pH: 7.28 pCO2: 35 mmHg HCO3: 12 mEq/L Na+: 138 mEq/L Cl-: 102 mEq/L What is the acid-base disorder?", "options": [{"label": "A", "text": "Simple metabolic acidosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis with respiratory alkalosis", "correct": false}, {"label": "C", "text": "Metabolic acidosis with respiratory acidosis", "correct": false}, {"label": "D", "text": "Mixed metabolic and respiratory acidosis", "correct": true}], "correct_answer": "D. Mixed metabolic and respiratory acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old woman with a history of chronic kidney disease and recent severe pneumonia is admitted to the intensive care unit. She has been experiencing increased shortness of breath, confusion, and fatigue. Laboratory tests reveal the following: Arterial blood gas: pH 7.28, HCO₃⁻ 18 mmol/L, PaCO₂ 50 mmHg Serum electrolytes: Na⁺ 140 mmol/L, K⁺ 4.2 mmol/L, Cl⁻ 100 mmol/L Based on the laboratory results and clinical presentation, what type of acid-base disorder is this patient experiencing?", "options": [{"label": "A", "text": "Metabolic acidosis—respiratory alkalosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis—respiratory acidosis", "correct": true}, {"label": "C", "text": "Metabolic alkalosis—respiratory acidosis", "correct": false}, {"label": "D", "text": "Metabolic acidosis—metabolic alkalosis", "correct": false}], "correct_answer": "B. Metabolic acidosis—respiratory acidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Mixed Acid-Base Disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Mixed <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> and Respiratory</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Metabolic acidosis—respiratory alkalosis<strong> </strong></p>\n<p style=\"text-align: center;\"><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Lactic acidosis, <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> in ICU</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Metabolic acidosis—respiratory acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Severe pneumonia, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Metabolic alkalosis—respiratory alkalosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Liver disease and diuretics</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Metabolic alkalosis—respiratory acidosis</p>\n<p style=\"text-align: center;\"><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">COPD on diuretics</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Mixed <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> Disorders</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Metabolic acidosis—metabolic alkalosis</p>\n<p style=\"text-align: center;\"><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Uremia with vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Metabolic acidosis—metabolic acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Diarrhea and <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis, <span class=\"customMeta\" data-dictid=\"6904566e541692777200fb8d790a3f\">toluene</span> toxicity, treatment of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> ketoacidosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old man with a history of chronic kidney disease and COPD presents to the emergency department with confusion, shortness of breath, and fatigue. He has been experiencing increased nausea and vomiting over the past week. Laboratory tests reveal: Arterial blood gas: pH 7.29, HCO₃⁻ 18 mmol/L, PaCO₂ 60 mmHg Serum electrolytes: Na⁺ 138 mmol/L, K⁺ 4.8 mmol/L, Cl⁻ 102 mmol/L Based on the provided laboratory results, what type of acid-base disorder is this patient experiencing?", "options": [{"label": "A", "text": "Respiratory acidosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": false}, {"label": "C", "text": "Mixed respiratory and metabolic acidosis", "correct": true}, {"label": "D", "text": "Fully compensated metabolic acidosis", "correct": false}], "correct_answer": "C. Mixed respiratory and metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with light-headedness and confusion along with tingling sensation of his limbs. He has also been experiencing persistent vomiting for the past three days. Arterial blood gas shows the following findings pH - 7.48 HCO3- - 38 mEq/L PaCO2 - 40 mm hg Based on the provided laboratory results, how would you classify the patient's metabolic disorder?", "options": [{"label": "A", "text": "Fully compensated metabolic alkalosis", "correct": false}, {"label": "B", "text": "Partially compensated metabolic alkalosis", "correct": true}, {"label": "C", "text": "Uncompensated metabolic alkalosis", "correct": false}, {"label": "D", "text": "Normal acid-base balance", "correct": false}], "correct_answer": "B. Partially compensated metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman with a history of hypertension presents to the emergency department with confusion and muscle cramps. She reports having persistent vomiting for the last two days after taking an over-the-counter medication for indigestion. On examination, she has a blood pressure of 130/85 mmHg and shows signs of mild dehydration. Laboratory results reveal: Arterial blood gas: pH 7.48, HCO₃⁻ 30 mmol/L, PaCO₂ 45 mmHg Serum electrolytes: Na⁺ 140 mmol/L, K⁺ 3.0 mmol/L, Cl⁻ 88 mmol/L What is the most likely diagnosis for this patient based on the laboratory findings?", "options": [{"label": "A", "text": "Respiratory acidosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": false}, {"label": "C", "text": "Metabolic alkalosis", "correct": true}, {"label": "D", "text": "Respiratory alkalosis", "correct": false}], "correct_answer": "C. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man with a history of chronic kidney disease presents to the emergency department with fatigue and shortness of breath. He has been experiencing nausea and vomiting for the past two days. Laboratory tests reveal: Arterial blood gas: pH 7.30, HCO₃⁻ 12 mmol/L, PaCO₂ 30 mmHg Serum electrolytes: Na⁺ 140 mmol/L, Cl⁻ 104 mmol/L, K⁺ 5.0 mmol/L Based on the provided laboratory results, how would you classify the patient’s metabolic disorder?", "options": [{"label": "A", "text": "Fully compensated metabolic acidosis", "correct": false}, {"label": "B", "text": "Partially compensated metabolic acidosis", "correct": true}, {"label": "C", "text": "Uncompensated metabolic acidosis", "correct": false}, {"label": "D", "text": "Normal acid-base balance", "correct": false}], "correct_answer": "B. Partially compensated metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents to the emergency department with diarrhea for the past three days. She reports fatigue and mild abdominal cramping. Laboratory tests show the following: Arterial blood gas pH 7.30 HCO₃⁻ 15 mmol/L PaCO₂ 38 mmHg Serum electrolytes Na⁺ 140 mmol/L Cl⁻ 115 mmol/L K⁺ 4.5 mmol/L What is the type of metabolic acidosis?", "options": [{"label": "A", "text": "Normal Anion Gap Metabolic Acidosis", "correct": true}, {"label": "B", "text": "High Anion Gap Metabolic Acidosis", "correct": false}, {"label": "C", "text": "Respiratory Acidosis", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Normal Anion Gap Metabolic Acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old female with known COPD presents with increased muscle weakness and difficulty in breathing. On examination she appears confused and her arterial blood gas (ABG) results are as follows: pH : 7.29 PaCO₂ : 65 mm Hg HCO₃⁻ : 26 mEq/L PaO₂ : 65 mm Hg. Which of the following best describes the underlying mechanism for this patient's presentation?", "options": [{"label": "A", "text": "Increased metabolic rate leading to excess CO₂ production", "correct": false}, {"label": "B", "text": "Impaired ventilatory control due to central respiratory depression", "correct": false}, {"label": "C", "text": "Impaired responsiveness of the respiratory reflexes to states of hypoxia and hypercapnia", "correct": true}, {"label": "D", "text": "Decreased oxygen-carrying capacity of the blood", "correct": false}], "correct_answer": "C. Impaired responsiveness of the respiratory reflexes to states of hypoxia and hypercapnia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:757px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Respiratory Acidosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Respiratory <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> results from impaired <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> muscle fatigue, or abnormalities in <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> control</p>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Central <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression:</strong> Drugs (sedatives, anesthetics), alcohol, trauma, or <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> tumors.<strong>(Type 2 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure)</strong></li>\n</ul>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Respiratory muscle fatigue:</strong> <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">Motor neuron</span> diseases, <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> disorders, skeletal muscle disease.<strong>(Type 2 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure)</strong></li>\n</ul>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> issues:</strong> Improper settings, increased CO₂ production, high <span class=\"customMeta\" data-dictid=\"f934e237e81692777196cb5efd18f0\">positive end-expiratory pressure</span> (PEEP) in low <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output <strong>(Type 3 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure)</strong></li>\n</ul>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Obstructive lung disease:</strong> End-stage conditions, <span class=\"customMeta\" data-dictid=\"cc2003e35d1692777184a26dae1a68\">chronic obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease</span> (COPD). <strong>(Type 1 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure)</strong></li>\n</ul>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Restrictive lung disorders:</strong> Both <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> and lung issues <strong>(Type 1 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>Acute </strong>Respiratory Acidosis<strong>:</strong> <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">Compensatory</span> rise in HCO₃⁻ by 1 mmol/L for every 10-mmHg increase in PaCO₂ due to <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> buffering.</li>\n</ul>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Chronic </strong>Respiratory <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> (<strong>&gt;24 hrs</strong>)<strong>: </strong>Renal <span class=\"customMeta\" data-dictid=\"c623a72bdd16927771808d60122016\">adaptation</span> elevates HCO₃⁻ by 4 mmol/L per 10-mmHg PaCO₂ increase; HCO₃⁻ rarely exceeds 38 mmol/L.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>Acute </strong>hypercapnia<strong>:</strong> Anxiety, dyspnea, confusion, hallucinations, possible <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to coma.</li>\n</ul>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Chronic </strong>hypercapnia<strong>:</strong> Sleep disturbances, memory loss, daytime sleepiness, personality changes, motor disturbances (tremor, myoclonus, asterixis), headache, papilledema, and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> muscle weakness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>Main goal: </strong>Improve lung function.</li>\n</ul>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Acute</strong>: <span class=\"customMeta\" data-dictid=\"93fc46142c169277718989349069a3\">Immediate cause</span> <span class=\"customMeta\" data-dictid=\"82343f61171692777197b4a08bc719\">reversal</span> with measures like <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> and assisted ventilation; careful oxygen <span class=\"customMeta\" data-dictid=\"38938f6b8f16927772000e7292bb2e\">titration</span> for patients with chronic CO₂ retention.</li>\n</ul>\n<p style=\"text-align: center;\"> </p>\n<ul>\n<li style=\"text-align: center;\"><strong>Chronic</strong>: Avoid rapid CO₂ reduction (as it can cause<strong> </strong><strong>CO₂</strong><strong> <span class=\"customMeta\" data-dictid=\"67d67b341916927772029cd0d951df\">washout</span> a</strong>nd loss of <strong>respiratory </strong><strong>drive</strong>); gradual reduction to <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> PaCO₂; provide Cl⁻ and K⁺ to aid <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> HCO₃⁻ excretion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man presents to the emergency department with severe abdominal pain, vomiting, frequent urination, confusion, and labored, deep breathing and he is difficult to arouse. Lab investigations reveal the following findings Na+ - 135 mEq/L K+ - 5.2 mEq/L Cl - 100 mEq/L HCO3 - 15 mEq/L Serum pH - 7.15 What is the least likely cause of these findings?", "options": [{"label": "A", "text": "Methanol poisoning", "correct": false}, {"label": "B", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "C", "text": "Renal tubular acidosis", "correct": true}, {"label": "D", "text": "Renal failure", "correct": false}], "correct_answer": "C. Renal tubular acidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:788px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Definition</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align:center\">Primary decrease in HCO3⁻ or increase in H⁺ ions</li>\n<li style=\"text-align:center\">Characterized by ↓ pH and ↓ HCO3⁻</li>\n<li style=\"text-align:center\">Compensatory mechanism: ↓ PaCO2 through <span class=\"customMeta\" data-dictid=\"e07ff4a5ce1692777189b9e95326f3\">hyperventilation</span> (Kussmaul breathing)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (AG &gt; 12 mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (AG 6-12 mEq/L)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>Causes </strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>(Mnemonic: MUDPILES)</strong></h3>\n<ul>\n<li style=\"text-align:center\"><strong>M</strong>: Methanol<strong> (Option A)</strong></li>\n<li style=\"text-align:center\"><strong>U</strong>: Uremia (Renal failure)<strong> (Option D)</strong></li>\n<li style=\"text-align:center\"><strong>D</strong>: Diabetic <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> (DKA)<strong> (Option B)</strong></li>\n<li style=\"text-align:center\"><strong>P</strong>: Paraldehyde, Phenformin, Propylene glycol</li>\n<li style=\"text-align:center\"><strong>I</strong>: Iron tablets, Isoniazid</li>\n<li style=\"text-align:center\"><strong>L</strong>: Lactic acidosis</li>\n<li style=\"text-align:center\"><strong>E</strong>: <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">Ethylene</span> glycol</li>\n<li style=\"text-align:center\"><strong>S</strong>: Salicylates (late phase)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>(Mnemonic: HARD UP)</strong></h3>\n<ul>\n<li><strong>H</strong>: Hyperalimentation (TPN)</li>\n<li><strong>A</strong>: Acetazolamide</li>\n<li><strong>R</strong>: Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> <strong> </strong><strong>(Option C)</strong></li>\n<li><strong>D</strong>: Diarrhea</li>\n<li><strong>U</strong>: Ureteral diversion</li>\n<li><strong>P</strong>: Pancreatic fistula</li>\n<li>GIT fistulas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h2 style=\"text-align:center\"><strong>Clinical Features</strong></h2>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">General Features:</p>\n<ul>\n<li style=\"text-align:center\">Lethargy</li>\n<li style=\"text-align:center\">Confusion</li>\n<li style=\"text-align:center\">Fatigue</li>\n<li style=\"text-align:center\">Nausea/vomiting</li>\n<li style=\"text-align:center\">Deep, rapid breathing (Kussmaul)</li>\n</ul>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\">Specific Features:</p>\n<ul>\n<li style=\"text-align:center\">DKA: Fruity breath, polyuria, polydipsia</li>\n<li style=\"text-align:center\">Uremia: Itching, volume overload</li>\n<li style=\"text-align:center\">Lactic acidosis: Shock, hypotension</li>\n<li style=\"text-align:center\">Toxic ingestion: Visual disturbances (methanol), <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> crystals (ethylene glycol)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An intern reviews the following electrolyte levels for a patient: Sodium (Na⁺): 140 mEq/L Chloride (Cl⁻): 100 mEq/L Bicarbonate (HCO₃⁻): 24 mEq/L Potassium (K⁺): 4.0 mEq/L What is the calculated anion gap for this patient?", "options": [{"label": "A", "text": "12 mEq/L", "correct": false}, {"label": "B", "text": "16 mEq/L", "correct": true}, {"label": "C", "text": "20 mEq/L", "correct": false}, {"label": "D", "text": "24 mEq/L", "correct": false}], "correct_answer": "B. 16 mEq/L", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Maintenance of <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">Anion</span> Gap</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Major unmeasured anions:</p>\n<ul>\n<li style=\"text-align: center;\">Proteins (mainly <strong>albumin</strong>)</li>\n<li style=\"text-align: center;\">Phosphate</li>\n<li style=\"text-align: center;\">Sulfate</li>\n<li style=\"text-align: center;\">Organic acids</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Major unmeasured cations:</p>\n<ul>\n<li style=\"text-align: center;\">Calcium</li>\n<li style=\"text-align: center;\">Magnesium</li>\n<li style=\"text-align: center;\">Potassium</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old anxious female presents with hyperventilation during a panic attack. ABG shows: pH: 7.48 PaCO2: 20 mmHg HCO3-: 22 mEq/L Which acid-base disorder is present?", "options": [{"label": "A", "text": "Uncompensated respiratory alkalosis", "correct": false}, {"label": "B", "text": "Partially compensated respiratory alkalosis", "correct": true}, {"label": "C", "text": "Fully compensated respiratory alkalosis", "correct": false}, {"label": "D", "text": "Mixed respiratory and metabolic alkalosis", "correct": false}], "correct_answer": "B. Partially compensated respiratory alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with severe COPD presents with worsening breathlessness. His ABG shows: pH : 7.28, PaCO2 : 65 mmHg, HCO3 -: 30 mEq/L Which stage of respiratory acidosis does this represent?", "options": [{"label": "A", "text": "Uncompensated respiratory acidosis", "correct": false}, {"label": "B", "text": "Partially compensated respiratory acidosis", "correct": true}, {"label": "C", "text": "Fully compensated respiratory acidosis", "correct": false}, {"label": "D", "text": "Mixed respiratory and metabolic acidosis", "correct": false}], "correct_answer": "B. Partially compensated respiratory acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding the test shown in the image, which is done prior to arterial blood sampling is not true?", "options": [{"label": "A", "text": "Preferred site for arterial sampling is the radial artery between the flexor carpi radialis tendon and the styloid process", "correct": false}, {"label": "B", "text": "Both ulnar and radial arteries should be released simultaneously after occlusion", "correct": true}, {"label": "C", "text": "The presence of collaterals is confirmed if the hand becomes flushed after releasing one artery", "correct": false}, {"label": "D", "text": "Pressure should be applied to the site for 5 minutes after blood sampling to prevent hematoma", "correct": false}], "correct_answer": "B. Both ulnar and radial arteries should be released simultaneously after occlusion", "question_images": ["https://image.prepladder.com/notes/VJXSVghA9JprCO52PPrH1744319541.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:739px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Allen Test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">Radial</span> artery: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> forearm</p>\n<p>• <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">Ulnar</span> artery: <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> forearm</p>\n<p>• Deep arch: Mainly from <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> artery</p>\n<p>• <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">Superficial</span> arch: Mainly from <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preferred Site for arterial sampling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> between <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> carpi <span class=\"customMeta\" data-dictid=\"282d33f842169277719716e285a377\">radialis</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> and <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Before <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> cannulation</p>\n<p>• Prior to arterial line placement</p>\n<p>• Before <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> catheterization</p>\n<p>• Pre-radial <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> harvest</p>\n<p>• Before <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gas sampling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Modified &lt;span class=\" custommeta\"=\"\" data-dictid=\"ad883bfd3f1692777181ca1dd644b8\"/>Allen Test 1\" data-author=\"NA\" data-hash=\"8959\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"293\" src=\"https://image.prepladder.com/notes/KhDfZYfvfDJ9LUOvcdhk1744319650.png\" width=\"293\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<figure class=\"caption_element\"><img alt=\"Modified &lt;span class=\" custommeta\"=\"\" data-dictid=\"ad883bfd3f1692777181ca1dd644b8\"/>Allen Test steps\" data-author=\"NA\" data-hash=\"8960\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" src=\"https://image.prepladder.com/notes/Lrej1yO5mqNw6aUnGuk41744319738.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>Sequential release allows assessment of individual <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> flow</li>\n<li>Cannot evaluate <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> if both are released together <strong>(Option B)</strong></li>\n<li>Examines one hand at a time</li>\n<li>Avoid elbow overextension</li>\n<li>Palm should initially blanch</li>\n<li>Normal color should return quickly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive Test: <strong>(Option C)</strong></p>\n<p>• Color returns within 10 seconds → Adequate <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> flow</p>\n\t\t\t \n\n\t\t\t<p>Negative Test:</p>\n<p>• Persistent <span class=\"customMeta\" data-dictid=\"dd5d862f051692777194647422e1c9\">pallor</span> after release → inadequate <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> flow →May need additional testing</p>\n<p>• Consider temperature effects</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precaution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pressure applied on blood <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> site for 5 minutes after <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> is done <strong>(Option D)</strong><strong> </strong>to prevent hematoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents to the emergency department with anxiety, dizziness, and circumoral numbness. She also reports chest tightness and difficulty taking a deep breath. Physical examination reveals tachypnea and carpopedal spasms. Arterial blood gas shows pH: 7.48, PaCO2: 28 mmHg, HCO3: 22 mEq/L, PaO2: 98 mmHg. Which of the following sets of additional findings would be most consistent with this acid-base disorder?", "options": [{"label": "A", "text": "Hypoxemia, cyanosis, and metabolic acidosis", "correct": false}, {"label": "B", "text": "Paresthesias, reduced cerebral blood flow and decreased ionized calcium", "correct": true}, {"label": "C", "text": "Hypertension, pulmonary edema, and increased ionized calcium", "correct": false}, {"label": "D", "text": "Somnolence, asterixis, and increased cerebral blood flow", "correct": false}], "correct_answer": "B. Paresthesias, reduced cerebral blood flow and decreased ionized calcium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• Dizziness</p>\n<p style=\"text-align: center;\">• Mental confusion</p>\n<p style=\"text-align: center;\">• Paresthesias</p>\n<p style=\"text-align: center;\">• <span class=\"customMeta\" data-dictid=\"a042d4d7881692777184ae941a44b9\">Circumoral</span> numbness</p>\n<p style=\"text-align: center;\">• Seizures (severe cases)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• Due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> cerebral blood flow</p>\n<p style=\"text-align: center;\">• From rapid ↓ PaCO2</p>\n<p style=\"text-align: center;\">• May occur without hypoxemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiovascular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• Chest tightness/pain</p>\n<p style=\"text-align: center;\">• Palpitations</p>\n<p style=\"text-align: center;\">• Arrhythmias</p>\n<p style=\"text-align: center;\">• Possible <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• Due to <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> vasoconstriction</p>\n<p style=\"text-align: center;\">• ↓ ionized <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> effects</p>\n<p style=\"text-align: center;\">• <span class=\"customMeta\" data-dictid=\"26c59156491692777183e66150a323\">Bohr effect</span> on O2 delivery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neuromuscular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• <span class=\"customMeta\" data-dictid=\"ae4dc0619116927771831407152055\">Carpopedal</span> spasms</p>\n<p style=\"text-align: center;\">• Tetany</p>\n<p style=\"text-align: center;\">• Muscle twitching</p>\n<p style=\"text-align: center;\">• Weakness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• From ↓ ionized calcium</p>\n<p style=\"text-align: center;\">• Enhanced nerve excitability</p>\n<p style=\"text-align: center;\">• Similar to hypocalcemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Laboratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• ↑ pH</p>\n<p style=\"text-align: center;\">• ↓ PaCO2</p>\n<p style=\"text-align: center;\">• ↓ Ionized calcium</p>\n<p style=\"text-align: center;\">• ↓ K+, ↓ PO4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• Acute: ↓ HCO3- by 2 mEq/L per 10 mmHg ↓ PaCO2</p>\n<p style=\"text-align: center;\">• Chronic: ↓ HCO3- by 4-5 mEq/L per 10 mmHg ↓ PaCO2</p>\n<p style=\"text-align: center;\">• <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">Electrolyte</span> shifts into cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Underlying Disease:</strong></p>\n<p style=\"text-align: center;\">• Treat primary condition</p>\n<p style=\"text-align: center;\">• Address anxiety if present</p>\n<p style=\"text-align: center;\">• Manage <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> if present</p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><strong>Hyperventilation Syndrome:</strong></p>\n<p style=\"text-align: center;\">• Reassurance</p>\n<p style=\"text-align: center;\">• Rebreathing techniques</p>\n<p style=\"text-align: center;\">• Paper bag breathing if needed</p>\n<p style=\"text-align: center;\">• β-blockers if needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">• Primary focus on the underlying cause</p>\n<p style=\"text-align: center;\">• Avoid sedatives for anxiety</p>\n<p style=\"text-align: center;\">• Monitor during mechanical ventilation</p>\n<p style=\"text-align: center;\">• Adjust <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> settings if needed</p>\n<p style=\"text-align: center;\">• Regular monitoring of blood gases</p>\n<p style=\"text-align: center;\">• Address psychological factors</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old pregnant woman at 28 weeks gestation presents with light-headedness and tingling in her fingers. Her vitals show RR 24/min, and arterial blood gas reveals: pH: 7.46, PaCO2: 32 mmHg, HCO3: 23 mEq/L. Which of the following best explains the pathogenesis of her acid-base disturbance?", "options": [{"label": "A", "text": "Direct CNS depression causing decreased respiratory drive", "correct": false}, {"label": "B", "text": "Progesterone-mediated increase in ventilatory response", "correct": true}, {"label": "C", "text": "Compensatory hyperventilation from metabolic acidosis", "correct": false}, {"label": "D", "text": "Compensatory hyperventilation from metabolic acidosis", "correct": false}], "correct_answer": "B. Progesterone-mediated increase in ventilatory response", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:683px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathogenic Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CNS Stimulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Pain</p>\n<p style=\"text-align:center\">• Anxiety/panic</p>\n<p style=\"text-align:center\">• Fever</p>\n<p style=\"text-align:center\">• Stroke</p>\n<p style=\"text-align:center\">• Meningitis</p>\n<p style=\"text-align:center\">• Brain tumor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Direct <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> center</p>\n<p style=\"text-align:center\">• Increased <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> drive</p>\n<p style=\"text-align:center\">• Often <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> presentation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hypoxemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• High altitude</p>\n<p style=\"text-align:center\">• Pneumonia</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> edema</p>\n<p style=\"text-align:center\">• Severe anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> chemoreceptors</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">Compensatory</span> hyperventilation</p>\n<p style=\"text-align:center\">• Attempt to increase O2 delivery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hormonal/Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Pregnancy</p>\n<p style=\"text-align:center\">• Progesterone</p>\n<p style=\"text-align:center\">• Salicylates</p>\n<p style=\"text-align:center\">• Methylxanthines</p>\n<p style=\"text-align:center\">• Catecholamines</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Increased sensitivity to CO2</p>\n<p style=\"text-align:center\">• Direct <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> stimulation</p>\n<p style=\"text-align:center\">• Enhanced <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> response</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Systemic Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Sepsis</p>\n<p style=\"text-align:center\">• Liver failure</p>\n<p style=\"text-align:center\">• Heart failure</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> embolism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Multiple mechanisms</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> mediators</p>\n<p style=\"text-align:center\">• Altered <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demands</p>\n<p style=\"text-align:center\">• Early marker of disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mechanical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Mechanical ventilation</p>\n<p style=\"text-align:center\">• Iatrogenic</p>\n<p style=\"text-align:center\">• Exercise</p>\n<p style=\"text-align:center\">• Heat exposure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• External factors affecting ventilation</p>\n<p style=\"text-align:center\">• Inappropriate <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> settings</p>\n<p style=\"text-align:center\">• Increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demands</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with severe COPD presents with worsening confusion and somnolence. Arterial blood gas shows: pH: 7.25 PaCO2: 70 mmHg HCO3: 32 mEq/L PaO2: 55 mmHg. Which of the following represents the most appropriate initial management approach?", "options": [{"label": "A", "text": "Rapidly normalize PaCO2 with mechanical ventilation", "correct": false}, {"label": "B", "text": "Provide controlled oxygen therapy and treat underlying COPD exacerbation", "correct": true}, {"label": "C", "text": "Give sodium bicarbonate to correct acidemia", "correct": false}, {"label": "D", "text": "Observe and monitor without intervention", "correct": false}], "correct_answer": "B. Provide controlled oxygen therapy and treat underlying COPD exacerbation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:728px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chronic Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Special Considerations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Respiratory Support</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Controlled O2 therapy</p>\n<p style=\"text-align:center\">• Consider NIV/CPAP</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">Intubation</span> if needed</p>\n<p style=\"text-align:center\">• Monitor O2 saturation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Long-term O2 therapy</p>\n<p style=\"text-align:center\">• Home <span class=\"customMeta\" data-dictid=\"0e4135f3bc1692777193047657d8c5\">NIV</span> if indicated</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> rehabilitation</p>\n<p style=\"text-align:center\">• Sleep study if needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Avoid high O2 in COPD</p>\n<p style=\"text-align:center\">• Target SpO2 88-92%</p>\n<p style=\"text-align:center\">• Low <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume(5-6 ml/kg)</p>\n<p style=\"text-align:center\">• Monitor for CO2 retention</p>\n<p style=\"text-align:center\">• Consider sleep disorders</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Medical Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Bronchodilators</p>\n<p style=\"text-align:center\">• Corticosteroids if indicated</p>\n<p style=\"text-align:center\">• Treat infection if present</p>\n<p style=\"text-align:center\">• Avoid sedation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Optimize <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> medications</p>\n<p style=\"text-align:center\">• Manage comorbidities</p>\n<p style=\"text-align:center\">• Vaccinations</p>\n<p style=\"text-align:center\">• Smoking cessation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Drug interactions</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"79506a117416927771988bbe7a8302\">Side effect</span> monitoring</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">Adherence</span> assessment</p>\n<p style=\"text-align:center\">• Prevention strategies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Frequent ABGs</p>\n<p style=\"text-align:center\">• Continuous vitals</p>\n<p style=\"text-align:center\">• Mental status</p>\n<p style=\"text-align:center\">• Work of breathing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Regular PFTs</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">Periodic</span> ABGs</p>\n<p style=\"text-align:center\">• Symptom diary</p>\n<p style=\"text-align:center\">• Quality of life measures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Avoid rapid correction</p>\n<p style=\"text-align:center\">• Watch for complications</p>\n<p style=\"text-align:center\">• Monitor <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> status</p>\n<p style=\"text-align:center\">• Follow electrolytes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man with severe COPD presents with progressive confusion, daytime sleepiness, and morning headaches over the past month. On examination, he has a coarse tremor and asterixis. Arterial blood gas shows pH 7.32, PaCO2 68 mmHg, HCO3- 34 mEq/L. Which combination of additional findings would be most consistent with this patient's acid-base disorder?", "options": [{"label": "A", "text": "Acute anxiety, hallucinations, and respiratory distress", "correct": false}, {"label": "B", "text": "Sleep disorders, personality changes, and polycythemia", "correct": true}, {"label": "C", "text": "Acute dyspnea, psychosis, and normal bicarbonate", "correct": false}, {"label": "D", "text": "Muscle weakness, confusion, and metabolic acidosis", "correct": false}], "correct_answer": "B. Sleep disorders, personality changes, and polycythemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:756px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chronic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Acidosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Anxiety (due to <span class=\"customMeta\" data-dictid=\"1f0bd058f91692777189f9a7c1992e\">hypercapnia</span> stimulating <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> center)</p>\n<p style=\"text-align:center\">• Confusion (from rapid rise in CO2 affecting brain function)</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"1cb2d1482916927771964c2890313e\">Psychosis</span> (due to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> cerebral effects of hypercapnia)</p>\n<p style=\"text-align:center\">• Hallucinations (from <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> CO2 narcosis)</p>\n<p style=\"text-align:center\">• May progress to <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">coma</span> (severe CO2 <span class=\"customMeta\" data-dictid=\"9cecc0269c1692777193b12fa5a9c4\">narcosis</span> affecting consciousness)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Daytime <span class=\"customMeta\" data-dictid=\"beeeac6882169277719829db4504e9\">somnolence</span> (chronic CO2 retention)</p>\n<p style=\"text-align:center\">• Memory loss (chronic cerebral <span class=\"customMeta\" data-dictid=\"c623a72bdd16927771808d60122016\">adaptation</span> to elevated CO2)</p>\n<p style=\"text-align:center\">• Personality changes (long-term effects of CO2 on brain)</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"8fc96e0f801692777182e62c6fa8dc\">Asterixis</span> (metabolic <span class=\"customMeta\" data-dictid=\"539bcbde1816927771869c822915a9\">derangement</span> from chronic CO2 retention)</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"bb6d2476421692777200c2af1ac0c8\">Tremor</span> (neuromuscular effects of chronic hypercapnia)</p>\n<p style=\"text-align:center\">• Myoclonic jerks (neuromuscular <span class=\"customMeta\" data-dictid=\"982688ae75169277719041afa70c42\">irritability</span> from chronic CO2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> (compensatory response to high CO2)</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> (immediate response to acidemia)</p>\n<p style=\"text-align:center\">• Use of <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> muscles (attempt to increase ventilation)</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"9bde62b1091692777183cd433d9d47\">Bronchospasm</span> (airway response to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> acidosis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Chronic <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> (adaptation to chronic CO2 retention)</p>\n<p style=\"text-align:center\">• Sleep disorders (central effects of chronic hypercapnia)</p>\n<p style=\"text-align:center\">• Morning headaches (nocturnal CO2 retention)</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"4534214488169277718575e08a9bc0\">Cor</span> pulmonale signs (right heart strain from chronic hypoxia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laboratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• ↓ pH</p>\n<p style=\"text-align:center\">• ↑ PaCO2</p>\n<p style=\"text-align:center\">• HCO3- ↑ by 1 mEq/L per 10 mmHg ↑ PaCO2</p>\n<p style=\"text-align:center\">• Often with hypoxemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• ↓ pH (less severe)</p>\n<p style=\"text-align:center\">• ↑ PaCO2</p>\n<p style=\"text-align:center\">• HCO3- ↑ by 4 mEq/L per 10 mmHg ↑ PaCO2</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"7fd466a9c016927771962d5b061b0f\">Polycythemia</span> may develop</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• Severe asthma/bronchospasm</p>\n<p style=\"text-align:center\">• Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> depression (drugs/trauma)</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">Neuromuscular</span> weakness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">• COPD</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">Obesity</span> hypoventilation</p>\n<p style=\"text-align:center\">• <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">Neuromuscular</span> disorders</p>\n<p style=\"text-align:center\">• Kyphoscoliosis</p>\n<p style=\"text-align:center\">• Central hypoventilation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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Which statement is true regarding his condition?", "options": [{"label": "A", "text": "Diagnosis requires symptoms for at least 2 consecutive months.", "correct": false}, {"label": "B", "text": "Smoking cessation is the only intervention that positively impacts COPD", "correct": true}, {"label": "C", "text": "Inhaled bronchodilators are the primary treatment for chronic bronchitis.", "correct": false}, {"label": "D", "text": "Hemoptysis is the initial symptom indicative of chronic bronchitis.", "correct": false}], "correct_answer": "B. Smoking cessation is the only intervention that positively impacts COPD", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:559px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Bronchitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cough and <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> production lasting for at <strong>least 3 months in each of 2 consecutive years. (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One of the phenotypes associated with COPD, alongside emphysema. Large <span class=\"customMeta\" data-dictid=\"4a371bd76e16927771835d6c738d1d\">bronchi</span> overtime become inflamed and scarred.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cigarette smoking (95% of COPD</strong> cases in the UK attributed to tobacco smoke).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial symptoms include cough, <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> production, and <strong>\"smoker's cough\";</strong> <span class=\"customMeta\" data-dictid=\"444cf910041692777188685b347d0f\">hemoptysis</span> may occur during exacerbations. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Consider chronic asthma, tuberculosis, bronchiectasis, congestive heart failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chest X-ray, blood count, and alpha-1 antitrypsin <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">assay</span> to rule out other conditions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduce exposure to harmful particles and manage symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking cessation (only intervention that positively impacts COPD) <strong>(Option B)</strong>, <strong>inhaled bronchodilators (Option C ruled out)</strong>,<strong> glucocorticoids.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally progressive; influenced by age (inversely related) and post-bronchodilator FEV1 (directly related).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension; common causes of death include <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> disease, and lung cancer.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male patient with COPD presents with severe respiratory distress. Before initiating Non-Invasive Ventilation (NIV), which of the following conditions would be considered as absolute contraindication?", "options": [{"label": "A", "text": "Severe hypoxemia with pH &amp;lt; 7.1", "correct": false}, {"label": "B", "text": "Lack of spontaneous breathing or gasping", "correct": true}, {"label": "C", "text": "Post upper gastrointestinal surgery", "correct": false}, {"label": "D", "text": "Massive retention of secretions despite bronchoscopy", "correct": false}], "correct_answer": "B. Lack of spontaneous breathing or gasping", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding the management of COPD is correct ?", "options": [{"label": "A", "text": "Inhaled corticosteroids (ICS) should be used as monotherapy in all COPD patients", "correct": false}, {"label": "B", "text": "Long-acting bronchodilators are the mainstay of treatment for moderate to severe COPD", "correct": true}, {"label": "C", "text": "Antibiotics are routinely prescribed for the prevention of COPD exacerbations", "correct": false}, {"label": "D", "text": "Pulmonary rehabilitation is only recommended for patients with mild COPD", "correct": false}], "correct_answer": "B. Long-acting bronchodilators are the mainstay of treatment for moderate to severe COPD", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Identify and Address Underlying Cause Treating the underlying cause is key (e.g., treating heart failure resolves pleural effusion, treating pneumonia alleviates cough/breathlessness).</li><li>↳ Identify and Address Underlying Cause</li><li>↳ Treating the underlying cause is key (e.g., treating heart failure resolves pleural effusion, treating pneumonia alleviates cough/breathlessness).</li><li>↳ Treating the underlying cause is key (e.g., treating heart failure resolves pleural effusion, treating pneumonia alleviates cough/breathlessness).</li><li>↳ Assess Severity GOLD Classification for COPD : Based on post-bronchodilator FEV1, guiding treatment escalation. mMRC Dyspnoea Scale : Assesses breathlessness severity, helps in decisions like pulmonary rehab or oxygen therapy. BODE Index for COPD : Uses BMI, airflow obstruction, dyspnoea, and exercise capacity to predict mortality risk and prioritise interventions.</li><li>↳ Assess Severity</li><li>↳ GOLD Classification for COPD : Based on post-bronchodilator FEV1, guiding treatment escalation. mMRC Dyspnoea Scale : Assesses breathlessness severity, helps in decisions like pulmonary rehab or oxygen therapy. BODE Index for COPD : Uses BMI, airflow obstruction, dyspnoea, and exercise capacity to predict mortality risk and prioritise interventions.</li><li>↳ GOLD Classification for COPD : Based on post-bronchodilator FEV1, guiding treatment escalation.</li><li>↳ GOLD Classification for COPD</li><li>↳ mMRC Dyspnoea Scale : Assesses breathlessness severity, helps in decisions like pulmonary rehab or oxygen therapy.</li><li>↳ mMRC Dyspnoea Scale</li><li>↳ BODE Index for COPD : Uses BMI, airflow obstruction, dyspnoea, and exercise capacity to predict mortality risk and prioritise interventions.</li><li>↳ BODE Index for COPD</li><li>↳ Individualise Treatment Comorbidities : Conditions like heart disease, diabetes, or renal impairment can affect drug choices. Drug Interactions : Consider interactions between respiratory and other medications. Patient Preferences : Shared decision-making regarding inhaler devices and treatment options.</li><li>↳ Individualise Treatment</li><li>↳ Comorbidities : Conditions like heart disease, diabetes, or renal impairment can affect drug choices. Drug Interactions : Consider interactions between respiratory and other medications. Patient Preferences : Shared decision-making regarding inhaler devices and treatment options.</li><li>↳ Comorbidities : Conditions like heart disease, diabetes, or renal impairment can affect drug choices.</li><li>↳ Comorbidities</li><li>↳ Drug Interactions : Consider interactions between respiratory and other medications.</li><li>↳ Drug Interactions</li><li>↳ Patient Preferences : Shared decision-making regarding inhaler devices and treatment options.</li><li>↳ Patient Preferences</li><li>↳ Inhaled corticosteroids (ICS) as monotherapy (Option A) is incorrect because ICS should not be used alone in COPD management. They are typically used in combination with bronchodilators in patients with frequent exacerbations.</li><li>↳ Inhaled corticosteroids (ICS) as monotherapy (Option A)</li><li>↳ Antibiotics for prevention of exacerbations (Option C) is incorrect because antibiotics are reserved for acute exacerbations and not used routinely for prevention.</li><li>↳ Antibiotics for prevention of exacerbations (Option C)</li><li>↳ Pulmonary rehabilitation only for mild COPD (Option D) is incorrect as pulmonary rehabilitation is recommended for patients with moderate to severe COPD, not just mild cases.</li><li>↳ Pulmonary rehabilitation only for mild COPD (Option D)</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with chronic obstructive pulmonary disease (COPD) reports increasing breathlessness over the past few months. He now has to stop for breath after walking about 100 metres on level ground. According to the modified Medical Research Council (mMRC) dyspnoea scale, which grade best describes his level of breathlessness?", "options": [{"label": "A", "text": "Grade 1", "correct": false}, {"label": "B", "text": "Grade 2", "correct": false}, {"label": "C", "text": "Grade 3", "correct": true}, {"label": "D", "text": "Grade 4", "correct": false}], "correct_answer": "C. Grade 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:567px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description of Breathlessness</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not troubled by breathlessness except on strenuous exertion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short of breath when hurrying on the level or walking up a slight hill. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Walks slower than others of the same age or stops for breath when walking. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stops for breath after walking 100 metres or after a few minutes on the level.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Too breathless to leave the house or breathless while dressing/undressing. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following interventions has been shown to significantly improve survival in patients with chronic obstructive pulmonary disease (COPD)?", "options": [{"label": "A", "text": "Pulmonary rehabilitation", "correct": false}, {"label": "B", "text": "Smoking cessation", "correct": true}, {"label": "C", "text": "Oral glucocorticoids during exacerbations", "correct": false}, {"label": "D", "text": "Pneumococcal vaccination", "correct": false}], "correct_answer": "B. Smoking cessation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents for routine follow-up. He reports increased breathlessness while walking on level ground and has experienced two exacerbations in the past year. According to the 2023 GOLD classification, which group does this patient belong to?", "options": [{"label": "A", "text": "Group A: Low risk, low symptoms", "correct": false}, {"label": "B", "text": "Group B: Low risk, high symptoms", "correct": false}, {"label": "C", "text": "Group C: High risk, low symptoms", "correct": false}, {"label": "D", "text": "Group D: High risk, high symptoms", "correct": true}], "correct_answer": "D. Group D: High risk, high symptoms", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9iyBJhEtdotIMmzDvsrZ1744321768.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goals</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short-acting bronchodilators (e.g., albuterol) as needed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptom control and improved quality of life.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initiate long-acting bronchodilators (LABA/LAMA).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focus on symptom relief with low <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>E (formerly C &amp; D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>LABA/LAMA or LABA + <span class=\"customMeta\" data-dictid=\"e2c420c53d1692777189e40c773793\">ICS</span> (depending on <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> history).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comprehensive management to reduce symptoms and exacerbations.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old woman with a history of Chronic Obstructive Pulmonary Disease (COPD) is evaluated for her BODE Index score. Her current Body Mass Index (BMI) is 20 kg/m², her post-bronchodilator FEV1 is 42% of the predicted value, she reports a mMRC dyspnoea score of 3, and she walks 340 metres during a 6-minute walk test. What is her total BODE Index score?", "options": [{"label": "A", "text": "4", "correct": false}, {"label": "B", "text": "5", "correct": false}, {"label": "C", "text": "6", "correct": true}, {"label": "D", "text": "7", "correct": false}], "correct_answer": "C. 6", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/2e8UQbJhyZ8aNu72w00R1744321596.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Score Range</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Body Mass Index (BMI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures body fat based on height and weight; lower <span class=\"customMeta\" data-dictid=\"765e9149d01692777183c3989c6590\">BMI</span> indicates poorer prognosis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 to 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluated by post-bronchodilator FEV1% predicted; lower values signify severe <span class=\"customMeta\" data-dictid=\"99caf903791692777180bc28743310\">airflow</span> obstruction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 to 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Dyspnoea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assessed using the modified <span class=\"customMeta\" data-dictid=\"77ded5edf5169277719341a57e79e9\">MRC</span> dyspnoea scale; higher scores indicate greater breathlessness.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 to 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Exercise Capacity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measured by the distance walked in 6 minutes; shorter distances reflect poorer exercise tolerance.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 to 3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male with a long-standing history of chronic obstructive pulmonary disease (COPD) presents to the clinic with worsening breathlessness and cough. His smoking history is significant for 45 pack-years. O/E, he has bilateral wheezes and a respiratory rate of 24 breaths per minute. His oxygen saturation is 89% on room air, and spirometry confirms a post-bronchodilator FEV1/FVC ratio of 60%. Which of the following is the most appropriate first-line treatment to improve his breathlessness and reduce the risk of exacerbations?", "options": [{"label": "A", "text": "Oral theophylline combined with ICS", "correct": false}, {"label": "B", "text": "Long-acting bronchodilator (LABA) combined with an inhaled glucocorticoid", "correct": true}, {"label": "C", "text": "Long-term oxygen therapy", "correct": false}, {"label": "D", "text": "Pulmonary rehabilitation", "correct": false}], "correct_answer": "B. Long-acting bronchodilator (LABA) combined with an inhaled glucocorticoid", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Focuses on quality of life and symptom control in advanced COPD.</li><li>↳ Morphine for breathlessness, benzodiazepines for anxiety.</li><li>↳ Discuss resuscitation preferences with patients before critical illness.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bronchodilators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central to managing COPD</strong>; inhaled route preferred. Short-acting for mild cases; long-acting for moderate to severe cases. Oral bronchodilators (e.g., theophylline) are a second option due to side effects. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Inhaled Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combined with LABAs to improve lung function, reduce exacerbations, and improve quality of life. Risk of <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> in elderly patients. Triple therapy adds a LAMA to LABA/glucocorticoid combo. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Oral Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> exacerbations but avoided long-term due to side effects (e.g., osteoporosis).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pulmonary Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves exercise, education, and <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> counselling. Reduces symptoms, improves exercise tolerance and quality of life. Typically lasts 6–12 weeks. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Oxygen Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term oxygen therapy (LTOT) for patients with severe hypoxaemia (PaO2 &lt; 7.3 kPa). Use &gt;15 hours/day improves survival. <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">Ambulatory</span> oxygen for patients desaturating on exercise. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Surgical Intervention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bullectomy and <span class=\"customMeta\" data-dictid=\"dd1db6e4e91692777191b3081e39a4\">lung volume reduction</span> surgery (LVRS) for upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> or large bullae. Lung <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> for advanced cases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman with a history of chronic obstructive pulmonary disease (COPD) presents with increased breathlessness, cough, and sputum production over the last two days. She appears distressed and has a respiratory rate of 28 breaths per minute. Her oxygen saturation is 88% on room air. Which of the following management strategies is most appropriate for her immediate treatment?", "options": [{"label": "A", "text": "Initiate high-flow oxygen therapy to maintain oxygen saturation above 95%", "correct": false}, {"label": "B", "text": "Start nebulised bronchodilator therapy with salbutamol and ipratropium", "correct": true}, {"label": "C", "text": "Begin intravenous glucocorticoids immediately", "correct": false}, {"label": "D", "text": "Order a chest X-ray before any treatment is provided", "correct": false}], "correct_answer": "B. Start nebulised bronchodilator therapy with salbutamol and ipratropium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arterial blood gases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess severity of hypoxaemia, hypercapnia, acidaemia; guide oxygen therapy and ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identify complications such as pneumonia, pneumothorax, or pleural effusion. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Oxygen Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer<strong> controlled oxygen at 24% or 28%</strong> to maintain PaO2 &gt; 8 kPa (60 mmHg) or SaO2 &gt; 90%. <strong>(Option A ruled out)</strong></li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gas monitoring to adjust therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bronchodilators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Use nebulised short-acting β2-agonists (e.g., salbutamol, terbutaline) with anticholinergics (e.g., ipratropium).</li>\n<li>If oxygen sensitivity is a concern, use compressed air for nebulisation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> (30 mg for 10 days) to reduce symptoms and improve lung function.Reduces frequency and severity of exacerbations.</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> for repeated courses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibiotic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicated for increased <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> purulence, volume, or breathlessness.</li>\n<li>Use simple regimens (aminopenicillin, tetracycline, macrolide); <span class=\"customMeta\" data-dictid=\"dd4d53634b1692777184851322327e\">co-amoxiclav</span> in areas with β-lactamase organisms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Safe for mild to moderate <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis; helps reduce <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> need and mortality.</li>\n<li>Not suitable for patients unable to protect their airway.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanical Ventilation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consider if there is a <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> cause, no prior <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, or if <span class=\"customMeta\" data-dictid=\"0e4135f3bc1692777193047657d8c5\">NIV</span> has failed/contraindicated.</li>\n<li>Decisions should involve the patient, family, and GP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> oedema.</li>\n<li>Limited evidence for <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> aminophylline; consider <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> risk.</li>\n<li>Doxapram may be used short-term for low <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with a 6-month history of worsening breathlessness, chronic cough, and occasional sputum production. He has a 30-pack-year smoking history. On examination, there is no finger clubbing, and pulse oximetry shows oxygen saturation of 92% on room air. Spirometry reveals an FEV1/FVC ratio of 60% post-bronchodilator. What is the most appropriate next investigation to assess the severity of his condition?", "options": [{"label": "A", "text": "Chest X-ray", "correct": false}, {"label": "B", "text": "Blood gas analysis", "correct": false}, {"label": "C", "text": "High-resolution computed tomography (HRCT)", "correct": false}, {"label": "D", "text": "Spirometry with post-bronchodilator FEV1%", "correct": true}], "correct_answer": "D. Spirometry with post-bronchodilator FEV1%", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects alternative diagnoses, complications like <span class=\"customMeta\" data-dictid=\"4534214488169277718575e08a9bc0\">cor</span> pulmonale, bullae, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure, or lung cancer. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Blood count</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excludes anaemia, detects polycythaemia or infection. Assays α1-antitrypsin in younger patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spirometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirms <span class=\"customMeta\" data-dictid=\"99caf903791692777180bc28743310\">airflow</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (post-bronchodilator FEV1/FVC &lt; 70%), assesses <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> severity. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lung volume measurement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses hyperinflation, uses <span class=\"customMeta\" data-dictid=\"a06b8ce45e169277718831d679651c\">helium</span> <span class=\"customMeta\" data-dictid=\"409e887c94169277718652d5db3c32\">dilution</span> or body <span class=\"customMeta\" data-dictid=\"5e7bc7da6d16927771950fcdea984a\">plethysmography</span> for severe cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gas transfer measurement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low gas transfer suggests emphysema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Exercise tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses exercise tolerance, response to therapy, and prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pulse oximetry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifies need for <span class=\"customMeta\" data-dictid=\"05a627febd169277718668accc0c83\">domiciliary</span> oxygen (O2 <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> &lt; 93%).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>High-resolution CT (HRCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects, characterises, quantifies emphysema, guides <span class=\"customMeta\" data-dictid=\"dd1db6e4e91692777191b3081e39a4\">lung volume reduction</span> surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arterial blood gas analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure and acid-base status. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FEV₁ % of Predicted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exacerbations (Risk)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I (Mild)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FEV₁ ≥ 80% of predicted</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often none or mild symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare or no exacerbations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II (Moderate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FEV₁ 50–79% of predicted</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms worsen with exertion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 or more exacerbations per year</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III (Severe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FEV₁ 30–49% of predicted</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe symptoms, limits daily activities</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent exacerbations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV (Very Severe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FEV₁ &lt; 30% of predicted or FEV₁ &lt; 50% with chronic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very severe symptoms, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure may occur</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very frequent exacerbations, potentially life-threatening</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man with a 40-pack-year smoking history presents with chronic productive cough, worsening breathlessness, and peripheral oedema. Physical examination reveals central cyanosis and ankle swelling. Arterial blood gas analysis shows raised PaCo2and hypoxia. Which of the following conditions best describes the patient's clinical phenotype?", "options": [{"label": "A", "text": "Pink puffer", "correct": false}, {"label": "B", "text": "Blue bloater", "correct": true}, {"label": "C", "text": "Bronchiectasis", "correct": false}, {"label": "D", "text": "Asthma", "correct": false}], "correct_answer": "B. Blue bloater", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hypercapnia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated CO2 levels in the blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Polycythaemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">red blood cell</span> concentration due to chronic low oxygen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Oedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluid retention, often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> and hypercapnia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cough, <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> production, breathlessness, oedema, morning headaches.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient presents with a history of chronic cough and sputum production for the past several years. He is thin and exhibits significant breathlessness primarily during physical activity, but he reports minimal symptoms at rest. Arterial blood gas analysis shows a normal PaCO2. Which of the following is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Chronic bronchitis", "correct": false}, {"label": "B", "text": "Asthma", "correct": false}, {"label": "C", "text": "Emphysema", "correct": true}, {"label": "D", "text": "Interstitial lung disease", "correct": false}], "correct_answer": "C. Emphysema", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cough and <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> production (often \"smoker's cough\")</p>\n<p>Breathlessness, mainly during physical activity with minimal symptoms at rest or overnight</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quiet breath sounds</p>\n<p>Thin body habitus</p>\n<p>Possible crackles on lung auscultation, particularly with infection</p>\n<p>Late-stage may show finger <span class=\"customMeta\" data-dictid=\"4defbc994e16927771848875f94fee\">clubbing</span> (not typical for COPD, warrants further investigation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial Blood Gasses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal PaCO2 (35-45 mmHg) until late-stage</p>\n<p>Increased PaCO2 leads to <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> as the disease progresses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest X-Ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May show <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> but often normal until advanced stages</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary Function Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Airflow obstruction</p>\n<p>Reduced FEV1/FVC ratio &lt;70% (key indicator of COPD)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) presents with worsening shortness of breath and edema. Right heart catheterization reveals a mean pulmonary artery pressure of 30 mmHg. Which of the following statements about pulmonary hypertension (PH) in this patient is most accurate?", "options": [{"label": "A", "text": "Pulmonary hypertension in COPD is primarily caused by increased left atrial pressure.", "correct": false}, {"label": "B", "text": "The prognosis of COPD is directly proportional to age.", "correct": false}, {"label": "C", "text": "Right ventricular hypertrophy may be observed on an electrocardiogram (ECG).", "correct": true}, {"label": "D", "text": "Treatment options for pulmonary hypertension in COPD primarily include corticosteroids.", "correct": false}], "correct_answer": "C. Right ventricular hypertrophy may be observed on an electrocardiogram (ECG).", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>COPD Treatments </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">Hypertension</span> Treatments</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking cessation (Most important)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diuretic therapy for right-sided heart failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhaled bronchodilators</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplemental oxygen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhaled corticosteroids (glucocorticoids) <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Double lung transplantation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxygen therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary <span class=\"customMeta\" data-dictid=\"48ab5c66fd1692777200b7a31ef74f\">thromboendarterectomy</span> (for chronic <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> thromboembolic disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary rehabilitation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atrial septostomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a long history of smoking presents to the clinic with chronic cough and wheezing. He mentions that he had multiple respiratory infections during childhood and was born with low birth weight. Which of the following factors is most likely to have the greatest impact on the progression of his Chronic Obstructive Pulmonary Disease (COPD)?", "options": [{"label": "A", "text": "Airway hyper-reactivity", "correct": false}, {"label": "B", "text": "Tobacco smoke", "correct": true}, {"label": "C", "text": "Recurrent infections", "correct": false}, {"label": "D", "text": "Impaired lung growth", "correct": false}], "correct_answer": "B. Tobacco smoke", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tobacco Smoke</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary risk factor</strong>; risk increases with amount and duration of smoking; responsible for <strong>90% of <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> cases</strong>. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indoor Air Pollution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant risk from cooking with <span class=\"customMeta\" data-dictid=\"710a0f411416927771831201ad5566\">biomass</span> fuels (wood, dung) in enclosed spaces, especially in developing countries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Occupational Exposures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Linked to exposure to coal dust, silica, and cadmium; coal worker's <span class=\"customMeta\" data-dictid=\"67bf7be75e16927771951318e1670e\">pneumoconiosis</span> (CWP) can resemble COPD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low Birth Weight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with lower lung function in adulthood, raising <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impaired Lung Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Influenced by childhood infections or <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> smoking, leading to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> lung function later in life. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recurrent Infections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can accelerate the decline in FEV1 (lung function) and alter <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> responses, increasing lung damage risk. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alpha1-antitrypsin <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> reduces protective lung protein levels; other genetic <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> factors may also contribute.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Airway Hyper-reactivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased sensitivity to environmental triggers, which may facilitate <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> development. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HIV Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with emphysema, a subtype of COPD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low Socioeconomic Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Correlates with higher <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> risk, potentially due to multiple factors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cannabis Smoking</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identified as a contributing factor.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy presents with wheezing and shortness of breath, worsening at night. His symptoms are triggered by dust and pet dander. Spirometry shows an obstructive pattern that improves with a bronchodilator. What is the underlying mechanism?", "options": [{"label": "A", "text": "IgG-mediated immune complexes.", "correct": false}, {"label": "B", "text": "IgE-mediated mast cell degranulation.", "correct": true}, {"label": "C", "text": "Bronchial irritation from pollutants.", "correct": false}, {"label": "D", "text": "Viral infection causing airway remodeling.", "correct": false}], "correct_answer": "B. IgE-mediated mast cell degranulation.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/S6CauvwJqGDri7VpzaZF1744320776.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with progressive dyspnea and a history of smoking for 25 years. Imaging studies reveal abnormal enlargement of air spaces distal to the terminal bronchioles. Which of the following types of emphysema is most likely seen in this patient?", "options": [{"label": "A", "text": "Panacinar emphysema", "correct": false}, {"label": "B", "text": "Paraseptal emphysema", "correct": false}, {"label": "C", "text": "Centriacinar emphysema", "correct": true}, {"label": "D", "text": "Bullous emphysema", "correct": false}], "correct_answer": "C. Centriacinar emphysema", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/OZSL7Hi6vxHmf7sw8Z8d1744321319.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:503px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Centriacinar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged air spaces primarily in the central part of the acinus. <strong>(Option C) </strong>seen in chronic smokers, upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of lungs are predominantly affected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Panacinar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uniform <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of air spaces throughout the acinus. <strong>(Option A ruled out) </strong>seen with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> 1 antitrypsin <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> in younger age group.lower <span class=\"customMeta\" data-dictid=\"2a5408f38416927771914f1e170959\">lobes of lung</span> are commonly involved.associated with liver failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paraseptal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlargement occurs near the <span class=\"customMeta\" data-dictid=\"8067ea0c85169277719561c9591e9d\">pleura</span> or septa. <strong>(Option B ruled out) </strong><strong>increase risk of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> pneumothorax.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male, with a 30-year history of smoking, presents with a chronic productive cough for the last 2 years, worsening shortness of breath, and recent weight loss. Examination reveals bilateral wheezing and peripheral edema imaging shows alveolar wall destruction beyond terminal bronchiole. Which of the following pathophysiological mechanisms is primarily responsible for his condition?", "options": [{"label": "A", "text": "Pulmonary vascular remodeling", "correct": false}, {"label": "B", "text": "Alpha-1 antitrypsin deficiency", "correct": false}, {"label": "C", "text": "Airflow limitation due to loss of elastic tissue", "correct": true}, {"label": "D", "text": "Hypersecretion of mucus from goblet cells", "correct": false}], "correct_answer": "C. Airflow limitation due to loss of elastic tissue", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucus hypersecretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlargement of <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> glands and goblet cells → chronic <span class=\"customMeta\" data-dictid=\"ce5a7a84ff16927771830347fbbbff\">bronchitis</span> (cough + <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> for ≥3 months/year). <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emphysema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alveolar destruction by proteases and oxidants → permanent <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> airspaces.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Airflow Limitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> tissue + <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> → <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> closure, gas trapping, and hyperinflation.</p>\n<p>This is the primary mechanism for the <span class=\"customMeta\" data-dictid=\"99caf903791692777180bc28743310\">airflow</span> limitation. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> remodeling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Structural changes in <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vessels.eventually causing PAH. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weight Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Altered fat metabolism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skeletal Muscle Dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> reduces physical capacity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impaired <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function → salt and water retention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteoporosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased bone density.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> contributes to complications.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old woman presents to the emergency department with worsening asthma symptoms, fever, and a rash consisting of purpura on her lower extremities. Laboratory findings reveal eosinophilia (1200 cells/μL) and elevated inflammatory markers. A biopsy of the skin lesion shows extravascular granulomas. Which of the following statements about her condition is false?", "options": [{"label": "A", "text": "Patients often present with systemic symptoms like malaise and weight loss.", "correct": false}, {"label": "B", "text": "The condition typically involves necrotizing vasculitis affecting small and medium-sized blood vessels.", "correct": false}, {"label": "C", "text": "Cardiac involvement may lead to complications such as myocarditis and pericarditis.", "correct": false}, {"label": "D", "text": "It primarily affects large blood vessels, leading to significant vascular occlusion.", "correct": true}], "correct_answer": "D. It primarily affects large blood vessels, leading to significant vascular occlusion.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with chronic shortness of breath, dry cough, fatigue, and weight loss for the past six months. He works in a pigeon breeding facility and reports worsening symptoms over time. High-resolution CT (HRCT) of the chest reveals reticular changes, ground-glass opacities, and traction bronchiectasis. Which of the following statements about his condition is true?", "options": [{"label": "A", "text": "It is caused by a Type I hypersensitivity reaction mediated by IgE antibodies.", "correct": false}, {"label": "B", "text": "Pulmonary fibrosis is a known complication of chronic HP.", "correct": true}, {"label": "C", "text": "Acute HP presents with symptoms several days after antigen exposure.", "correct": false}, {"label": "D", "text": "HRCT is typically normal in hypersensitivity pneumonitis.", "correct": false}], "correct_answer": "B. Pulmonary fibrosis is a known complication of chronic HP.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Source</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Farmer’s lung</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thermophilic <span class=\"customMeta\" data-dictid=\"476751a9761692777180c98c5932e2\">actinomycetes</span> (e.g., <span class=\"customMeta\" data-dictid=\"fa4ccef29f16927771981556b7ecb8\">Saccharopolyspora</span> rectivirgula); fungus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grain, mouldy hay, silage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bagassosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thermophilic actinomycetes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sugarcane</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bird fancier’s lung</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proteins derived from parakeets, pigeons, budgerigars</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bird feathers, droppings, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> proteins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hot tub lung</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cladosporium species; <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> avium complex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contaminated water, <span class=\"customMeta\" data-dictid=\"223653d0be1692777192d7323599a2\">mould</span> on ceiling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Woodworker’s lung</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alternaria species; <span class=\"customMeta\" data-dictid=\"461ee544961692777182696a650b05\">Bacillus</span> subtilis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oak, cedar, pine, mahogany dusts</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements best characterizes brittle asthma?", "options": [{"label": "A", "text": "Symptoms develop gradually over a few days, allowing time for preventive action.", "correct": false}, {"label": "B", "text": "It is characterized by sudden exacerbations with little or no warning.", "correct": true}, {"label": "C", "text": "Patients with brittle asthma typically have heightened awareness of airway narrowing.", "correct": false}, {"label": "D", "text": "The primary cause of brittle asthma is well understood and easily managed.", "correct": false}], "correct_answer": "B. It is characterized by sudden exacerbations with little or no warning.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient Perception</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Some patients have a <strong>blunted awareness</strong> of <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> narrowing, making it hard to detect early symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unpredictability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden onset and severity complicate management and timely intervention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impact on Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lack of awareness leads to <strong>delayed treatment</strong>, increasing the risk of severe exacerbations.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male with a history of asthma presents with symptoms occurring four times a week, occasional nighttime awakenings, and the need for rescue inhaler use three times a week. His post-bronchodilator FEV1 is 72% of the predicted value. According to the asthma classification guidelines, how would you categorize the severity and control of his asthma?", "options": [{"label": "A", "text": "Mild asthma, controlled", "correct": false}, {"label": "B", "text": "Moderate asthma, partly controlled", "correct": true}, {"label": "C", "text": "Severe asthma, uncontrolled", "correct": false}, {"label": "D", "text": "Moderate asthma, uncontrolled", "correct": false}], "correct_answer": "B. Moderate asthma, partly controlled", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Controlled </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partly Controlled </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uncontrolled </strong><strong>(Options C &amp; D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Daytime Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms &gt; twice/week</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent daytime symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Limitations of Activities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any limitations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant limitations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nocturnal Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any nighttime symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent nighttime symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Need for Rescue Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; twice/week</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; twice/week</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent use of rescue medication</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lung Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal (PEF or FEV1)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 80% of predicted/personal best</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significantly <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> lung function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exacerbations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 1 per year</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weekly exacerbations</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient with a history of asthma presents with symptoms occurring more than three times a week and nocturnal awakenings at least once a week. After evaluating the patient's condition, the physician decides to initiate treatment. Which of the following is the most appropriate initial step in the management of this patient?", "options": [{"label": "A", "text": "Increase the dose of short-acting β2-agonist.", "correct": false}, {"label": "B", "text": "Start regular inhaled glucocorticoids (ICS).", "correct": true}, {"label": "C", "text": "Start prednisolone at the lowest effective dose.", "correct": false}, {"label": "D", "text": "Add a long-acting β2-agonist (LABA).", "correct": false}], "correct_answer": "B. Start regular inhaled glucocorticoids (ICS).", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Occasional Short-Acting β2-Agonists(rescue therapy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For mild, <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> (symptoms &lt;1/week, &lt;2 <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> episodes/month).</li>\n<li>Use bronchodilators like <span class=\"customMeta\" data-dictid=\"479585b1c81692777198b4f752d734\">salbutamol</span> or terbutaline as needed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular Preventer Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initiate if exacerbations occur within 2 years or symptoms are frequent (≥3/week) or <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> awakenings occur weekly.</li>\n<li><strong>Inhaled Glucocorticoids (ICS)</strong>: e.g., beclometasone, <span class=\"customMeta\" data-dictid=\"b43d582eda16927771835f2ed1d581\">budesonide</span> (starting dose: 400 μg/day for adults).</li>\n<li>Alternatives: Chromones, <span class=\"customMeta\" data-dictid=\"5a4fd169911692777191c1cb27b0d7\">leukotriene</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists, theophyllines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Add-on Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Review adherence, <span class=\"customMeta\" data-dictid=\"302965be571692777190f632502628\">inhaler</span> technique, and aggravating factors if poorly controlled.</li>\n<li>Increase <span class=\"customMeta\" data-dictid=\"e2c420c53d1692777189e40c773793\">ICS</span> dose or add <strong>Long-Acting β2-Agonist (LABA)</strong>; combination inhalers are beneficial. <strong>(Options A &amp; D ruled out)</strong></li>\n<li>Consider oral <span class=\"customMeta\" data-dictid=\"5a4fd169911692777191c1cb27b0d7\">leukotriene</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists (e.g., montelukast 10 mg/day) if needed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Addition of a Fourth Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For inadequate control with moderate <span class=\"customMeta\" data-dictid=\"e2c420c53d1692777189e40c773793\">ICS</span> dose, increase to 2000 μg/day or add <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> glucocorticoids for upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> symptoms.</li>\n<li>Other options: Long-acting antimuscarinics, theophyllines, slow-release β2-agonists.</li>\n<li>Discontinue ineffective add-on therapies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continuous/Frequent Oral Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prescribe <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> at the lowest effective dose, typically in the morning. <strong>(Option C ruled out)</strong></li>\n<li>Monitor for <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> side effects (long-term use risks).</li>\n<li>Consider <strong>Omalizumab</strong> for <span class=\"customMeta\" data-dictid=\"afad60190f1692777182663499dc42\">atopic</span> patients or <strong>Mepolizumab</strong> for <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cases.</li>\n<li>Immunosuppressants are less common due to variable <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> and side effects.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old male presents with recurrent episodes of chest tightness, wheezing, and shortness of breath 10 minutes after running. The symptoms usually resolve within 30 minutes. Which of the following is the most appropriate pre-exercise treatment?", "options": [{"label": "A", "text": "Long-acting beta agonist (LABA) taken daily", "correct": false}, {"label": "B", "text": "Short-acting beta agonist (SABA) used 15 minutes before exercise", "correct": true}, {"label": "C", "text": "Inhaled corticosteroid (ICS) used immediately after exercise", "correct": false}, {"label": "D", "text": "Leukotriene receptor antagonist (LTRA) taken during an acute episode", "correct": false}], "correct_answer": "B. Short-acting beta agonist (SABA) used 15 minutes before exercise", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents with a history of recurrent wheezing and shortness of breath, particularly during the winter months. She reports that her symptoms worsen with cold air and after respiratory infections. She does not have any known allergies, and her skin prick tests for common allergens are negative. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Atopic asthma", "correct": false}, {"label": "B", "text": "Occupational asthma", "correct": false}, {"label": "C", "text": "Intrinsic asthma", "correct": true}, {"label": "D", "text": "Cough-variant asthma", "correct": false}], "correct_answer": "C. Intrinsic asthma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sensitization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>No evidence of <span class=\"customMeta\" data-dictid=\"7396dd35a41692777181bd7038fa9b\">allergen</span> sensitization</li>\n<li>Skin test results usually negative</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Family history</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Less common positive family history of asthma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common triggers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Respiratory infections (e.g., rhinovirus, parainfluenza virus, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> syncytial virus)</li>\n<li>Inhaled air pollutants (tobacco smoke, <span class=\"customMeta\" data-dictid=\"978b9c4c1a1692777199fc90ace6a5\">sulfur</span> dioxide, ozone, <span class=\"customMeta\" data-dictid=\"391d32291016927771932bab695579\">nitrogen</span> dioxide)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other triggers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Cold exposure</li>\n<li>Exercise</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Contributes to chronic <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and hyperreactivity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Overlap with <span class=\"customMeta\" data-dictid=\"afad60190f1692777182663499dc42\">atopic</span> asthma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Some triggers (e.g., <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections, air pollutants) can also trigger <span class=\"customMeta\" data-dictid=\"afad60190f1692777182663499dc42\">atopic</span> asthma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old girl presents with recurrent wheezing and difficulty breathing, especially during spring. Her symptoms worsen at night and with exercise. She has a family history of asthma. Physical examination reveals wheezing and a skin prick test shows positive reactions to grass pollen. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Exercise-induced asthma", "correct": false}, {"label": "B", "text": "Extrinsic asthma", "correct": true}, {"label": "C", "text": "Intrinsic Asthma", "correct": false}, {"label": "D", "text": "Non-atopic asthma", "correct": false}], "correct_answer": "B. Extrinsic asthma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type of Hypersensitivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>IgE-mediated (Type I)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Usually begins in childhood</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Triggers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Environmental allergens (dust, pollen, <span class=\"customMeta\" data-dictid=\"bfe913d6861692777184fefa14d08a\">cockroach</span> dander, animal dander, certain foods)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cofactors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Family History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Positive family history of asthma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Immediate wheal-and-flare reaction in skin tests</li>\n<li>High total <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\">IgE</span> levels</li>\n<li>RAST for specific <span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\">IgE</span> antibodies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunologic Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Th2 and IgE-mediated</li>\n<li>Acute-phase (immediate) and late-phase reactions</li>\n<li>Key cytokines: IL-4, IL-5, IL-13</li>\n<li>Key <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells: Eosinophils, <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells, neutrophils, T lymphocytes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents to the clinic with a history of asthma. He reports that he has been using his rescue inhaler (SABA) more frequently, experiencing symptoms on most days and waking up at least twice a week due to shortness of breath. His current management includes as-needed SABA but no regular controller medication. What is the most appropriate next step in his asthma management?", "options": [{"label": "A", "text": "Continue current treatment and monitor symptoms.", "correct": false}, {"label": "B", "text": "Start low-dose inhaled corticosteroids for daily control.", "correct": true}, {"label": "C", "text": "Increase the dosage of the SABA.", "correct": false}, {"label": "D", "text": "Add a leukotriene receptor antagonist for better control.", "correct": false}], "correct_answer": "B. Start low-dose inhaled corticosteroids for daily control.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/hvW2an2Y7DrkJ9czaQxt1744320986.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presents with complaints of wheezing and shortness of breath that have worsened over the past few weeks. He notes that his symptoms often occur at night and are triggered by exposure to dust and exercise. Spirometry shows a FEV1/FVC ratio of 65%. After using a short-acting β2-agonist, his FEV1 increases by 20%. Which of the following findings would most likely be observed in this patient?", "options": [{"label": "A", "text": "Increased total lung capacity", "correct": true}, {"label": "B", "text": "Decreased DLCO", "correct": false}, {"label": "C", "text": "Increased forced vital capacity", "correct": false}, {"label": "D", "text": "Decreased residual volume", "correct": false}], "correct_answer": "A. Increased total lung capacity", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spirometry/PFTs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Best initial test</li>\n<li>IOC</li>\n<li>Obstructive pattern\n\t\t\t\t<ul>\n<li>Reversible with short-acting β2-agonists (SABAs)</li>\n</ul>\n</li>\n<li>Findings:\n\t\t\t\t<ul>\n<li>FEV1/FVC &lt; 70%</li>\n<li>↓ FEV1</li>\n<li>Normal or ↓ FVC<strong> (Option C)</strong></li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Volume (RV) <strong>(Option D)</strong></li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"b0e95f9af21692777200e8a9faabe7\">Total Lung Capacity</span> (TLC)</li>\n<li>Normal or ↑ <span class=\"customMeta\" data-dictid=\"68325001361692777186184e298e9d\">Diffusing Capacity</span> of Lung for <span class=\"customMeta\" data-dictid=\"bb021d26d3169277718336718849a5\">Carbon Monoxide</span> (DLCO)<strong> (Option B)</strong></li>\n</ul>\n</li>\n<li>Reversibility:\n\t\t\t\t<ul>\n<li>Increase in FEV1 ≥ 12% and &gt;200 mL with SABA (albuterol)</li>\n</ul>\n</li>\n<li>PFTs between exacerbations: Often normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Methacholine Challenge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Tests for bronchial hyperresponsiveness</li>\n<li>Positive if ≥20% decrease in FEV1</li>\n<li>Sensitive but not specific</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arterial blood gas </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Early\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> (↓ PaCO2, ↑ pH) due to hyperventilation</li>\n</ul>\n</li>\n<li>Late\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> due to muscle fatigue (normalizing PaCO2, normalizing pH, ↓ PaO2)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Normal appearance to <span class=\"customMeta\" data-dictid=\"301f9a675d16927771892fb39029d3\">hyperinflation</span> with <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> of the diaphragm</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about the Hygiene hypothesis is incorrect?", "options": [{"label": "A", "text": "Clean environments may impair immune system maturation in children.", "correct": false}, {"label": "B", "text": "Endotoxin exposure is essential for proper immune development.", "correct": false}, {"label": "C", "text": "Fetal immune system is suppressed to prevent rejection of maternal tissue.", "correct": false}, {"label": "D", "text": "Lack of exposure to germs is linked to a decreased risk of developing asthma.", "correct": true}], "correct_answer": "D. Lack of exposure to germs is linked to a decreased risk of developing asthma.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 38 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 20 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following statements are false regarding primary lung abscesses?", "options": [{"label": "A", "text": "Most cases are polymicrobial infections.", "correct": false}, {"label": "B", "text": "Hematologic dissemination is one of the causes", "correct": true}, {"label": "C", "text": "Poor dental hygiene is an independent risk factor for developing lung abscesses", "correct": false}, {"label": "D", "text": "Staphylococcus aureus can cause lung abscesses in individuals with alcohol use disorder.", "correct": false}], "correct_answer": "B. Hematologic dissemination is one of the causes", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient presents with fever, productive cough, and pleuritic chest pain. A chest CT scan reveals a fluid collection in the pleural space with a thickened pleura. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Empyema", "correct": true}, {"label": "B", "text": "Lung abscess", "correct": false}, {"label": "C", "text": "Pneumonia", "correct": false}, {"label": "D", "text": "Pulmonary edema", "correct": false}], "correct_answer": "A. Empyema", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/3IZrcMfVX3YTqn0qPB7o1744318682.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient presents with a productive cough, fever, and shortness of breath. A chest X-ray reveals a lobar consolidation. Which of the following is the most likely causative organism of community-acquired pneumonia in this patient?", "options": [{"label": "A", "text": "Klebsiella pneumoniae", "correct": false}, {"label": "B", "text": "Haemophilus influenzae", "correct": false}, {"label": "C", "text": "Streptococcus pneumoniae", "correct": true}, {"label": "D", "text": "Pseudomonas aeruginosa", "correct": false}], "correct_answer": "C. Streptococcus pneumoniae", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old HIV-positive patient presents with a non-productive cough, dyspnea, and low-grade fever. A Gomori methenamine silver stain of a bronchoalveolar lavage specimen was done. What is the most appropriate treatment for this patient?", "options": [{"label": "A", "text": "Azithromycin", "correct": false}, {"label": "B", "text": "Amphotericin B", "correct": false}, {"label": "C", "text": "Co-trimoxazole", "correct": true}, {"label": "D", "text": "Itraconazole", "correct": false}], "correct_answer": "C. Co-trimoxazole", "question_images": ["https://image.prepladder.com/notes/CPzkoW8HPjcSewUmkiSL1744318463.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with fever, cough, and chest discomfort. His chest X-ray reveals right lower lobe consolidation. Which of the following features would be more consistent with atypical pneumonia?", "options": [{"label": "A", "text": "Gradual onset with a dry cough", "correct": true}, {"label": "B", "text": "High-grade fever", "correct": false}, {"label": "C", "text": "Lobar consolidation on chest X-ray", "correct": false}, {"label": "D", "text": "Productive cough with purulent sputum", "correct": false}], "correct_answer": "A. Gradual onset with a dry cough", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 y/o man with COPD presents with 3 days of worsening shortness of breath, fever, and productive cough. He appears confused and has a respiratory rate of 32/min, BP of 85/55 mmHg, and BUN of 25 mg/dL. What is the most appropriate management?", "options": [{"label": "A", "text": "Outpatient treatment with azithromycin", "correct": false}, {"label": "B", "text": "Inpatient treatment with levofloxacin and azithromycin", "correct": false}, {"label": "C", "text": "ICU admission with piperacillin-tazobactam and vancomycin", "correct": true}, {"label": "D", "text": "Inpatient treatment with amoxicillin alone", "correct": false}], "correct_answer": "C. ICU admission with piperacillin-tazobactam and vancomycin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CURB-65</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>C</strong>) Confusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>U</strong>) Urea: <span class=\"customMeta\" data-dictid=\"eeb0ec7e661692777183f957a8794b\">BUN</span> &gt;19mg/dL (&gt;7 mmol/L)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>R</strong>) <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> rate ≥30/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>B</strong>) <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">Blood Pressure</span> – <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP ≤90 mmHg or diastolic BP ≤60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>65</strong>) Age ≥65 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 y/o woman is admitted to the hospital with a high fever, productive cough, and pleuritic chest pain. A physical examination reveals diminished breath sounds on the right side, and she appears confused. The chest X-ray is given below. Despite this, the physician considers further testing. Which of the following investigations should be prioritized next to confirm the causative organism of the suspected diagnosis?", "options": [{"label": "A", "text": "Sputum Gram stain and culture", "correct": true}, {"label": "B", "text": "Complete Blood Count", "correct": false}, {"label": "C", "text": "CT chest", "correct": false}, {"label": "D", "text": "Influenza testing", "correct": false}], "correct_answer": "A. Sputum Gram stain and culture", "question_images": ["https://image.prepladder.com/notes/F3pQC3B9Kxdw2YdpzOAs1744318003.png"], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Investigation Findings</li><li>↳ Investigation</li><li>↳ Investigation</li><li>↳ Investigation</li><li>↳ Findings</li><li>↳ Findings</li><li>↳ Findings</li><li>↳ Initial Evaluation Clinical suspicion based on patient history and physical examination.</li><li>↳ Initial Evaluation</li><li>↳ Initial Evaluation</li><li>↳ Initial Evaluation</li><li>↳ Clinical suspicion based on patient history and physical examination.</li><li>↳ Clinical suspicion based on patient history and physical examination.</li><li>↳ Clinical suspicion based on patient history and physical examination.</li><li>↳ Chest Radiography The most important initial test for pneumonia diagnosis. Shows pulmonary infiltrate; indicates type (lobar, interstitial, unilateral, or bilateral). Cannot reliably differentiate between bacterial and non-bacterial causes. Lobar pneumonia. Reference article, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-26886\" data-hash=\"8942\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/lobar-pneumonia\" data-tags=\"\" height=\"284\" src=\"https://image.prepladder.com/notes/F3pQC3B9Kxdw2YdpzOAs1744318003.png\" width=\"286\" /&gt; {{caption_text}}</li><li>↳ Chest Radiography</li><li>↳ Chest Radiography</li><li>↳ Chest Radiography</li><li>↳ The most important initial test for pneumonia diagnosis. Shows pulmonary infiltrate; indicates type (lobar, interstitial, unilateral, or bilateral). Cannot reliably differentiate between bacterial and non-bacterial causes. Lobar pneumonia. Reference article, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-26886\" data-hash=\"8942\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/lobar-pneumonia\" data-tags=\"\" height=\"284\" src=\"https://image.prepladder.com/notes/F3pQC3B9Kxdw2YdpzOAs1744318003.png\" width=\"286\" /&gt; {{caption_text}}</li><li>↳ The most important initial test for pneumonia diagnosis. Shows pulmonary infiltrate; indicates type (lobar, interstitial, unilateral, or bilateral). Cannot reliably differentiate between bacterial and non-bacterial causes.</li><li>↳ The most important initial test for pneumonia diagnosis.</li><li>↳ important initial test</li><li>↳ Shows pulmonary infiltrate; indicates type (lobar, interstitial, unilateral, or bilateral).</li><li>↳ Cannot reliably differentiate between bacterial and non-bacterial causes.</li><li>↳ CT Scan More accurate than a chest X-ray. Focal dense opacification of an entire lobe occurs, with relative sparing of the large airways. Associated findings may include ground-glass opacities in a lobar or segmental pattern, indicating areas of partial involvement or atelectasis. pneumonia CT\" data-author=\"Al Khateeb A, Lobar pneumonia. Case study, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-50499\" data-hash=\"8948\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/lobar-pneumonia\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/notes/kLwyh6x1QTPtUmWsJLAL1744318203.png\" width=\"321\" /&gt; {{caption_text}} Image shows left upper lung lobe consolidation of heterogenous density, with multiple air bronchograms, and small left pleural effusion</li><li>↳ CT Scan</li><li>↳ CT Scan</li><li>↳ CT Scan</li><li>↳ More accurate than a chest X-ray. Focal dense opacification of an entire lobe occurs, with relative sparing of the large airways. Associated findings may include ground-glass opacities in a lobar or segmental pattern, indicating areas of partial involvement or atelectasis. pneumonia CT\" data-author=\"Al Khateeb A, Lobar pneumonia. Case study, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-50499\" data-hash=\"8948\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/lobar-pneumonia\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/notes/kLwyh6x1QTPtUmWsJLAL1744318203.png\" width=\"321\" /&gt; {{caption_text}} Image shows left upper lung lobe consolidation of heterogenous density, with multiple air bronchograms, and small left pleural effusion</li><li>↳ More accurate than a chest X-ray. Focal dense opacification of an entire lobe occurs, with relative sparing of the large airways. Associated findings may include ground-glass opacities in a lobar or segmental pattern, indicating areas of partial involvement or atelectasis.</li><li>↳ More accurate than a chest X-ray.</li><li>↳ Focal dense opacification of an entire lobe occurs, with relative sparing of the large airways. Associated findings may include ground-glass opacities in a lobar or segmental pattern, indicating areas of partial involvement or atelectasis.</li><li>↳ Image shows left upper lung lobe consolidation of heterogenous density, with multiple air bronchograms, and small left pleural effusion</li><li>↳ Image shows left upper lung lobe consolidation of heterogenous density, with multiple air bronchograms, and small left pleural effusion</li><li>↳ Laboratory Tests Complete Blood Count (CBC): Look for leukocytosis (leftward shift) as a sign of infection. Leukopenia may indicate a poor prognosis. Inflammatory Biomarkers: ESR and acute phase reactants to assess severity.</li><li>↳ Laboratory Tests</li><li>↳ Laboratory Tests</li><li>↳ Laboratory Tests</li><li>↳ Complete Blood Count (CBC): Look for leukocytosis (leftward shift) as a sign of infection. Leukopenia may indicate a poor prognosis. Inflammatory Biomarkers: ESR and acute phase reactants to assess severity.</li><li>↳ Complete Blood Count (CBC): Look for leukocytosis (leftward shift) as a sign of infection. Leukopenia may indicate a poor prognosis. Inflammatory Biomarkers: ESR and acute phase reactants to assess severity.</li><li>↳ Complete Blood Count (CBC): Look for leukocytosis (leftward shift) as a sign of infection. Leukopenia may indicate a poor prognosis.</li><li>↳ Look for leukocytosis (leftward shift) as a sign of infection. Leukopenia may indicate a poor prognosis.</li><li>↳ Look for leukocytosis (leftward shift) as a sign of infection.</li><li>↳ Leukopenia may indicate a poor prognosis.</li><li>↳ Inflammatory Biomarkers: ESR and acute phase reactants to assess severity.</li><li>↳ Sputum Analysis Sputum Gram stain and culture critical for suspected lobar pneumonia. Sputum culture is the most specific diagnostic test for identifying the causative organism. (Option A)</li><li>↳ Sputum Analysis</li><li>↳ Sputum Analysis</li><li>↳ Sputum Analysis</li><li>↳ Sputum Gram stain and culture critical for suspected lobar pneumonia. Sputum culture is the most specific diagnostic test for identifying the causative organism. (Option A)</li><li>↳ Sputum Gram stain and culture critical for suspected lobar pneumonia. Sputum culture is the most specific diagnostic test for identifying the causative organism. (Option A)</li><li>↳ Sputum Gram stain and culture critical for suspected lobar pneumonia.</li><li>↳ Sputum culture is the most specific diagnostic test for identifying the causative organism. (Option A)</li><li>↳ most specific diagnostic test</li><li>↳ (Option A)</li><li>↳ Influenza Testing Recommended during winter months due to the risk of co-infection with pneumonia.</li><li>↳ Influenza Testing</li><li>↳ Influenza Testing</li><li>↳ Influenza Testing</li><li>↳ Recommended during winter months due to the risk of co-infection with pneumonia.</li><li>↳ Recommended during winter months due to the risk of co-infection with pneumonia.</li><li>↳ Recommended during winter months due to the risk of co-infection with pneumonia.</li><li>↳ winter months</li><li>↳ Patient Stratification Use CURB-65 and the pneumonia severity index to determine hospitalization needs.</li><li>↳ Patient Stratification</li><li>↳ Patient Stratification</li><li>↳ Patient Stratification</li><li>↳ Use CURB-65 and the pneumonia severity index to determine hospitalization needs.</li><li>↳ Use CURB-65 and the pneumonia severity index to determine hospitalization needs.</li><li>↳ Use CURB-65 and the pneumonia severity index to determine hospitalization needs.</li><li>↳ Additional Testing Hospitalized patients: sputum culture, blood culture, and/or urine antigen testing before antibiotics.</li><li>↳ Additional Testing</li><li>↳ Additional Testing</li><li>↳ Additional Testing</li><li>↳ Hospitalized patients: sputum culture, blood culture, and/or urine antigen testing before antibiotics.</li><li>↳ Hospitalized patients: sputum culture, blood culture, and/or urine antigen testing before antibiotics.</li><li>↳ Hospitalized patients: sputum culture, blood culture, and/or urine antigen testing before antibiotics.</li><li>↳ Invasive Procedures Thoracocentesis, bronchoscopy, pleural biopsy, and pleural fluid culture are rarely performed. Open lung biopsy is the ultimate specific diagnostic test.</li><li>↳ Invasive Procedures</li><li>↳ Invasive Procedures</li><li>↳ Invasive Procedures</li><li>↳ Thoracocentesis, bronchoscopy, pleural biopsy, and pleural fluid culture are rarely performed. Open lung biopsy is the ultimate specific diagnostic test.</li><li>↳ Thoracocentesis, bronchoscopy, pleural biopsy, and pleural fluid culture are rarely performed. Open lung biopsy is the ultimate specific diagnostic test.</li><li>↳ Thoracocentesis, bronchoscopy, pleural biopsy, and pleural fluid culture are rarely performed.</li><li>↳ Open lung biopsy is the ultimate specific diagnostic test.</li><li>↳ Open lung biopsy is the ultimate specific diagnostic test.</li><li>↳ Complete Blood Count (Option B): While a CBC can provide valuable information about infection (e.g., leukocytosis), it does not identify the causative organism. It is more useful for assessing the overall severity of the infection.</li><li>↳ Complete Blood Count (Option B):</li><li>↳ CT scan of the chest (Option C): A CT scan is more accurate than a chest X-ray but is not the first-line test for confirming pneumonia. It is typically reserved for cases with high suspicion and a negative X-ray due to its cost and radiation exposure.</li><li>↳ CT scan of the chest (Option C):</li><li>↳ Influenza testing (Option D) is important during winter months, especially if co-infection with pneumonia is suspected. However, it does not directly identify the causative organism of lobar pneumonia, making it less relevant in this immediate context.</li><li>↳ Influenza testing (Option D)</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Initial Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Clinical suspicion based on patient history and physical examination.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest Radiography</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>The most <strong>important initial test</strong> for <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> diagnosis.</li>\n<li>Shows <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infiltrate; indicates type (lobar, interstitial, unilateral, or bilateral).</li>\n<li>Cannot reliably <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between bacterial and non-bacterial causes.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Lobar pneumonia\" custommeta\"=\"\" data-author=\"Paks M, Silverstone L, Knipe H, et al. &lt;span class=\" data-dictid=\"82ded933641692777191ee421dc094\"/>Lobar pneumonia. Reference article, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-26886\" data-hash=\"8942\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/lobar-pneumonia\" data-tags=\"\" height=\"284\" src=\"https://image.prepladder.com/notes/F3pQC3B9Kxdw2YdpzOAs1744318003.png\" width=\"286\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CT Scan</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>More accurate than a chest X-ray.</li>\n<li>Focal dense <span class=\"customMeta\" data-dictid=\"990cbfd3111692777194c6967ee125\">opacification</span> of an entire <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> occurs, with relative sparing of the large airways. Associated findings may include <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities in a <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> pattern, indicating areas of partial involvement or atelectasis.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Lobar &lt;span class=\" custommeta\"=\"\" data-dictid=\"1000989d33169277719652247cd559\"/>pneumonia CT\" data-author=\"Al Khateeb A, <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">Lobar</span> pneumonia. Case study, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-50499\" data-hash=\"8948\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/lobar-pneumonia\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/notes/kLwyh6x1QTPtUmWsJLAL1744318203.png\" width=\"321\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<ul>\n<li>Image shows left upper lung <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"b1357efd5116927771859dfba380e7\">consolidation</span> of <span class=\"customMeta\" data-dictid=\"b2dafdf91e16927771884f1d4b5107\">heterogenous</span> density, with multiple air bronchograms, and small left pleural effusion</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Complete <span class=\"customMeta\" data-dictid=\"57525e6f6416927771835d0fb0bee5\">Blood Count</span> (CBC):\n\t\t\t\t<ul>\n<li>Look for <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> (leftward shift) as a sign of infection.</li>\n<li>Leukopenia may indicate a poor prognosis.</li>\n</ul>\n</li>\n<li>Inflammatory Biomarkers: <span class=\"customMeta\" data-dictid=\"49069760291692777187e0e72db819\">ESR</span> and <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> phase reactants to assess severity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sputum Analysis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Sputum <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">Gram</span> <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> and culture critical for suspected <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> pneumonia.</li>\n<li>Sputum culture is the <strong>most specific <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</strong> for identifying the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organism. <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Influenza Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Recommended during <strong>winter months </strong>due to the risk of co-infection with pneumonia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Patient Stratification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Use CURB-65 and the <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> severity index to determine <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> needs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hospitalized patients: <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> culture, blood culture, and/or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> testing before antibiotics.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Invasive Procedures</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Thoracocentesis, bronchoscopy, pleural biopsy, and pleural fluid culture are rarely performed.</li>\n<li><strong>Open lung <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is the ultimate specific <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements are true regarding breath sounds?", "options": [{"label": "A", "text": "Vesicular breath sounds are soft, low-pitched sounds heard at the bronchus", "correct": false}, {"label": "B", "text": "Bronchial sounds are loud, high-pitched best heard at lung bases of normal lung", "correct": false}, {"label": "C", "text": "Egophony is the increased resonance of voice sounds heard when auscultating the lungs", "correct": true}, {"label": "D", "text": "Whispered pectoriloquy rules out the presence of lung consolidation", "correct": false}], "correct_answer": "C. Egophony is the increased resonance of voice sounds heard when auscultating the lungs", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0GByqO70qaubY8O2eceS1744317842.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bronchial Sounds</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vesicular Sounds</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tracheobronchial tree</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Finer lung parenchyma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Loud, harsh, high-pitched</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Soft, low-pitched</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Predominantly expiratory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Predominantly inspiratory</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Heard over the <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> or right apex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Best appreciated at <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> lung bases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Abnormality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Abnormal if heard in other areas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Normal in healthy lung areas</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 year old man presents to the ED with a 5-day history of fever, productive cough, and worsening shortness of breath. On examination, he exhibits tachypnea, and his sputum is thick and yellowish. He complains of sharp pleuritic chest pain when taking deep breaths. The physician notes increased vocal fremitus and egophony on examination. Based on the clinical features presented, which of the following findings is most likely to be noted upon auscultation of this patient’s lungs?", "options": [{"label": "A", "text": "Absence of breath sounds", "correct": false}, {"label": "B", "text": "Wheezing", "correct": false}, {"label": "C", "text": "Ronchi", "correct": false}, {"label": "D", "text": "Presence of crackles and bronchial breath sounds", "correct": true}], "correct_answer": "D. Presence of crackles and bronchial breath sounds", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following conditions of pneumonia to their respective causative organisms: 1. Alcoholic patient with Pneumonia a) Legionella pneumophila 2. Pneumonia due to contact with Bats b) Coxiella burnetii 3. Pneumonia after Hotel/cruise c) Pneumococcus pneumonia 4. Pneumonia due to contact with Goat/sheep d) Histoplasmosis", "options": [{"label": "A", "text": "1-c, 2-d, 3-a, 4-b", "correct": true}, {"label": "B", "text": "1-d, 2-b, 3-a, 4-c", "correct": false}, {"label": "C", "text": "1-a, 2-b, 3-d, 4-a", "correct": false}, {"label": "D", "text": "1-b, 2-c, 3-d, 4-a", "correct": false}], "correct_answer": "A. 1-c, 2-d, 3-a, 4-b", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o woman presents with the characteristic fingers as shown in the image, along with chronic cough, daily production of large amounts of purulent sputum and a history of recurrent lung infections over the past several years. Her CT scan revealed the following findings. A biopsy of the affected lung tissue is performed. Which of the following histopathological findings is most likely present?", "options": [{"label": "A", "text": "Hypertrophy of the bronchial arteries.", "correct": true}, {"label": "B", "text": "Presence of caseating granulomas", "correct": false}, {"label": "C", "text": "Extensive alveolar damage", "correct": false}, {"label": "D", "text": "Bronchiectatic cavities lined exclusively by ciliated epithelium", "correct": false}], "correct_answer": "A. Hypertrophy of the bronchial arteries.", "question_images": ["https://image.prepladder.com/notes/wMZ2m9RfFnI6Jy0PwWDq1744315061.png", "https://image.prepladder.com/notes/vfpklhUzmA4Q4DrWk4nN1744315198.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bronchiectasis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irreversible <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of the <span class=\"customMeta\" data-dictid=\"4a371bd76e16927771835d6c738d1d\">bronchi</span> leads to chronic <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> infection and progressive lung damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Areas Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathological Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cylindrical (Tubular): Most common.</strong></li>\n<li>Varicose.</li>\n<li>Cystic.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Focal Bronchiectasis</u>: <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> and is due to <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (e.g., tumour, foreign body).</li>\n<li><u>Diffuse Bronchiectasis</u>: Widespread, from <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> or <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> causes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bronchiectatic cavities lined by <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> epithelium, or normal <span class=\"customMeta\" data-dictid=\"633c742e4116927771845f77370d44\">ciliated</span> epithelium. <strong>(Option D)</strong></li>\n<li>Inflammatory changes in bronchial walls.</li>\n<li><strong>Bronchial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> hypertrophy.</strong></li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> lead to the destruction of normal lung tissue in advanced cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old student presents with a 10-day history of dry cough, mild fever, and fatigue, but has been able to attend daily activities. Chest X-ray shows patchy infiltrates and a physical exam reveals mild crackles. Which of the following is the LEAST likely causative agent of this patient's condition?", "options": [{"label": "A", "text": "Mycoplasma pneumoniae", "correct": false}, {"label": "B", "text": "Chlamydia pneumoniae", "correct": false}, {"label": "C", "text": "Legionella pneumophila", "correct": false}, {"label": "D", "text": "Klebsiella pneumoniae", "correct": true}], "correct_answer": "D. Klebsiella pneumoniae", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 y/o male with a h/o DM presents to the ER with a persistent cough, high fever, and shortness of breath. He recently returned from a week-long cruise in the Caribbean. O/E, he has decreased breath sounds on one side, and a chest X-ray reveals infiltrates that are suggestive of pneumonia. Given the patient's history and recent travel, which of the following is the most likely causative organism for his pneumonia?", "options": [{"label": "A", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "B", "text": "Legionella species", "correct": true}, {"label": "C", "text": "Haemophilus influenzae", "correct": false}, {"label": "D", "text": "Mycoplasma pneumoniae", "correct": false}], "correct_answer": "B. Legionella species", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Community-Acquired <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> (CAP)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Atypical Pneumonia</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outpatients</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hospitalized Patients</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes M.pneumoniae C.pneumoniae, and <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common causes:</p>\n<p>S.pneumoniae, M.pneumoniae</p>\n<p>H. influenzae, C.pneumoniae, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> viruses(influenza, RSV).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-ICU</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ICU Patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar pathogens to outpatients, plus <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathogens include</p>\n<p>S.pneumoniae, S. aureus (including MRSA), <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species, <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> bacilli, and H. influenzae.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methicillin-resistant <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> aureus (MRSA)</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can cause CAP, often complicating <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> infections.</li>\n<li>Community-acquired <span class=\"customMeta\" data-dictid=\"fdcadd75c416927771935379e47ef6\">MRSA</span> (CA-MRSA) has emerged as a significant cause of <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> pneumonia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumococcal Pneumonia</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Higher risk in elderly patients, and those with comorbidities like dementia, heart failure, <span class=\"customMeta\" data-dictid=\"75a3b02a801692777184b9cb7f0c0a\">cerebrovascular</span> disease, alcoholism, smoking, COPD, and <strong>HIV infection</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CA-MRSA Pneumonia</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More likely in patients with prior skin infections or following <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> illnesses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enterobacteriaceae</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common in patients recently hospitalized, those treated with antibiotics, or those with comorbidities like alcoholism, heart failure, or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudomonas aeruginosa</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Found in patients with severe structural lung diseases such as bronchiectasis, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> fibrosis, or advanced COPD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Legionella Infection</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with risk factors like diabetes, hematologic malignancies, cancer, severe <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease, HIV, smoking, male gender, and recent travel (air conditioners, shower, hotels, cruise ships). It is an important cause of <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> pneumonia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following represents the correct order of pathological stages in classic pneumonia?", "options": [{"label": "A", "text": "Edema Stage → Gray Hepatization → Red Hepatization → Resolution Stage", "correct": false}, {"label": "B", "text": "Edema Stage → Red Hepatization → Gray Hepatization → Resolution Stage", "correct": true}, {"label": "C", "text": "Gray Hepatization → Red Hepatization → Edema Stage → Resolution Stage", "correct": false}, {"label": "D", "text": "Red Hepatization → Resolution Stage → Edema Stage → Gray Hepatization", "correct": false}], "correct_answer": "B. Edema Stage → Red Hepatization → Gray Hepatization → Resolution Stage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HvaYMwDn80eRfoCWKOUS1740663167.png", "https://image.prepladder.com/notes/mCVTH7A5dVSRrXg8f3T31744317317.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o man with a history of bronchiectasis presents for follow-up after sputum analysis reveals Mycobacterium avium complex (MAC) infection. What is the recommended treatment regimen for this patient's infection?", "options": [{"label": "A", "text": "Itraconazole + Rifampin + Ethambutol", "correct": false}, {"label": "B", "text": "Macrolide + Rifampin + Ethambutol", "correct": true}, {"label": "C", "text": "Macrolide + Isoniazid + Ethambutol", "correct": false}, {"label": "D", "text": "Rifampin + Isoniazid + Pyrazinamide", "correct": false}], "correct_answer": "B. Macrolide + Rifampin + Ethambutol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotic Treatment</strong>:</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute Exacerbations</strong>: Target common pathogens (<em>Haemophilus influenzae</em>, <em>Pseudomonas aeruginosa</em>) for at least 7–10 days.</li>\n<li><strong>NTM Infections</strong>: Complex treatment with specific <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> criteria, requiring multiple positive <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> cultures and histopathological evidence.</li>\n<li><strong>Regimen for MAC</strong>: For macrolide-sensitive <span class=\"customMeta\" data-dictid=\"7519fc85511692777191a7f67777eb\">MAC</span> in HIV-negative patients: <span class=\"customMeta\" data-dictid=\"f5744538d81692777191ebc73a4466\">macrolide</span> + <span class=\"customMeta\" data-dictid=\"0a8c2e2c42169277719721608c50a4\">rifampin</span> + ethambutol.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bronchial Hygiene</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Enhance <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> with hydration, mucolytics, bronchodilators, hyperosmolar agents, and chest physiotherapy.</li>\n<li>Pulmonary rehabilitation and exercise</li>\n<li>Use <span class=\"customMeta\" data-dictid=\"d3957bd7ec16927771931064fb9a0a\">mucolytic</span> dornase (DNase) in CF-related bronchiectasis; avoid it in non-CF cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-Inflammatory Therapy</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inhaled glucocorticoids may reduce <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> and <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> production; with limited effect on lung function or <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> rates.</li>\n<li>Consider oral/systemic glucocorticoids for <span class=\"customMeta\" data-dictid=\"5a31874e311692777183c5a3cc719e\">bronchiectasis</span> due to ABPA and <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases.</li>\n<li>Itraconazole may benefit ABPA patients. <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Refractory Cases</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> suppuration; lung <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> for advanced bronchiectasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent infections can cause <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> resistance and severe hemoptysis, requiring intubation, identification of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> sources, and possible bronchial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> or surgery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Address immunodeficiencies with <span class=\"customMeta\" data-dictid=\"49be0416121692777188dc8944b7bc\">gamma</span> globulin, <span class=\"customMeta\" data-dictid=\"25d0db637516927772019da4d7b8f7\">vaccinate</span> against <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> and pneumococcus, and consider suppressive antibiotics (daily oral, rotating schedules, macrolides, inhaled, or <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> IV) for patients with <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o male presents with a chronic productive cough, dyspnea, and occasional hemoptysis. A chest radiograph of the patient is given. Which investigation would be most appropriate for confirming the provisional diagnosis?", "options": [{"label": "A", "text": "Sputum analysis", "correct": false}, {"label": "B", "text": "Chest computed tomography (CT)", "correct": true}, {"label": "C", "text": "Pulmonary function tests (PFTs)", "correct": false}, {"label": "D", "text": "Bronchoscopy", "correct": false}], "correct_answer": "B. Chest computed tomography (CT)", "question_images": ["https://image.prepladder.com/notes/6YnJ9wU2frtSLS8kuUiD1744315471.png"], "explanation_images": ["https://image.prepladder.com/notes/FxSLpXyJm1nlu94vLnNu1744315601.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bronchiectasis - Tram track sign</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HRCT</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Bronchiectasis Tram Track appearance\" data-author=\"Edney G, Tram track sign (on chest radiograph). Case study, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-61866\" data-hash=\"8916\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/tram-track-sign-on-chest-radiograph\" data-tags=\"\" height=\"346\" src=\"https://image.prepladder.com/notes/FxSLpXyJm1nlu94vLnNu1744315601.png\" width=\"324\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n\t\t\t \n\n\t\t\t<p><strong>Black arrows pointing to tram track sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bronchiectasis HRCT Tram track sign\" custommeta\"=\"\" data-author=\"Bickle I, &lt;span class=\" data-dictid=\"38c41e122116927771859b63deb0ed\"/>Cystic bronchiectasis. Case study, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-40909\" data-hash=\"8917\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/cystic-bronchiectasis-11#image-17291646\" data-tags=\"\" height=\"334\" src=\"https://image.prepladder.com/notes/D03Ll1en4BVRbIfB7kuT1744315720.png\" width=\"412\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p><strong>Red arrows pointing to tram track sign</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 y/o woman with a history of recurrent lung infections presents to the emergency. She reports increased sputum volume and a change in sputum colour. O/E, she demonstrates wheezing and crackles. What does the change in sputum production most likely indicate?", "options": [{"label": "A", "text": "Initiation of effective airway clearance therapy", "correct": false}, {"label": "B", "text": "Worsening infection and inflammation", "correct": true}, {"label": "C", "text": "The onset of remission in chronic lung disease", "correct": false}, {"label": "D", "text": "Onset of allergic reaction", "correct": false}], "correct_answer": "B. Worsening infection and inflammation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bronchiectasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Physical Examination Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Persistent Productive Cough: There is thick, copious sticky <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> due to impaired <span class=\"customMeta\" data-dictid=\"d90d813c741692777193a2b52ba508\">mucociliary</span> clearance.</li>\n<li>Shortness of Breath (Dyspnea)</li>\n<li>Pleuritic Pain or Discomfort</li>\n<li>Hemoptysis</li>\n<li>Fatigue and Weight Loss</li>\n<li>Acute Exacerbations: Increased <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> volume and <span class=\"customMeta\" data-dictid=\"777aac4b1e1692777196dae7606bb8\">purulence</span> indicate worsening infection or inflammation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Crackles and Wheezing: Commonly heard during auscultation, crackles suggest alveolar involvement, while wheezing indicates <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction.</li>\n<li>Clubbing: <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">Enlargement</span> and rounding of the fingertips.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is commonly associated with bronchiectasis affecting the lower lobes?", "options": [{"label": "A", "text": "Cystic Fibrosis", "correct": false}, {"label": "B", "text": "Allergic Bronchopulmonary Aspergillosis", "correct": false}, {"label": "C", "text": "Nontuberculous mycobacterial infection", "correct": false}, {"label": "D", "text": "Chronic Recurrent Aspiration", "correct": true}], "correct_answer": "D. Chronic Recurrent Aspiration", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lobe Involvement in Bronchiectasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Upper Lung Fields</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mid Lung Fields</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lower Lung Fields</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Central Airways</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cystic <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">Fibrosis</span> <strong>(Option A ruled out)</strong></li>\n<li>Post-radiation Fibrosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nontuberculous Mycobacterial (NTM) Infection <strong>(Option C ruled out)</strong></li>\n<li>Dyskinetic/ Immotile <span class=\"customMeta\" data-dictid=\"c3ceefdd5c16927771840391a4a4a4\">Cilia</span> Syndrome.</li>\n<li>AAT-1 deficiency</li>\n<li>Brocks syndrome</li>\n<li>Yellow nail syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> Aspiration</strong>: Conditions like <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> disorders result in aspiration. <strong>(Option D)</strong></li>\n<li>End-stage Fibrotic Lung Disease: <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">Traction</span> <span class=\"customMeta\" data-dictid=\"5a31874e311692777183c5a3cc719e\">bronchiectasis</span> as a result of parenchymal <span class=\"customMeta\" data-dictid=\"eaec97de1d1692777186b2ce902b4d\">distortion</span> and fibrosis.</li>\n<li>Hypogammaglobulinemia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Allergic <span class=\"customMeta\" data-dictid=\"96449e83e1169277718352d3106918\">Bronchopulmonary</span> <span class=\"customMeta\" data-dictid=\"f20677153f1692777182eb3e84f780\">Aspergillosis</span> (ABPA) <strong>(Option B ruled out)</strong></li>\n<li><strong>Congenital conditions that primarily impact the central airways: </strong>Tracheobronchomegaly (Mounier-Kuhn Syndrome) and Williams-Campbell Syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40 y/o man, a non-smoker, presents with shortness of breath, chronic cough, and repeated respiratory infections. His chest CT shows emphysema and bronchiectasis. Lab results indicate low alpha-1 antitrypsin levels. What is the most likely reason for the bronchiectasis seen in this patient?", "options": [{"label": "A", "text": "Idiopathic airway dilation", "correct": false}, {"label": "B", "text": "Recurrent infections due to defective chloride transport", "correct": false}, {"label": "C", "text": "Impaired ciliary function leading to mucus retention", "correct": false}, {"label": "D", "text": "Increased neutrophil elastase activity causing damage", "correct": true}], "correct_answer": "D. Increased neutrophil elastase activity causing damage", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o female with asthma presents with worsening cough, wheezing, and episodes of hemoptysis. Chest imaging reveals central bronchiectasis, and blood tests show elevated total IgE levels and eosinophil count. What is the most likely cause of the bronchiectasis?", "options": [{"label": "A", "text": "Cystic fibrosis", "correct": false}, {"label": "B", "text": "Primary ciliary dyskinesia", "correct": false}, {"label": "C", "text": "Allergic bronchopulmonary aspergillosis (ABPA)", "correct": true}, {"label": "D", "text": "Idiopathic bronchiectasis", "correct": false}], "correct_answer": "C. Allergic bronchopulmonary aspergillosis (ABPA)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of Bronchiectasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Congenital Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acquired Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Other Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cystic Fibrosis</strong>: Causes thick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> build-up in the lungs, leading to <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections and <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> bronchiectasis.</li>\n<li><strong>Ciliary <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">Dysfunction</span> Syndromes</strong>: Conditions like primary <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> <span class=\"customMeta\" data-dictid=\"aa971a0b1c169277718621174b6657\">dyskinesia</span> and Kartagener’s syndrome cause <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"d90d813c741692777193a2b52ba508\">mucociliary</span> clearance, resulting in bronchiectasis.</li>\n<li><strong>Primary Hypogammaglobulinaemia</strong>: Low <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> production leads to repeated infections and <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> damage, causing bronchiectasis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Severe Infections</strong>: Childhood infections like whooping <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> and <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> can damage airways (Usually <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> type).</li>\n<li><strong>Pulmonary Tuberculosis</strong>: Can result in both <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> and <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> bronchiectasis.</li>\n<li><strong>Suppurative Pneumonia</strong></li>\n<li><strong>Inhaled Foreign Bodies</strong>: <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> causes <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"5a31874e311692777183c5a3cc719e\">bronchiectasis</span> by preventing <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> beyond the blockage.</li>\n<li><strong>Allergic <span class=\"customMeta\" data-dictid=\"96449e83e1169277718352d3106918\">Bronchopulmonary</span> <span class=\"customMeta\" data-dictid=\"f20677153f1692777182eb3e84f780\">Aspergillosis</span> (ABPA)</strong>: An allergic reaction to <span class=\"customMeta\" data-dictid=\"e3baadccd91692777182c9724090b3\">Aspergillus</span> mainly causing central <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> bronchiectasis.</li>\n<li><strong>Bronchial Tumours</strong>: Can obstruct airways.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic</strong>: Accounts for a significant proportion of cases.</li>\n<li><strong>Rheumatoid Arthritis</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 16-year-old female with cystic fibrosis presents with increased productive cough, fever, and worsening shortness of breath. Her sputum culture grows Pseudomonas aeruginosa. Which of the following best explains why this organism commonly causes respiratory infections in cystic fibrosis patients?", "options": [{"label": "A", "text": "Defective neutrophil chemotaxis to the site of infection", "correct": false}, {"label": "B", "text": "Abnormal periciliary fluid layer leading to impaired mucociliary clearance", "correct": true}, {"label": "C", "text": "Direct immunosuppressive effect of the CFTR protein mutation", "correct": false}, {"label": "D", "text": "Increased expression of bacterial adhesion molecules on respiratory epithelium", "correct": false}], "correct_answer": "B. Abnormal periciliary fluid layer leading to impaired mucociliary clearance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:655px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CFTR Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> <strong>Defective chloride/bicarbonate transport</strong></li>\n<li> Located in <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> membranes</li>\n<li> F508del (phenylalanine is replaced) <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> most common (~70%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Airway Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> Depleted periciliary fluid layer</li>\n<li> <strong>Thick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> accumulation</strong></li>\n<li> <strong>Impaired <span class=\"customMeta\" data-dictid=\"d90d813c741692777193a2b52ba508\">mucociliary</span> clearance</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infection Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> <strong>Common pathogens: P. aeruginosa, S. aureus</strong></li>\n<li> Chronic bacterial colonization</li>\n<li><strong> Progressive bronchiectasis</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Impact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li> <strong>Recurrent pneumonia</strong></li>\n<li> Progressive lung damage</li>\n<li> Requires aggressive <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-month-old infant presents with failure to thrive, recurrent respiratory infections, and elevated sweat chloride. Genetic testing reveals two copies of the F508del mutation in the CFTR gene. This mutation results in a protein that fails to reach the cell surface due to degradation in the endoplasmic reticulum. Which class of CFTR mutation does this represent, and what percentage of CF patients carry at least one copy of this mutation?", "options": [{"label": "A", "text": "Class I mutation; ~30% of patients", "correct": false}, {"label": "B", "text": "Class II mutation; ~70% of patients", "correct": true}, {"label": "C", "text": "Class III mutation; ~50% of patients", "correct": false}, {"label": "D", "text": "Class IV mutation; ~40% of patients", "correct": false}], "correct_answer": "B. Class II mutation; ~70% of patients", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mutation Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protein Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Impact</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class I &amp; II</p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No functional protein or severe processing defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pancreatic insufficiency, severe lung disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class III &amp; IV</p>\n<p><strong>(Option C, D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defective channel function or conductance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable pancreatic status, moderate lung disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced amount of normal protein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of pancreatic <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> compared to class I and II, milder lung disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class VI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased protein stability</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable severity based on protein <span class=\"customMeta\" data-dictid=\"a13747deff16927772016cfbf6b284\">turnover</span> rate</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:706px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Organ System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> plugging</li>\n<li>Bronchiectasis</li>\n<li>Chronic inflammation</li>\n<li>Submucosal <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> hypertrophy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic productive cough</li>\n<li>Recurrent infections</li>\n<li>Progressive dyspnea</li>\n<li>Digital clubbing</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>P. aeruginosa in sputum</li>\n<li>Obstructive pattern on PFTs</li>\n<li>Bronchiectasis on CT</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pancreatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duct obstruction</li>\n<li>Acinar cell destruction</li>\n<li>Fibrosis</li>\n<li>Fat replacement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malabsorption</li>\n<li>Steatorrhea</li>\n<li>Failure to thrive</li>\n<li>Fat-soluble vitamin deficiency</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low fecal elastase</li>\n<li>Elevated fecal fat</li>\n<li>Low vitamins A, D, E, K</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sweat Glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> transport</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> structure</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Salty-tasting skin</li>\n<li>Heat intolerance</li>\n<li>Salt depletion</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated sweat chloride</li>\n<li>&gt;60 mEq/L diagnostic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatobiliary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> plugging</li>\n<li>Focal <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> cirrhosis</li>\n<li>Multilobular cirrhosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neonatal cholestasis</li>\n<li>Portal hypertension</li>\n<li>Gallstones</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated liver enzymes</li>\n<li>Ultrasound changes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old boy comes to the emergency department with difficulty breathing and a productive cough. He has a history of recurrent sinusitis and otitis media and usually responds well to antibiotics. Crackles and wheezing are heard on pulmonary auscultation and CVS examination shows the cardiac point of maximum impulse on the right 5th intercostal space. Which of them is not seen in this condition?", "options": [{"label": "A", "text": "Dynein arm defect", "correct": false}, {"label": "B", "text": "Normal sweat chloride test", "correct": false}, {"label": "C", "text": "CFTR mutation", "correct": true}, {"label": "D", "text": "Defective mucociliary clearance", "correct": false}], "correct_answer": "C. CFTR mutation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:697px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kartagener's Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystic Fibrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Situs inversus</li>\n<li>Recurrent sinusitis</li>\n<li>Recurrent pneumonia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic cough</li>\n<li>Steatorrhea</li>\n<li>Failure to thrive</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dynein protein <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CFTR mutation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Problem</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defective <span class=\"customMeta\" data-dictid=\"d90d813c741692777193a2b52ba508\">mucociliary</span> <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> transport</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Male infertility</li>\n<li>Situs inversus</li>\n<li>Normal sweat chloride<strong> (Option B)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated sweat chloride</li>\n<li>Male and female infertility</li>\n<li>Pancreatic insufficiency</li>\n<li>Normal organ placement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old child presents with a chronic productive cough, nasal polyps, and poor weight gain despite normal appetite. Which of the following is the most likely associated condition?", "options": [{"label": "A", "text": "Primary ciliary dyskinesia", "correct": false}, {"label": "B", "text": "Asthma", "correct": false}, {"label": "C", "text": "Cystic fibrosis", "correct": true}, {"label": "D", "text": "Bronchopulmonary dysplasia", "correct": false}], "correct_answer": "C. Cystic fibrosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory System:</strong><br/>\n\t\t\tDue to <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> channels, <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> becomes dehydrated and highly viscous.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Airway Obstruction:</strong> Thickened <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> obstructs the airways, making it difficult to clear, trapping pathogens, and leading to frequent infections.</li>\n<li><strong>Chronic Infections:</strong> CF patients harbour chronic infections with <strong>Staphylococcus aureus, <span class=\"customMeta\" data-dictid=\"e8810d5c6b169277718827849b05a3\">Haemophilus</span> influenzae, and <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa.</strong> Over time, <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> evolves into a <strong>mucoid </strong>form that is highly resistant to treatment and worsens prognosis.</li>\n<li><strong>Inflammation and Bronchiectasis:</strong> Persistent infection leads to chronic <span class=\"customMeta\" data-dictid=\"041f0e547a1692777193350b3f7d39\">neutrophilic</span> inflammation, damaging <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> tissue and causing <span class=\"customMeta\" data-dictid=\"5a31874e311692777183c5a3cc719e\">bronchiectasis</span> (permanent <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> dilation). This <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response further exacerbates <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> accumulation and infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pancreas:</strong><br/>\n\t\t\tCFTR <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> leads to <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> of pancreatic ducts by thickened secretions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Exocrine Pancreatic Insufficiency: </strong>The ducts become obstructed, preventing <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> enzymes from reaching the intestines, leading to <strong>malabsorption, <span class=\"customMeta\" data-dictid=\"0e5348eb421692777199f7a9fc4b0c\">steatorrhea</span> (fatty stools), and poor weight gain</strong>.</li>\n<li><strong>Endocrine Dysfunction: </strong>Over time, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> damage pancreatic islets, increasing the risk of <strong>CF-related <span class=\"customMeta\" data-dictid=\"b6a934c67b16927771868fca92baf9\">diabetes mellitus</span> (CFRD)</strong>, a common <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> in adults with CF.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal Tract:</strong><br/>\n\t\t\tThick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> impacts various parts of the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> system.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Meconium <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">Ileus</span> in Newborns:</strong> Nearly 10-20% of newborns with CF present with <span class=\"customMeta\" data-dictid=\"19a40edc9816927771924fd7dd0efa\">meconium</span> ileus, an <span class=\"customMeta\" data-dictid=\"fb7b40ddbe1692777190ca311f4bd7\">intestinal obstruction</span> that can be life-threatening without <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</li>\n<li><strong>Distal Intestinal Obstructive Syndrome (DIOS):</strong> Older children and adults may experience DIOS, where thickened intestinal contents obstruct the lower intestines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CF can lead to <strong>biliary <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> </strong>due to <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> plugging in <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts. Approximately 5-10% of patients develop <span class=\"customMeta\" data-dictid=\"5f2e8f9d5816927771936322b6cf48\">multilobular</span> cirrhosis, which may progress to <strong>portal <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and liver failure</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reproductive System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Male Infertility: </strong>Males with CF will have a <strong>congenital <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> absence of the <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">vas</span> <span class=\"customMeta\" data-dictid=\"c8e17879f71692777185360caf5372\">deferens</span> (CBAVD)</strong>, leading to <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> despite <strong>normal spermatogenesis</strong>.</li>\n<li><strong>Female Infertility:</strong> Females with CF may also face <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> due to <strong>thick <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> mucus</strong> that hinders <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> penetration.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-month-old infant presents with recurrent respiratory infections and failure to thrive. Physical examination reveals digital clubbing and productive cough. A sweat test shows elevated chloride levels, but the genotype analysis for common CFTR mutations is inconclusive. Which of the following investigations is the next best step for confirming the diagnosis of cystic fibrosis in this patient?", "options": [{"label": "A", "text": "Bronchoalveolar lavage", "correct": false}, {"label": "B", "text": "Nasal potential difference measurement", "correct": true}, {"label": "C", "text": "Chest X-ray", "correct": false}, {"label": "D", "text": "Genetic panel including rare CFTR mutations", "correct": false}], "correct_answer": "B. Nasal potential difference measurement", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn screening for CF shows elevated immunoreactive trypsinogen (IRT) levels. What is the next best step in the diagnostic process?", "options": [{"label": "A", "text": "Repeat the IRT test in 6 months", "correct": false}, {"label": "B", "text": "Genetic testing for CFTR mutations", "correct": true}, {"label": "C", "text": "Chest X-ray", "correct": false}, {"label": "D", "text": "Fecal elastase levels", "correct": false}], "correct_answer": "B. Genetic testing for CFTR mutations", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following therapies directly targets the basic molecular defect in cystic fibrosis for a patient with a G551D mutation?", "options": [{"label": "A", "text": "Pancreatic enzyme supplements", "correct": false}, {"label": "B", "text": "Lumacaftor", "correct": false}, {"label": "C", "text": "Ivacaftor", "correct": true}, {"label": "D", "text": "Hypertonic saline nebulization", "correct": false}], "correct_answer": "C. Ivacaftor", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CFTR Modulators:</strong></p>\n<p>Target the root cause of CF in patients with specific mutations.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ivacaftor:</strong> A <strong>potentiator </strong>for <span class=\"customMeta\" data-dictid=\"992a9d591616927771880f3a9328f4\">gating</span> mutations like G551D, enhancing <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> transport by improving <span class=\"customMeta\" data-dictid=\"da0dfb8fa61692777184291349addf\">CFTR</span> channel opening. <strong>(Option C)</strong></li>\n<li><strong>Lumacaftor and Tezacaftor:</strong> <strong>Correctors </strong>that aid <span class=\"customMeta\" data-dictid=\"da0dfb8fa61692777184291349addf\">CFTR</span> protein folding and trafficking, effective for F508del homozygous patients when combined with ivacaftor.</li>\n<li><strong>Elexacaftor-Tezacaftor-Ivacaftor (Trikafta)</strong>:\n\t\t\t\t<ul>\n<li>A triple-combination therapy approved for patients with at least one F508del mutation.</li>\n<li>This combination substantially improves lung function, nutritional status, and quality of life.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary Therapy:</strong></p>\n<p>For improving <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> and managing chronic infections.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Airway <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">Clearance</span> Techniques (ACTs):</strong> Chest physiotherapy, high-frequency <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> oscillation, and oscillating positive <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> pressure (PEP) devices help mobilize and clear thick mucus.</li>\n<li><strong>Nebulized Medications:</strong>\n<ul>\n<li>Hypertonic <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> and <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">recombinant</span> human <span class=\"customMeta\" data-dictid=\"d26515fc0d1692777186f2866114a0\">DNase</span> (dornase alfa) thin <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> and enhance clearance.</li>\n<li>Inhaled antibiotics (e.g., tobramycin) are used for chronic <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> infections.</li>\n</ul>\n</li>\n<li><strong>Anti-inflammatory Agents:</strong> <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">Azithromycin</span> is used for intense <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> in CF lungs for its anti-inflammatory properties.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Digestive Support:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pancreatic <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> replacement therapy </strong>for managing pancreatic insufficiency. <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">Enzyme</span> supplements improve <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> and nutrient absorption.</li>\n<li>Fat-soluble vitamin supplementation (A, D, E, K) to prevent deficiencies.</li>\n<li><strong>High-calorie, high-protein diet: </strong>to maintain adequate growth and body weight.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CF Complications:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CF-related Diabetes (CFRD): </strong>Managed with insulin, as oral <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">hypoglycemic</span> agents are generally ineffective.</li>\n<li><strong>Liver Disease:</strong> <span class=\"customMeta\" data-dictid=\"fe9d24b51c169277720101dde3ec3a\">Ursodeoxycholic acid</span> can be used to manage <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> complications.</li>\n<li><strong>End-stage Lung Disease:</strong> Lung <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> is an option for advanced disease with <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure. <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">Median</span> survival post-transplant is over 9 years.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old obese male (BMI- 40) presents with complaints of loud snoring and daytime sleepiness. His wife reports that he complains of disturbed sleep due to waking up out of breath because of an obstruction of the airway. Polysomnography reveals repetitive episodes showing: Sharp inspiratory uptake Flattened/plateau wave Scooped out breathing pattern Flow limitation Oxygen desaturation What is the correct sequence of pathophysiologic events leading to his symptoms?", "options": [{"label": "A", "text": "REM sleep → Hypoxia → Pharyngeal dilator muscle relaxation → Airway narrowing → snoring", "correct": false}, {"label": "B", "text": "Pharyngeal dilator muscle relaxation → Airway narrowing → Flow limitation → Hypoxia → Cortical arousal", "correct": true}, {"label": "C", "text": "Obesity → Flow limitation → Airway collapse → Snoring → Bradycardia → Hypoxia", "correct": false}, {"label": "D", "text": "Hypoxia → Airway collapse → Flow limitation → Bradycardia → Cortical arousal", "correct": false}], "correct_answer": "B. Pharyngeal dilator muscle relaxation → Airway narrowing → Flow limitation → Hypoxia → Cortical arousal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with complaints of daytime sleepiness and morning headaches, and his wife reports loud snoring with episodes of gasping during sleep. His BMI is 32 kg/m², neck circumference is 44 cm, and he has retrognathia. His blood pressure is 148/92 mmHg. Which of the following combinations of additional clinical features and diagnostic findings would not be seen with obstructive sleep apnea in this patient?", "options": [{"label": "A", "text": "Fragmented sleep on PSG", "correct": false}, {"label": "B", "text": "Central obesity, elevated sweat chloride, pancreatic insufficiency", "correct": true}, {"label": "C", "text": "Nondipping nocturnal blood pressure pattern", "correct": false}, {"label": "D", "text": "Frequent arousals with oxygen desaturation", "correct": false}], "correct_answer": "B. Central obesity, elevated sweat chloride, pancreatic insufficiency", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:512px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nocturnal Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loud snoring</li>\n<li>Witnessed apneas</li>\n<li>Gasping/choking episodes</li>\n<li>Frequent awakenings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Daytime Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excessive daytime sleepiness</li>\n<li>Morning headaches</li>\n<li>Difficulty concentrating</li>\n<li>Irritability</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obesity (especially central)</li>\n<li>Large neck circumference</li>\n<li>Retrognathia</li>\n<li>Hypertension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fragmented sleep on PSG</li>\n<li>Frequent arousals</li>\n<li>Oxygen desaturation</li>\n<li>Nondipping <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> pattern</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PSG Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Typical <span class=\"customMeta\" data-dictid=\"1c7fb88b45169277719464b58ed4c5\">OSA</span> Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Events</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cessation of <span class=\"customMeta\" data-dictid=\"99caf903791692777180bc28743310\">airflow</span> ≥10 seconds</li>\n<li>Continued chest/abdominal effort</li>\n<li><strong>AHI 5-14 (mild), 15-29 (moderate), ≥30 (severe)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicates upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> with continued <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> effort</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxygen Saturation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intermittent desaturations ≥3% <span class=\"customMeta\" data-dictid=\"1dc6654c781692777185d3f1040369\">Cycling</span> pattern with events</li>\n<li>May see significant drops</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reflects severity and potential <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> impact</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sleep Architecture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased light sleep (N1)</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"7fdc13a6a116927771865b3a13263e\">deep sleep</span> (N3)</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"7bdd34850816927771973c86f95b79\">REM</span> sleep</li>\n<li>Fragmented sleep pattern</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicates sleep <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> and poor sleep quality</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arousals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Frequent <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> arousals</li>\n<li>Event-related arousals</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"bf639c9a2316927771825e1632d9fb\">arousal</span> index</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Leads to sleep <span class=\"customMeta\" data-dictid=\"c3bbd691781692777203582ec44b8c\">fragmentation</span> and daytime symptoms</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect regarding risk factors of Obstructive Sleep Apnea?", "options": [{"label": "A", "text": "Premenopausal women have the same risk for OSA as postmenopausal women", "correct": true}, {"label": "B", "text": "A 10% increase in body weight is associated with a &amp;gt;30% increase in apnea-hypopnea index (AHI)", "correct": false}, {"label": "C", "text": "Approximately 40-60% of OSA cases are attributable to excess body weight", "correct": false}, {"label": "D", "text": "Men have approximately twice the risk of developing OSA compared to women", "correct": false}], "correct_answer": "A. Premenopausal women have the same risk for OSA as postmenopausal women", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Impact</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Demographic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Male gender</li>\n<li>Older age</li>\n<li>Post-menopausal status</li>\n<li>Family history</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Men have 2x higher risk <strong>(Option D)</strong></li>\n<li>Risk increases with age</li>\n<li>Hormonal protection in <span class=\"customMeta\" data-dictid=\"a9f4834def16927771962441e4ed98\">premenopausal</span> women</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Retrognathia/micrognathia</li>\n<li>Increased neck <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> (&gt;40cm in women, &gt;43cm in men)</li>\n<li>Nasal obstruction</li>\n<li>Enlarged tonsils</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Affects <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> patency</li>\n<li>Increases collapsibility</li>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> diameter</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Body Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obesity (BMI &gt;30)</li>\n<li>Central adiposity</li>\n<li>Weight gain</li>\n<li>Large waist circumference</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>40-60% of <span class=\"customMeta\" data-dictid=\"1c7fb88b45169277719464b58ed4c5\">OSA</span> attributable to <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> weight <strong>(Option C)</strong></li>\n<li>10% weight gain increases AHI by &gt;30%<strong> (Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Endocrine disorders (hypothyroidism, acromegaly)</li>\n<li>Diabetes mellitus</li>\n<li>Hypertension</li>\n<li>Down syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increases susceptibility</li>\n<li>May affect treatment response</li>\n<li>Bidirectional relationship</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old man presents to his primary care physician with complaints of excessive daytime sleepiness and his spouse reports loud snoring with disturbed sleep due to breathing pauses during sleep. His BMI is 34 kg/m² and neck circumference is 43 cm. Which of the following should be the INITIAL step in evaluating this patient?", "options": [{"label": "A", "text": "Order an overnight polysomnography immediately", "correct": false}, {"label": "B", "text": "Start CPAP therapy based on symptoms", "correct": false}, {"label": "C", "text": "Obtain detailed sleep history with standardized sleepiness questionnaires and perform focused physical examination", "correct": true}, {"label": "D", "text": "Order overnight home oximetry", "correct": false}], "correct_answer": "C. Obtain detailed sleep history with standardized sleepiness questionnaires and perform focused physical examination", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:681px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detailed sleep history</li>\n<li>Bed partner history</li>\n<li>Epworth Sleepiness Scale</li>\n<li>Screening questionnaires</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assess symptom severity</li>\n<li>Document witnessed events</li>\n<li>Quantify daytime sleepiness</li>\n<li>Screen for risk factors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>BMI and neck circumference</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> examination</li>\n<li>Jaw structure assessment</li>\n<li>Nasal examination</li>\n<li>Cardiovascular evaluation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Identify <span class=\"customMeta\" data-dictid=\"04f89c4775169277718128d3461838\">anatomic</span> risk factors</li>\n<li>Assess for complications</li>\n<li>Guide treatment options</li>\n<li>Screen for comorbidities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sleep Study Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In-lab <span class=\"customMeta\" data-dictid=\"7299ece8c716927771962e23263e82\">polysomnography</span> (PSG)</li>\n<li>Home sleep testing (HST)</li>\n<li>Split-night study if indicated</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gold standard &amp; IOC</strong>: PSG</li>\n<li>HST for selected patients</li>\n<li>Quantify disease severity</li>\n<li>Guide treatment decisions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ECG/cardiac evaluation</li>\n<li>Blood pressure monitoring</li>\n<li>Metabolic screening</li>\n<li>Cognitive/alertness testing</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assess complications</li>\n<li>Monitor comorbidities</li>\n<li>Guide comprehensive management</li>\n<li>Evaluate impairment</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man is diagnosed with moderate obstructive sleep apnea (AHI=22/hour) based on polysomnography. He has daytime sleepiness, BMI of 35 kg/m², and hypertension. Which of the following is the most appropriate initial treatment approach for this patient?", "options": [{"label": "A", "text": "Prescribe oral appliance therapy as first-line treatment", "correct": false}, {"label": "B", "text": "Initiate CPAP therapy with appropriate pressure titration and provide supportive care", "correct": true}, {"label": "C", "text": "Recommend uvulopalatopharyngoplasty without trying conservative measures", "correct": false}, {"label": "D", "text": "Lifestyle modification and weight loss", "correct": false}], "correct_answer": "B. Initiate CPAP therapy with appropriate pressure titration and provide supportive care", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Option</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications/Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages/Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CPAP Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First-line therapy &amp; Gold standard</strong></li>\n<li>All severity levels</li>\n<li>Requires <span class=\"customMeta\" data-dictid=\"38938f6b8f16927772000e7292bb2e\">titration</span> study</li>\n<li>Regular monitoring needed</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most effective option</li>\n<li>Reversible/non-invasive</li>\n<li>Insurance covered</li>\n<li>Adherence challenges</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle Modifications and weight loss</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight loss</li>\n<li>Sleep position therapy</li>\n<li>Alcohol avoidance</li>\n<li>Sleep hygiene</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adjunctive to primary therapy</li>\n<li>Long-term benefits</li>\n<li>No immediate relief</li>\n<li>Variable results</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral Appliances</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild to moderate OSA</li>\n<li>CPAP intolerance</li>\n<li>Good <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> health</li>\n<li>Normal TMJ</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More comfortable than CPAP</li>\n<li>Portable</li>\n<li>Less effective than CPAP</li>\n<li>Dental side effects</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Options</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Specific <span class=\"customMeta\" data-dictid=\"04f89c4775169277718128d3461838\">anatomic</span> defects</li>\n<li>Failed conservative therapy</li>\n<li>Carefully selected patients</li>\n<li>Bariatric surgery for obesity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Permanent solution</li>\n<li>No ongoing compliance needed</li>\n<li>Invasive</li>\n<li>Variable success rates</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male reports persistent daytime sleepiness, often dozing off during meetings and while watching television. He completes the Epworth Sleepiness Scale (ESS) and scores 12. What does a score of 12 indicate?", "options": [{"label": "A", "text": "Unlikely to be abnormally sleepy.", "correct": false}, {"label": "B", "text": "Average daytime sleepiness.", "correct": false}, {"label": "C", "text": "Possibly excessively sleepy; consider medical attention.", "correct": true}, {"label": "D", "text": "Excessively sleepy; seek immediate medical attention.", "correct": false}], "correct_answer": "C. Possibly excessively sleepy; consider medical attention.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Situation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>No Chance (0)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Slight Chance (1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Moderate Chance (2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>High Chance (3)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sitting and reading</p>\n</td>\n<td colspan=\"4\" rowspan=\"8\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No chance of dozing = 0</p>\n<p>Slight chance of dozing = 1</p>\n<p>Moderate chance of dozing = 2</p>\n<p>High chance of dozing = 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Watching television</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sitting inactive in a public space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lying down to rest in the afternoon when permitted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sitting and talking to someone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sitting quietly after lunch without alcohol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>As a passenger in a car for an hour without a break</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>In a car, while stopped for a few minutes in traffic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Total Score:</strong></p>\n</td>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>0 to 24</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old obese male presents to the clinic with excessive daytime sleepiness hypoventilation and difficulty breathing at night. His BMI is 32 kg/m², and arterial blood gas analysis shows a Paco2 of 48 mmHg recorded during the day. The patient reports loud snoring and episodes of gasping during sleep. He has a history of severe obesity and is suspected of having obstructive sleep apnea. Based on the scenario, which of the following diagnoses is most likely?", "options": [{"label": "A", "text": "Central Hypoventilation Syndrome", "correct": false}, {"label": "B", "text": "Obesity Hypoventilation Syndrome", "correct": true}, {"label": "C", "text": "Congenital Central Hypoventilation Syndrome", "correct": false}, {"label": "D", "text": "Simple Obstructive Sleep Apnea", "correct": false}], "correct_answer": "B. Obesity Hypoventilation Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old tall male presents to the emergency department with acute retrosternal chest pain and difficulty breathing after a vigorous bout of coughing. He reports having experienced frequent coughing spells over the past week due to a respiratory infection. On physical examination, subcutaneous emphysema is noted in the neck region. The chest X-ray of the patient is given below. Which of the following statements best describes a potential cause of this patient’s condition?", "options": [{"label": "A", "text": "The condition is likely caused by a foreign body in the airway.", "correct": false}, {"label": "B", "text": "Increased intra-alveolar pressure from excessive coughing can lead to alveolar rupture.", "correct": true}, {"label": "C", "text": "This condition is primarily associated with high BMI individuals.", "correct": false}, {"label": "D", "text": "Always a result of blunt trauma.", "correct": false}], "correct_answer": "B. Increased intra-alveolar pressure from excessive coughing can lead to alveolar rupture.", "question_images": ["https://image.prepladder.com/notes/R9ZF9UoaRXY0rlAIXbhJ1744436610.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:704px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumomediastinum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Air in the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> (mediastinal emphysema).</li>\n<li>Air can extravasate from airways, lungs, or <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> into the <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> space and may <span class=\"customMeta\" data-dictid=\"94b0b523e41692777186d3ed80c1ac\">dissect</span> into <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues, <span class=\"customMeta\" data-dictid=\"6de01005f61692777187a3003970c7\">epidural</span> space, pericardium, or peritoneal cavity.</li>\n<li><strong>Most common in younger males of tall <span class=\"customMeta\" data-dictid=\"3ed58981c41692777199e6abf079eb\">stature</span> with low BMI.</strong></li>\n<li>Pneumomediastinum is rare and usually self-limited</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Spontaneous (Primary) Pneumomediastinum:</strong> No identifiable cause, occurs in healthy individuals.</li>\n<li><strong>Secondary Pneumomediastinum:</strong> Caused by identifiable conditions,<strong> trauma being the most common cause (alveolar rupture).</strong>\n<ul>\n<li>Caused by <strong>intrinsic lung and <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> issues</strong> such as asthma, COPD, bronchiectasis, ILD, lung cancer,etc; <strong>iatrogenic </strong>factors including endoscopy, intubation, central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> access procedures, thoracostomy, and chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries; and <strong>traumatic </strong>events like <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma, <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> trauma, and blast injuries.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Macklin Phenomenon:</strong> Three-step process of <span class=\"customMeta\" data-dictid=\"989d4f0b441692777196f85841a273\">pneumomediastinum</span> development:\n\t\t\t\t<ul>\n<li>Increased intra-alveolar pressure leads to alveolar rupture.</li>\n<li>Air dissects into <span class=\"customMeta\" data-dictid=\"d54aac1d5516927771958b92a04d85\">peribronchial</span> and <span class=\"customMeta\" data-dictid=\"a606b55b4316927771956c3cb0d383\">perivascular</span> sheaths.</li>\n<li>Air spreads into the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> and surrounding tissue.</li>\n</ul>\n</li>\n<li>Causes of increased intra-alveolar pressure: Excessive vomiting, coughing, strenuous exertion, Valsalva maneuvers.</li>\n<li>Airway diseases (asthma, COPD) predispose to <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> injury from increased alveolar pressures.</li>\n<li>Forceful <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> during drug use can cause <span class=\"customMeta\" data-dictid=\"5b92d758801692777182d17f9d55bc\">barotrauma</span> and increase <span class=\"customMeta\" data-dictid=\"989d4f0b441692777196f85841a273\">pneumomediastinum</span> risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common Symptoms:\n\t\t\t\t<ul>\n<li>Retrosternal <span class=\"customMeta\" data-dictid=\"f8034b340e1692777184abcfab32f3\">chest pain</span> (60-100% of patients), often <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> and related to excessive coughing/vomiting.</li>\n<li>Dyspnea (75%).</li>\n<li>Coughing spells (80%).</li>\n<li>Neck pain (36%).</li>\n<li>Odynophagia, dysphagia, emesis, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n</ul>\n</li>\n<li>Common Signs on Physical Exam:\n\t\t\t\t<ul>\n<li>Subcutaneous <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> (70%).</li>\n<li><strong>Hamman sign:</strong> <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> crunch <span class=\"customMeta\" data-dictid=\"8a823442c116927771993039b6a37d\">synchronous</span> with heart sounds.</li>\n<li>Rhinolalia (nasal tone of speech), dysphonia, hoarseness, neck swelling, tachycardia, tachypnea.</li>\n</ul>\n</li>\n<li>Rare presentation: <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">Malignant</span> <span class=\"customMeta\" data-dictid=\"989d4f0b441692777196f85841a273\">pneumomediastinum</span> causing <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> physiology.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy presents to the emergency department with chest pain and difficulty breathing after experiencing a severe coughing fit. A chest X-ray is performed and is given below. Which of the following statements is true regarding the management of this condition?", "options": [{"label": "A", "text": "The primary diagnostic tool for this condition is a CT scan.", "correct": false}, {"label": "B", "text": "Surgical intervention is always required for treatment.", "correct": false}, {"label": "C", "text": "Conservative management is usually sufficient for most patients with this condition.", "correct": true}, {"label": "D", "text": "Prophylactic antibiotics are necessary for all patients diagnosed.", "correct": false}], "correct_answer": "C. Conservative management is usually sufficient for most patients with this condition.", "question_images": ["https://image.prepladder.com/notes/FSHqjzHvcMlOXgcMjb6e1744435742.png"], "explanation_images": ["https://image.prepladder.com/notes/FSHqjzHvcMlOXgcMjb6e1744435742.png", "https://image.prepladder.com/notes/UckKUqRD5ogCRHHMME571744436281.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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On examination, he has bilateral crackles on auscultation. A high-resolution CT scan reveals a crazy-paving pattern in the lungs. What is the most likely cause of his condition?", "options": [{"label": "A", "text": "Hypersensitivity pneumonitis", "correct": false}, {"label": "B", "text": "Idiopathic pulmonary fibrosis", "correct": false}, {"label": "C", "text": "Asbestosis", "correct": false}, {"label": "D", "text": "Silicosis", "correct": true}], "correct_answer": "D. Silicosis", "question_images": ["https://image.prepladder.com/notes/Xrs00AqMq8vzYoIC3D671744388230.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:308px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Known Causes of ILD</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exposure related causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Occupational exposure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Silicosis</strong></li>\n<li><strong>Asbestosis</strong>: exposure in <strong>cement industry</strong> <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment-related</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Radiation to the <span class=\"customMeta\" data-dictid=\"9e0ac98da71692777184489b28c5e4\">chest leads</span> to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</li>\n<li>Methotrexate</li>\n<li>Amiodarone</li>\n<li>Busulfan</li>\n<li>Bleomycin</li>\n<li>Cyclophosphamide</li>\n<li>Nitrofurantoin causes fleeting <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> opacities (transient or temporary shadows seen on chest imaging)</li>\n<li>Chemotherapeutics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Connective tissue</strong></p>\n<p><strong>disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rheumatoid arthritis</li>\n<li>Scleroderma</li>\n<li>Polymyositis/Dermatomyositis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulomatous disease with vasculitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wegener Granulomatosis</li>\n<li>Churg Strauss Syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulomatous lung disease </strong>(common to both known and unknown causes)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sarcoidosis</li>\n<li>Hypersensitivity pneumonitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:267px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Unknown causes of ILD</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Idiopathic interstitial</strong></p>\n<p><strong>pneumonia</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Idiopathic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (Associated with <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> Arthritis) <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nonspecific <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonitis</li>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"42c210d0a11692777183a6bf6ae819\">bronchiolitis</span> associated with ILD</li>\n<li>Desquamative <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonia</li>\n<li>Cryptogenic organising <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> (Associated with Polymyositis)</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonia</li>\n<li>Lymphocytic <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> (Associated with HIV)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Miscellaneous</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lymphangioleiomyomatosis</li>\n<li>Pulmonary alveolar proteinosis</li>\n<li>Langerhans cell histiocytosis</li>\n<li>Pleural parenchymal fibroelastosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulomatous lung disease</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sarcoidosis</li>\n<li>Hypersensitivity pneumonitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with a history of working in mining for over 20 years presents with chronic cough, shortness of breath, and fatigue. Chest X-ray reveals nodular opacities, primarily in the upper lobes. Which of the following complications is he at an increased risk of?", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Pneumothorax", "correct": false}, {"label": "C", "text": "Tuberculosis", "correct": true}, {"label": "D", "text": "Pleural effusion", "correct": false}], "correct_answer": "C. Tuberculosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old retired shipyard worker presents with exertional dyspnea and a persistent dry cough. Pulmonary function tests reveal a restrictive pattern. Which of the following radiographic findings is most characteristic of asbestosis?", "options": [{"label": "A", "text": "Upper lobe nodular opacities", "correct": false}, {"label": "B", "text": "Cavitary lesions", "correct": false}, {"label": "C", "text": "Bilateral pleural plaques", "correct": true}, {"label": "D", "text": "Hyperinflated lungs", "correct": false}], "correct_answer": "C. Bilateral pleural plaques", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with a long history of smoking presents with worsening dyspnea and a recent diagnosis of lung cancer. A lung biopsy reveals changes consistent with interstitial lung disease. Which type of ILD is most commonly associated with smoking?", "options": [{"label": "A", "text": "Lymphangioleiomyomatosis", "correct": false}, {"label": "B", "text": "Lymphocytic interstitial pneumonitis", "correct": false}, {"label": "C", "text": "Pulmonary Alveolar Proteinosis", "correct": false}, {"label": "D", "text": "Langerhans cell histiocytosis", "correct": true}], "correct_answer": "D. Langerhans cell histiocytosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/DwHZbCYBve3LelLNM8es1744388390.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Other Conditions Causing Smoking Related ILD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>HRCT findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory <span class=\"customMeta\" data-dictid=\"42c210d0a11692777183a6bf6ae819\">bronchiolitis</span> with ILD (RB-ILD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Central and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> bronchial wall thickening, <span class=\"customMeta\" data-dictid=\"2287afab0416927771845999a48e25\">centrilobular</span> nodules, and <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Desquamative <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> ( DIP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bilateral symmetric <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities are often more pronounced with other similar findings of RB-ILD.</li>\n<li>This can also occur in children with a family history of fibrosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old woman presents with worsening asthma, shortness of breath, and wheezing. She has a history of recurrent sinusitis and recent purpuric skin lesions on her legs. Lab tests show eosinophilia and positive p-ANCA. A chest CT reveals ground-glass opacities and lower lobe consolidation. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Wegener Granulomatosis", "correct": false}, {"label": "B", "text": "Sarcoidosis", "correct": false}, {"label": "C", "text": "Hypersensitivity pneumonia", "correct": false}, {"label": "D", "text": "Churg Strauss Syndrome", "correct": true}], "correct_answer": "D. Churg Strauss Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with worsening dyspnea on exertion and a dry cough. Examination reveals finger clubbing. Which findings might be observed during an interstitial lung disease (ILD) evaluation? Wheeze Inspiratory crackles Dullness to percussion Pigeon Breeder's Lung Increased tactile fremitus", "options": [{"label": "A", "text": "1,3,5", "correct": false}, {"label": "B", "text": "2,3,4", "correct": false}, {"label": "C", "text": "3,4,5", "correct": false}, {"label": "D", "text": "1,2,4", "correct": true}], "correct_answer": "D. 1,2,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/kOmG5IMGMQZQ0CLMlcxf1744388574.png", "https://image.prepladder.com/notes/ehTYxffvsSgOq7dmZXBt1744388657.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical signs and symptoms of ILD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shortness of breath</li>\n<li>Dry cough</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Haemoptysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rarely seen</li>\n<li>It is associated mostly with <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> vasculitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pleuritic pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in asbestosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pigeon Breeder's Lung</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in occupational history and <strong>hypersensitivity pneumonitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever with arthralgia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in <strong>Sarcoidosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bilateral inspiratory crackles</strong> are heard <strong>at the base of the lungs</strong></li>\n<li>Wheeze can be appreciated in conditions like <strong>sarcoidosis</strong>, <strong>Hypersensitivity <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> and Churg Strauss Syndrome.</strong></li>\n<li>Clubbing</li>\n</ul>\n<img alt=\"Nail clubbing\" data-author=\"\" data-hash=\"9526\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/kOmG5IMGMQZQ0CLMlcxf1744388574.png\"/>\n<ul>\n<li>Cyanosis</li>\n<li>Cor pulmonale</li>\n<li>Raynaud's phenomenon in <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue disorder</li>\n<li>Erythema nodosum in sarcoidosis</li>\n</ul>\n<img alt=\"Erythema nodosum.png\" data-author=\"\" data-hash=\"9527\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ehTYxffvsSgOq7dmZXBt1744388657.png\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with a 6-week history of cough, dyspnea, fever, and fatigue. Respiratory examination reveals inspiratory rales and pulmonary function tests reveal restrictive lung features. HRCT of the thorax shows patchy subpleural consolidative opacities with a ground-glass appearance and a reversed halo sign. A lung biopsy shows a uniform appearance of granulation tissue within the alveolar sac. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Atypical pneumonia", "correct": false}, {"label": "B", "text": "Cryptogenic organising pneumonia", "correct": true}, {"label": "C", "text": "Interstitial pulmonary fibrosis", "correct": false}, {"label": "D", "text": "Acute respiratory distress syndrome", "correct": false}], "correct_answer": "B. Cryptogenic organising pneumonia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cryptogenic Organising Pneumonia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients are usually 50-60 years of age</li>\n<li>Subacute onset with symptoms like cough, fever, malaise, fatigue and dyspnea.</li>\n<li><strong>Respiratory examination:</strong> Inspiratory rales</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pulmonary function tests: </strong>Restrictive lung deficits + hypoxemia</li>\n<li><strong>HRCT thorax</strong>\n<ul>\n<li>Patchy <span class=\"customMeta\" data-dictid=\"6136118183169277719961922f8790\">subpleural</span> consolidative opacities</li>\n<li>Localised ground glass opacities</li>\n<li><strong>Reversed <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> sign</strong> - rim of <span class=\"customMeta\" data-dictid=\"6136118183169277719961922f8790\">subpleural</span> sparing</li>\n</ul>\n</li>\n</ul>\n<img alt=\" Reverse &lt;span class=\" custommeta\"=\"\" data-dictid=\"95af91681416927771887742113c38\"/>Halo Sign\" data-author=\"\" data-hash=\"9531\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/d85q8jf9FWIObz0ERsrT1744388836.png\" /&gt;\n\t\t\t<ul>\n<li><strong>HPE: </strong>Patchy region of organising <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> with the uniform appearance of <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Corticosteroid therapy for 6 months</li>\n<li>Alternative therapy\n\t\t\t\t<ul>\n<li>Mycophenolate</li>\n<li>Cyclophosphamide</li>\n<li>Rituximab</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following types of hypersensitivity pneumonitis with their respective causative antigen. Disease Antigen 1. Farmer’s lungs A. Mycobacterium Avium complex 2. Tobacco grower’s lungs B. Isocyanates 3. Hot tub lungs C. Thermophilic actinomyces 4. Chemical worker lungs D. Penicillium casei 5. Cheese washer’s lungs E. Aspergillus clavatus", "options": [{"label": "A", "text": "1-E, 2-A, 3-D, 4-C, 5-B", "correct": false}, {"label": "B", "text": "1-C, 2-E, 3-A, 4-B, 5-D", "correct": true}, {"label": "C", "text": "1-D, 2-C, 3-B, 4-E, 5-A", "correct": false}, {"label": "D", "text": "1-A, 2-B, 3-E, 4-D, 5-C", "correct": false}], "correct_answer": "B. 1-C, 2-E, 3-A, 4-B, 5-D", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:758px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Etiology of <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">Hypersensitivity</span> pneumonitis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Farming and food processing </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bird and animal handler </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antigen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Farmer’s lungs </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\">Thermophilic actinomyces</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bird fancier </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Avian dropping</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bagassosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Duck fever</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Duck feather</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Mushroom worker’s lungs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Furrier’s lungs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Dust from animal fur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Coffee worker’s lungs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Coffee bean dust</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Lab worker’s lungs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Rat urine, serum, fur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cheese washer’s lungs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Penicillium casei</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pituitary <span class=\"customMeta\" data-dictid=\"cf2e5db74f1692777198e270bb0ada\">snuff</span> taker’s lungs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Animal protein</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Miller’s lungs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Sitophilus granarius</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Poultry worker’s lungs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Chicken <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> protein</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Malt worker’s lungs</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\">Aspergillus clavatus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Turkey handling disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Turkey <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> protein</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tobacco grower’s lungs </strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Wine maker’s lungs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Botrytis cinerea</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Other occupational exposures </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>Chemical worker’s lungs</strong></li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Isocyanates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>Hot tub lungs</strong></li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Cladosporium Sp.</p>\n<p style=\"text-align: center;\">Mycobacterium avium complex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Detergent worker’s lungs</li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Bacillus subtilis enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>AC lungs</strong></li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Aureobasidium</p>\n<p style=\"text-align: center;\">Candida albicans</p>\n<p style=\"text-align: center;\">Thermophilic actinomyces</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Machine operator’s lungs</li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Pseudomonas So.</p>\n<p style=\"text-align: center;\">Mycobacterium Sp.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>Sauna taker’s lungs </strong></li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Aureobasidium Sp.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\"><strong>Woodworker’s lungs</strong></li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Bacillus subtilis</p>\n<p style=\"text-align: center;\">Alternaria Sp.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Summer type pneumonitis</li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Trichosporon cutaneum</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a history of smoking presents with progressively worsening dyspnea and a non-productive cough for the past 6 months. HRCT findings, including subpleural reticulation, honeycombing, and traction bronchiectasis, suggest idiopathic pulmonary fibrosis (IPF). What is the treatment of choice for this condition?", "options": [{"label": "A", "text": "Monotherapy with Corticosteroid", "correct": false}, {"label": "B", "text": "Pirfenidone + Nintedanib", "correct": true}, {"label": "C", "text": "Prednisolone + Rituximab", "correct": false}, {"label": "D", "text": "Lung transplantation", "correct": false}], "correct_answer": "B. Pirfenidone + Nintedanib", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">Interstitial</span> lung disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Idiopathic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pirfenidone + Nintedanib</strong> <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nonspecific <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonitis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prednisolone + <span class=\"customMeta\" data-dictid=\"a6ed2a5f63169277718507c569e576\">cyclophosphamide</span> or <span class=\"customMeta\" data-dictid=\"e3802f488416927771979c6d76c756\">rituximab</span> </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Desquamative <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonitis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticosteroids</strong> <strong>(Option A) </strong>or</p>\n<p><strong>Cytotoxic agents (Azathioprine)</strong></p>\n<p><strong>Bronchodilators </strong>may be used</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cryptogenic organising pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticosteroids</strong></p>\n<p>Cyclophosphamide or <span class=\"customMeta\" data-dictid=\"e3802f488416927771979c6d76c756\">Rituximab</span> can be used alternatively</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hamman-Rich syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman with a history of progressive dyspnea and a chronic dry cough is being evaluated for suspected interstitial lung disease (ILD). She denies any history of smoking or exposure to environmental toxins. Physical examination reveals fine bibasilar inspiratory crackles. Which of the following is the investigation of choice for confirming the diagnosis?", "options": [{"label": "A", "text": "Pulmonary function test", "correct": false}, {"label": "B", "text": "Bronchoalveolar lavage", "correct": false}, {"label": "C", "text": "Fiberoptic bronchoscopy with cryo biopsy", "correct": true}, {"label": "D", "text": "HRCT of thorax", "correct": false}], "correct_answer": "C. Fiberoptic bronchoscopy with cryo biopsy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Interstitial Lung Disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical findings </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chest auscultation\n\t\t\t\t<ul>\n<li>End inspiratory fine crackles (Bibasilar)</li>\n<li>Wheezing in case of sarcoidosis</li>\n</ul>\n</li>\n<li>Digital clubbing</li>\n<li>Pedal oedema (if <span class=\"customMeta\" data-dictid=\"4534214488169277718575e08a9bc0\">cor</span> pulmonale present)</li>\n<li>Cyanosis may be present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> </strong></p>\n<ul>\n<li>Hilar <span class=\"customMeta\" data-dictid=\"344bcb4e391692777191307c1e0074\">lymphadenopathy</span> may present in sarcoidosis</li>\n<li>Basilar <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> opacities seen in asbestosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HRCT </strong><strong>(Option D)</strong></p>\n<ul>\n<li><strong>Subpleural <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> opacities </strong></li>\n<li>Traction <strong>bronchiectasis</strong> (airway distortion) due to lung fibrosis</li>\n<li><strong>Reverse <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> </strong>sign in <span class=\"customMeta\" data-dictid=\"e8284aa35e16927771853069c142b2\">Cryptogenic</span> organising pneumonia</li>\n<li>Helps select the location for biopsy</li>\n<li>Can suggest the type and degree of lung <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> but cannot confirm it.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary Function Tests </strong></p>\n<ul>\n<li>Helps <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between obstructive and restrictive lung disease but cannot confirm the diagnosis of <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> lung disease<strong> (Option A)</strong></li>\n<li><strong>TLC </strong>reduced</li>\n<li><strong>FEV1</strong>/<strong>FVC</strong> is normal or elevated</li>\n<li><strong>Restrictive</strong> pattern</li>\n<li><strong>Obstructive</strong> pattern may be seen in <span class=\"customMeta\" data-dictid=\"1bea5cbf1d16927771988b19241f4c\">sarcoidosis</span> due to hilar lymphadenopathy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n<ul>\n<li><strong>Fiberoptic <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> </strong>\n<ul>\n<li><strong>With Cryobiopsy: Investigation of choice to confirm diagnosis </strong><strong>(Option C)</strong></li>\n<li><strong>With <span class=\"customMeta\" data-dictid=\"d44b9fef2e1692777183fc6615f113\">Bronchoalveolar</span> lavage: </strong>can be helpful for <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> examination <strong>(Option B)</strong></li>\n</ul>\n</li>\n<li>Transbronchial <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> can also be done, but cryo <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is preferred</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoimmune panel </strong>helps identify the underlying cause.</p>\n<ul>\n<li><strong>Anti-CCP: </strong>Rheumatoid arthritis</li>\n<li><strong>Anti Jol Ab: </strong>Dermatomyositis</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 59-year-old man presents with recurrent cough, dyspnea, and fatigue for 8 months. His occupation as a bird breeder with exposure to bird droppings suggests hypersensitivity pneumonitis. Pulmonary function testing (PFT) reveals a restrictive pattern. Which of the following disorders should be considered in the differential diagnosis based on the PFT restrictive pattern?", "options": [{"label": "A", "text": "COPD", "correct": false}, {"label": "B", "text": "Idiopathic interstitial pneumonia", "correct": true}, {"label": "C", "text": "Asthma", "correct": false}, {"label": "D", "text": "Bronchiectasis", "correct": false}], "correct_answer": "B. Idiopathic interstitial pneumonia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disorder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pulmonary Function Test </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypersensitivity <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Restrictive</strong> pattern</li>\n<li>Total lung capacity ↓</li>\n<li>FEV1/FVC is normal or ↑</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Idiopathic <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initially\n\t\t\t\t<ul>\n<li>Only <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> is impaired; thus, DLCO is reduced</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> and FEV</li>\n</ul>\n</li>\n<li>As diseases progresses\n\t\t\t\t<ul>\n<li><strong>Restrictive</strong> pattern</li>\n<li>Total lung capacity ↓ due to lung fibrosis</li>\n<li>FEV1/FVC is normal, or ↑ a reduction in <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> is proportionally greater than a fall in FEV1.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>COPD </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Obstructive</strong> pattern.</li>\n<li>Total lung capacity ↑ due to trapping of air - lung hyperinflation.</li>\n<li>FEV1/FVC ↓ due to significant air outflow obstruction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bronchiectasis (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Obstructive</strong> pattern.</li>\n<li>Total lung capacity ↑ is due to the trapping of air.</li>\n<li>FEV1/FVC ↓ due to significant air outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> due to <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> plugging.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asthma (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Obstructive</strong> pattern</li>\n<li>Total lung capacity ↑ due to trapping of air</li>\n<li>FEV1/FVC ↓ due to significant air outflow obstruction</li>\n<li>Peak <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> flow rate ↓</li>\n<li>It is <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> with <span class=\"customMeta\" data-dictid=\"16abe8467e16927771837550ea9798\">bronchodilator</span> use</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presents with worsening shortness of breath and cough, producing copious sputum containing gelatinous material. Laboratory tests reveal no evidence of infectious processes. The physician suspects pulmonary alveolar proteinosis. Which mechanism is most responsible for her condition?", "options": [{"label": "A", "text": "Deficiency of surfactant proteins due to genetic mutation", "correct": false}, {"label": "B", "text": "Autoimmune response leading to GM-CSF blockade", "correct": true}, {"label": "C", "text": "Exposure to silica dust causing alveolar damage", "correct": false}, {"label": "D", "text": "Allergic reaction to environmental pollutants", "correct": false}], "correct_answer": "B. Autoimmune response leading to GM-CSF blockade", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old male presents with progressive dyspnea and a chronic cough with gelatinous sputum. Pulmonary function tests show a restrictive pattern and a normal FEV1/FVC ratio. A chest X-ray reveals bilateral patchy opacifications and a high-resolution CT shows a crazy paving pattern with no signs of infection. What is the most characteristic finding of this condition?", "options": [{"label": "A", "text": "Increased neutrophilic infiltration", "correct": false}, {"label": "B", "text": "Positive Periodic Acid-Schiff (PAS) staining", "correct": true}, {"label": "C", "text": "Granuloma formation", "correct": false}, {"label": "D", "text": "Honeycombing fibrosis", "correct": false}], "correct_answer": "B. Positive Periodic Acid-Schiff (PAS) staining", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 11 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 62-year-old male with a history of smoking presents with chronic cough, weight loss, and recent hemoptysis. A chest X-ray is done and is provided below. Which of the following is the most likely primary source of this lesion?", "options": [{"label": "A", "text": "Renal cell carcinoma", "correct": true}, {"label": "B", "text": "Breast carcinoma", "correct": false}, {"label": "C", "text": "Gastric adenocarcinoma", "correct": false}, {"label": "D", "text": "Thyroid carcinoma", "correct": false}], "correct_answer": "A. Renal cell carcinoma", "question_images": ["https://image.prepladder.com/notes/OXEqybsmVRxZw4HxyWk01744304222.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with a history of chronic liver disease presents with progressive shortness of breath, fatigue, and mild chest discomfort over the past few weeks. On examination, there is decreased bilateral breath sound intensity with dullness on percussion at the lung bases. A chest X-ray shows the following features. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bilateral Hydrothorax", "correct": true}, {"label": "B", "text": "Empyema Thoracis", "correct": false}, {"label": "C", "text": "Hydropneumothorax", "correct": false}, {"label": "D", "text": "Congestive Heart Failure with Pleural Effusion", "correct": false}], "correct_answer": "A. Bilateral Hydrothorax", "question_images": ["https://image.prepladder.com/notes/rIieAEvLtPjkrFlrOOGo1744305112.png"], "explanation_images": ["https://image.prepladder.com/notes/gQXUw1jEtxOOq6wFe9Ej1744312997.png", "https://image.prepladder.com/notes/PkRk2ciHxcQdaocoRGPK1744313124.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man visits OPD with the following presentation as shown in the image. His chest CT shows bronchiectasis. Which of the following statements is INCORRECT regarding this patient's digital finding?", "options": [{"label": "A", "text": "The condition involves proliferation of connective tissue at the nail base", "correct": false}, {"label": "B", "text": "It can be associated with cystic fibrosis and lung cancer", "correct": false}, {"label": "C", "text": "The condition always indicates irreversible tissue changes", "correct": true}, {"label": "D", "text": "The pathogenesis involves platelet-derived growth factors", "correct": false}], "correct_answer": "C. The condition always indicates irreversible tissue changes", "question_images": ["https://image.prepladder.com/notes/ELAC1WAtOclzbC3iw35k1744305435.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clubbing of Fingers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">Enlargement</span> of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> segments of fingers and toes</p>\n<p>• <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">Proliferation</span> of <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue <strong>(Option A)</strong></p>\n<p>• Particularly on <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> surface</p>\n<p>• Changes at base of clubbed nail</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">Connective</span> tissue proliferation</p>\n<p>• Exact mechanism unknown</p>\n<p>• Platelet-derived growth factors implicated<strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bulbous <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">Enlargement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> Phalanges</li>\n<li>Loss of the Normal Angle Between the Nail and the Nailbed (Lovibond’s Angle)</li>\n<li>Increased Sponginess of the Soft Tissue at the Base of the Nail</li>\n<li>Nail Changes:</li>\n<li><strong>Nail flattening</strong>/<strong>nail curvature</strong></li>\n<li><strong>Hippocratic fingers</strong>: The <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">tips</span> of the fingers become enlarged, and the nails curve downward</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schamroth’s Sign:</strong></p>\n<ul>\n<li><strong>Normal</strong>: A small diamond-shaped window should be visible between the nails when the fingers are positioned in this way.</li>\n<li><strong>Positive Schamroth’s Sign</strong>: The window disappears, and there is no gap between the nails, indicating the loss of the normal angle at the nail bed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Cyanotic <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart disease</p>\n<p>• <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">Infective</span> endocarditis</p>\n<p>• Bronchiectasis</p>\n<p>• <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">Fibrosis</span> <strong>(Option B)</strong></p>\n<p>• Lung cancer</p>\n<p>• Tuberculosis</p>\n<p>• <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Can be <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> or acquired</p>\n<p>• May be <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> in certain circumstances</p>\n<p>• Associated with hypertrophic osteoarthropathy</p>\n<p>• Can cause pain and arthritis-like changes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presents to the emergency department with sudden onset of right-sided chest pain and mild shortness of breath. He is tall, thin, and a smoker. Physical examination reveals decreased breath sounds on the right side with hyperresonance on percussion. Chest X-ray is given below. The patient is hemodynamically stable with oxygen saturation of 96% on room air. What is the most appropriate initial management?", "options": [{"label": "A", "text": "Discharge with follow-up in 2-4 weeks", "correct": false}, {"label": "B", "text": "Needle aspiration", "correct": true}, {"label": "C", "text": "Immediate tube thoracostomy", "correct": false}, {"label": "D", "text": "High-flow oxygen and observation for 24 hours", "correct": false}], "correct_answer": "B. Needle aspiration", "question_images": ["https://image.prepladder.com/notes/ZjldnzmY3nUl138QviLm1744306120.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:695px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> (PSP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Young, tall, thin males</p>\n<p>• Sharp chest pain</p>\n<p>• Mild dyspnea</p>\n<p>• Decreased breath sounds</p>\n<p>• Hyperresonant percussion</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Chest X-ray</p>\n<p>• <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> (if needed)</p>\n<p>• E-FAST ultrasound</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Size &lt; 2cm, asymptomatic: Observation</p>\n<p>• Size &gt; 2cm or symptomatic: Needle aspiration</p>\n<p>• Failed aspiration: Tube thoracostomy</p>\n<p>• Recurrent: Consider VATS/pleurodesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Secondary <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> (SSP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Underlying lung disease</p>\n<p>• Severe dyspnea</p>\n<p>• Significant chest pain</p>\n<p>• <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> distress</p>\n<p>• Higher risk of tension</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Chest X-ray</p>\n<p>• <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> (mandatory)</p>\n<p>• <span class=\"customMeta\" data-dictid=\"218fc9685d1692777180b8b609dd48\">ABG</span> analysis</p>\n<p>• Underlying disease workup</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Size &lt; 1cm: O₂ + observation</p>\n<p>• Size 1-2cm: Needle aspiration</p>\n<p>• Size &gt; 2cm: Tube thoracostomy</p>\n<p>• All cases: Treat underlying condition</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male is brought to the emergency department after a motor vehicle accident with chest trauma. He is in severe respiratory distress with BP 80/50 mmHg, HR 142/min, RR 32/min. Physical examination reveals absent breath sounds. The X-ray is attached below. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "CT Head for identifying possible cerebral injury", "correct": false}, {"label": "B", "text": "Start high-flow oxygen", "correct": false}, {"label": "C", "text": "Immediate needle decompression", "correct": true}, {"label": "D", "text": "Intercostal tube", "correct": false}], "correct_answer": "C. Immediate needle decompression", "question_images": ["https://image.prepladder.com/notes/7Rle68pwnc4TIv8Q4JAr1744312530.png"], "explanation_images": ["https://image.prepladder.com/notes/7Rle68pwnc4TIv8Q4JAr1744312530.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tension Pneumothorax</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n<p>• Hypotension</p>\n<p>• <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">Tachycardia</span> (&gt;134 bpm)</p>\n<p>• <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">Tracheal</span> deviation</p>\n<p>• JVD</p>\n<p>• Cyanosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Clinical diagnosis</p>\n<p>• Don't wait for imaging</p>\n<p>• Post-procedure CXR</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Immediate: Needle decompression</p>\n<p>• Definitive: Tube thoracostomy</p>\n<p>• Follow-up: <span class=\"customMeta\" data-dictid=\"8126bfda4a1692777195ede6823750\">Pleurodesis</span> consideration</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old female receiving a blood transfusion for severe anemia develops acute dyspnea, tachypnea, and hypertension 30 minutes into the transfusion. Her blood pressure is 168/95 mmHg, and chest auscultation reveals bilateral crackles. Which of the following represents the most appropriate immediate management?", "options": [{"label": "A", "text": "Continue transfusion but at a slower rate", "correct": false}, {"label": "B", "text": "Stop transfusion and administer diuretics", "correct": true}, {"label": "C", "text": "Administer acetaminophen and continue transfusion", "correct": false}, {"label": "D", "text": "Stop transfusion and start steroids", "correct": false}], "correct_answer": "B. Stop transfusion and administer diuretics", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Transfusion-Associated <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">Circulatory</span> <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (TACO)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Common and underrecognized <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> adverse reaction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>1-10% per <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> transfusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Preexisting fluid overload</p>\n<p>• <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> dysfunction</p>\n<p>• Large volume of RBCs</p>\n<p>• Excessive rate of transfusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Dyspnea</p>\n<p>• Hypertension</p>\n<p>• <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> crackles</p>\n<p>• Elevated brain <span class=\"customMeta\" data-dictid=\"bd16654d3e169277719371077d7a8c\">natriuretic</span> peptide</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Prevention in High-Risk Patients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Slow <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> rate (RBCC over 3-4 h)</p>\n<p>• Close monitoring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Stop transfusion</p>\n<p>• Administer O2</p>\n<p>• Give diuretics</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents to the emergency department with acute dyspnea and bilateral crackles. His blood pressure is 160/90 mmHg, heart rate 110/min, and respiratory rate 28/min. Physical examination reveals jugular venous distention, bilateral pedal edema, and an S3 gallop. Chest X-ray is given below. His pulmonary capillary wedge pressure (PCWP) is 25 mmHg. Which of the following is the most appropriate initial management?", "options": [{"label": "A", "text": "High-flow oxygen and observation", "correct": false}, {"label": "B", "text": "Immediate intubation", "correct": false}, {"label": "C", "text": "IV furosemide and nitrates", "correct": true}, {"label": "D", "text": "Antibiotics and steroids", "correct": false}], "correct_answer": "C. IV furosemide and nitrates", "question_images": ["https://image.prepladder.com/notes/dqp7LA22sYrnL07rnk801744307397.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Edema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Increased <span class=\"customMeta\" data-dictid=\"20b745c46c1692777189374f036950\">hydrostatic</span> pressure</p>\n<p>• <span class=\"customMeta\" data-dictid=\"9a065f288c1692777191f5b93fa49b\">Left heart</span> dysfunction</p>\n<p>• <span class=\"customMeta\" data-dictid=\"99ab51b3d316927771944ee50a26ac\">PCWP</span> &gt;18 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Increased <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> permeability</p>\n<p>• Direct lung injury</p>\n<p>• Normal <span class=\"customMeta\" data-dictid=\"99ab51b3d316927771944ee50a26ac\">PCWP</span> (&lt;18 mmHg)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• MI/CAD</p>\n<p>• CHF</p>\n<p>• Valvular heart disease</p>\n<p>• Cardiomyopathy</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• ARDS</p>\n<p>• Sepsis</p>\n<p>• Trauma</p>\n<p>• Toxins/drugs</p>\n<p>• High altitude</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• JVD present</p>\n<p>• <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">Peripheral</span> edema</p>\n<p>• S3 gallop</p>\n<p>• <span class=\"customMeta\" data-dictid=\"5098fe73d116927771838b3dad7c36\">Cardiomegaly</span> on CXR</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• No JVD</p>\n<p>• No <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> edema</p>\n<p>• Normal heart sounds</p>\n<p>• Normal heart size on CXR</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Initial Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Diuretics (furosemide)</p>\n<p>• Nitrates</p>\n<p>• Proper positioning</p>\n<p>• Oxygen support</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Treat underlying cause</p>\n<p>• Supportive care</p>\n<p>• <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">Mechanical ventilation</span> if needed</p>\n<p>• No role for diuretics</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with a 40-pack-year smoking history presents with progressive dyspnea, productive cough, and weight loss. Physical examination reveals a barrel chest, decreased breath sounds, and prolonged expiration. Chest X-ray is given below. His FEV1/FVC ratio is 0.65 and doesn't improve with bronchodilators. Which of the following is the most likely pathological finding in this patient?", "options": [{"label": "A", "text": "Inflammation of bronchial walls with mucus hypersecretion", "correct": false}, {"label": "B", "text": "Permanent enlargement of airspaces distal to terminal bronchioles", "correct": true}, {"label": "C", "text": "Bronchial wall thickening with reversible airway obstruction", "correct": false}, {"label": "D", "text": "Interstitial fibrosis with restrictive pattern", "correct": false}], "correct_answer": "B. Permanent enlargement of airspaces distal to terminal bronchioles", "question_images": ["https://image.prepladder.com/notes/vhhA9QtUap8cqtz5Ng8N1744307839.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Emphysema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Destruction of alveolar walls</p>\n<p>• <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">Abnormal</span> permanent <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of airspaces</p>\n<p>• <strong>Elastase/anti-elastase imbalance</strong></p>\n<p>• <strong>Loss of <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> recoil</strong></p>\n<p>• Decreased gas exchange surface area</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• <strong>Smoking (80-90% cases)</strong></p>\n<p>• <strong>Alpha-1 antitrypsin <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (1-2%)</strong></p>\n<p>• Environmental pollutants</p>\n<p>• <span class=\"customMeta\" data-dictid=\"710a0f411416927771831201ad5566\">Biomass</span> fuel exposure</p>\n<p>• Occupational exposure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• Progressive dyspnea</p>\n<p>• Chronic cough</p>\n<p>• Barrel chest</p>\n<p>• Pursed-lip breathing</p>\n<p>• Weight loss</p>\n<p>• \"Pink puffer\" appearance</p>\n<p>• Use of <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> muscles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Radiological Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• <strong>Hyperinflation</strong></p>\n<p>•<strong> Flattened diaphragm</strong></p>\n<p>• Increased lung volumes</p>\n<p>• <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> heart shadow</p>\n<p>• Increased <span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\">retrosternal</span> airspace</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>• <strong>Spirometry (FEV1/FVC &lt; 0.7)</strong></p>\n<p>• Chest X-ray</p>\n<p>• <strong>CT scan</strong></p>\n<p>• Alpha-1 antitrypsin levels</p>\n<p>• <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">Arterial blood</span> gases</p>\n<p>• DLCO (decreased)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>• Smoking cessation</strong></p>\n<p><strong>• Bronchodilators (SABA, LABA)</strong></p>\n<p><strong>• Anticholinergics (SAMA, LAMA)</strong></p>\n<p><strong>• Inhaled corticosteroids</strong></p>\n<p>• <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> rehabilitation</p>\n<p>• Oxygen therapy if indicated</p>\n<p>• Surgery in selected cases</p>\n<p>• Vaccinations (influenza, pneumococcal)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man with a history of deep vein thrombosis is brought to the emergency department by his wife after he suddenly developed sharp, stabbing chest pain and shortness of breath while at home. He describes the pain as worse when taking a deep breath. The X-ray taken is displayed below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pneumonia", "correct": false}, {"label": "B", "text": "Atelectasis", "correct": false}, {"label": "C", "text": "Pulmonary infarction due to pulmonary embolism", "correct": true}, {"label": "D", "text": "Lung abscess", "correct": false}], "correct_answer": "C. Pulmonary infarction due to pulmonary embolism", "question_images": ["https://image.prepladder.com/notes/R30UQ4AdY5SxRgCWgJK41744308084.png"], "explanation_images": ["https://image.prepladder.com/notes/gwPEA34mLjOQiQmtew3b1744311283.png", "https://image.prepladder.com/notes/QwtzOtmZ9SeOkrYIzaM51744311729.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Pneumonia\" data-author=\"Mikael Häggström, M.D.\" data-hash=\"8868\" data-license=\"CC-Zero\" data-source=\"https://commons.wikimedia.org/wiki/File:X-ray_of_lobar_pneumonia.jpg\" data-tags=\"\" height=\"232\" src=\"https://image.prepladder.com/notes/gwPEA34mLjOQiQmtew3b1744311283.png\" width=\"278\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><strong>Pneumonia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumonia (Option A), </strong>is incorrect as <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> usually presents on <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> as a<strong> patchy</strong> or <strong>lobar consolidation</strong>, often <strong>not triangular</strong> or <strong>pleural-based</strong>. <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> can be found in any <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> but is not typically wedge-shaped with an <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> pointing toward the hilum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Atelactasis\" data-author=\"Hellerhoff \" data-hash=\"8871\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Mediastinalshift_bei_BC.jpg\" data-tags=\"\" height=\"292\" src=\"https://image.prepladder.com/notes/QwtzOtmZ9SeOkrYIzaM51744311729.png\" width=\"304\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><strong>Atelectasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atelectasis (Option B), </strong>is incorrect as <span class=\"customMeta\" data-dictid=\"7a5ca69ddf16927771829cd4e4d464\">atelectasis</span> usually presents on <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> as <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> or wedge-shaped opacities but <strong>tends to involve volume loss or shifting of adjacent structures</strong>, such as the <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> or mediastinum, toward the affected area.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Lung abscess\" custommeta\"=\"\" data-author=\"Dr. Yale Rosen Atlas of &lt;span class=\" data-dictid=\"10e2dee19e1692777196673db90c23\"/>Pulmonary Pathology\" data-hash=\"8851\" data-license=\"CC-BY-SA-2.0\" data-source=\"https://www.flickr.com/photos/pulmonary_pathology/7468374820\" data-tags=\"\" height=\"267\" src=\"https://image.prepladder.com/notes/8ajgu1swqVUXwUaIEbvV1744309932.png\" width=\"249\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><strong>Lung abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lung <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> (Option D), </strong>is incorrect as a lung <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> usually presents on <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">x-ray</span> as a <strong>localized cavity</strong> with an <strong>air-fluid level if <span class=\"customMeta\" data-dictid=\"8c3efbee661692777184685e54c75e\">communicating</span> with an airway</strong>. Abscesses are usually <strong>round or <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> in shape</strong>, not wedge-shaped or pleural-based like Hampton’s Hump.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient presents to the pulmonary clinic with a history of progressive shortness of breath and a chronic cough. He is a long-term smoker and has a family history of respiratory diseases. A spirometry test is performed, and the flow-volume loop is plotted. What is the most likely diagnosis based on the patient’s symptoms and the shape of his flow-volume loop?", "options": [{"label": "A", "text": "Restrictive lung disease", "correct": false}, {"label": "B", "text": "Obstructive lung disease", "correct": true}, {"label": "C", "text": "Normal lung function", "correct": false}, {"label": "D", "text": "Fixed upper airway obstruction", "correct": false}], "correct_answer": "B. Obstructive lung disease", "question_images": ["https://image.prepladder.com/notes/UjGJLUT0O7zNhYxax0wx1744310334.png"], "explanation_images": ["https://image.prepladder.com/notes/QvEHxYJPdzgYIhH7ZSKS1744308519.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Loop Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Expiratory Curve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inspiratory Curve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Example Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symmetrical, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symmetrical, rounded</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Healthy lungs <strong>(Option C ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstructive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scooped (concave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>COPD, asthma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Restrictive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Narrow, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Narrow, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary fibrosis, pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fixed Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened (box-like)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened (box-like)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tracheal stenosis, large <span class=\"customMeta\" data-dictid=\"2aa25c8cad1692777188842dd483eb\">goiter</span> <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">Extrathoracic</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vocal cord dysfunction, laryngeal tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">Intrathoracic</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tracheomalacia, <span class=\"customMeta\" data-dictid=\"7cabf0723c1692777183971e234185\">bronchogenic</span> tumor</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the Condition with the Correct Description on X-ray: 1. Pneumatocele a. 2. Tuberculosis (TB) b. 3. Miliary TB c. 4. Lung Abscess d.", "options": [{"label": "A", "text": "1 - b, 2 - c, 3 - a, 4 - d", "correct": true}, {"label": "B", "text": "1 - a, 2 - b, 3 - c, 4 - d", "correct": false}, {"label": "C", "text": "1 - d, 2 - c, 3 - b, 4 - a", "correct": false}, {"label": "D", "text": "1 - c, 2 - b, 3 - d, 4 - a", "correct": false}], "correct_answer": "A. 1 - b, 2 - c, 3 - a, 4 - d", "question_images": ["https://image.prepladder.com/notes/YnuvCMdt4FK33ab218LV1744310788.png", "https://image.prepladder.com/notes/SeQHPFIjKFoHUPVKm02H1744310661.png", "https://image.prepladder.com/notes/oWGByRPJzpDATbbqLSIh1744310100.png", "https://image.prepladder.com/notes/8ajgu1swqVUXwUaIEbvV1744309932.png"], "explanation_images": ["https://image.prepladder.com/notes/SeQHPFIjKFoHUPVKm02H1744310661.png", "https://image.prepladder.com/notes/YnuvCMdt4FK33ab218LV1744310788.png", "https://image.prepladder.com/notes/8ajgu1swqVUXwUaIEbvV1744309932.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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Upon physical examination, decreased breath sounds are noted on the left side. A chest X-ray reveals the findings presented below. A thoracentesis is performed, yielding a milky white fluid with elevated lactate dehydrogenase (LDH) and the presence of cholesterol crystals. Considering these findings, what underlying agent could be responsible for this presentation?", "options": [{"label": "A", "text": "Pneumococcus", "correct": false}, {"label": "B", "text": "Staphylococcus aureus", "correct": false}, {"label": "C", "text": "Malignancy", "correct": false}, {"label": "D", "text": "Mycobacterium tuberculosis", "correct": true}], "correct_answer": "D. Mycobacterium tuberculosis", "question_images": ["https://image.prepladder.com/notes/wr1vuCrbA8ZqD1BG4fc41744382783.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Effusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fluid Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fluid Analysis Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumonia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection leading to inflammation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straw-coloured or cloudy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High protein, high LDH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Empyema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacterial infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cloudy or turbid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very high protein, very high LDH, low pH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chylothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphatic disruption</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Milky or creamy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated triglycerides, <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> predominance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudochylothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic inflammation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Milky (but cholesterol-laden)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cholesterol crystals, high lymphocytes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the ABG values in Column A with their corresponding acid-base disorders in Column B. Column A Column B 1. pH 7.48, pCO2 45, HCO3 35 A. Fully compensated respiratory acidosis 2. pH 7.32, pCO2 28, HCO3 14 B. Partially compensated metabolic alkalosis 3. pH 7.40, pCO2 30, HCO3 20 C. Partially compensated metabolic acidosis 4. pH 7.38, pCO2 68, HCO3 32 D. Fully compensated respiratory alkalosis", "options": [{"label": "A", "text": "1-B, 2-C, 3-D, 4-A", "correct": true}, {"label": "B", "text": "1-C, 2-B, 3-A, 4-D", "correct": false}, {"label": "C", "text": "1-A, 2-D, 3-C, 4-B", "correct": false}, {"label": "D", "text": "1-D, 2-A, 3-B, 4-C", "correct": false}], "correct_answer": "A. 1-B, 2-C, 3-D, 4-A", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with severe substernal chest pain, difficulty breathing, and puffy swelling of the chest wall after multiple episodes of vomiting due to binge drinking. Upon examination, auscultation reveals a characteristic crunching sound. A chest X-ray demonstrates the presence of subcutaneous emphysema. Based on the clinical presentation, what is the next best step in managing this patient?", "options": [{"label": "A", "text": "Administer intravenous antibiotics", "correct": false}, {"label": "B", "text": "Perform an urgent thoracotomy", "correct": true}, {"label": "C", "text": "Provide supplemental oxygen", "correct": false}, {"label": "D", "text": "Obtain a CT scan of the chest", "correct": false}], "correct_answer": "B. Perform an urgent thoracotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the emergency department after experiencing sudden chest pain and shortness of breath. He is a long-time smoker with no history of lung disease. A chest X-ray confirms a right-sided pneumothorax. Which type of pneumothorax is this patient most likely experiencing?", "options": [{"label": "A", "text": "Secondary spontaneous pneumothorax", "correct": false}, {"label": "B", "text": "Traumatic pneumothorax", "correct": false}, {"label": "C", "text": "Primary spontaneous pneumothorax", "correct": true}, {"label": "D", "text": "Tension pneumothorax", "correct": false}], "correct_answer": "C. Primary spontaneous pneumothorax", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:803px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Common Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> Pneumothorax</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs<strong> </strong><strong>without underlying lung disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often due to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> pleural blebs</li>\n<li>Seen commonly in smokers</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Simple aspiration</li>\n<li>Thoracoscopy if recurrent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>pre-existing lung conditions </strong>(e.g., COPD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More life-threatening due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> reserve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tube thoracostomy</li>\n<li>Thoracoscopy or <span class=\"customMeta\" data-dictid=\"8126bfda4a1692777195ede6823750\">pleurodesis</span> if needed</li>\n<li>Thoracoscopy with <span class=\"customMeta\" data-dictid=\"3b4c96c9d01692777199d56349e8d8\">stapling</span> of blebs and pleural <span class=\"customMeta\" data-dictid=\"2ff3cc6c8a16927771802154170e4f\">abrasion</span> if surgery is contraindicated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Traumatic <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs during <strong>mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> or resuscitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> (from medical procedures)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tube thoracostomy</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"4be129c8311692777188780148e955\">hemopneumothorax</span> with dual chest tubes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> <strong>(Option D) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Results from <strong>physical injury</strong> (blunt or penetrating)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Positive pressure in pleural space</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> compromise</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Emergency treatment with large bore needle <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> followed by thoracostomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female with a history of COPD presents to the emergency department with sudden onset left-sided chest pain. A chest X-ray reveals a small left-sided pneumothorax with a depth of 0.5 cm. The patient is otherwise stable, with no significant respiratory distress and a normal vital sign profile. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Administer high-flow oxygen and observe for 24 hours", "correct": true}, {"label": "B", "text": "Perform needle aspiration", "correct": false}, {"label": "C", "text": "Discharge with follow-up in 2-4 weeks", "correct": false}, {"label": "D", "text": "Thoracoscopy with pleural abrasion", "correct": false}], "correct_answer": "A. Administer high-flow oxygen and observe for 24 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male presents to the emergency department after a motorcycle accident. He is experiencing severe shortness of breath and sharp left-sided chest pain. On examination, he has tachycardia and low oxygen saturation. A chest X-ray confirms a large left-sided pneumothorax. Vitals are HR: 120 bpm, BP: 70/40. What would be the most appropriate first step in the management of this patient?", "options": [{"label": "A", "text": "Insert a thoracostomy tube", "correct": false}, {"label": "B", "text": "Administer supplemental oxygen", "correct": false}, {"label": "C", "text": "Perform needle decompression", "correct": true}, {"label": "D", "text": "Schedule video-assisted thoracoscopic surgery (VATS)", "correct": false}], "correct_answer": "C. Perform needle decompression", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with chest pain and shortness of breath with a heart rate of 145 beats per minute is being examined in the casualty. Which of the following clinical features is not seen in a pneumothorax?", "options": [{"label": "A", "text": "Absent breath sounds", "correct": false}, {"label": "B", "text": "Hamman’s sign", "correct": true}, {"label": "C", "text": "Jugular venous distension", "correct": false}, {"label": "D", "text": "Hypotension", "correct": false}], "correct_answer": "B. Hamman’s sign", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was brought to the hospital with noticeable difficulty in breathing. On examination, he has tachycardia, tachypnea, and asymmetrical lung expansion. A supine chest X-ray is taken and shown below. Identify the marked sign/structure in this patient's chest radiograph.", "options": [{"label": "A", "text": "Collapsed lung", "correct": false}, {"label": "B", "text": "Visceral pleura", "correct": false}, {"label": "C", "text": "Hemidiapraghm depression", "correct": false}, {"label": "D", "text": "Deep sulcus sign", "correct": true}], "correct_answer": "D. Deep sulcus sign", "question_images": ["https://image.prepladder.com/notes/ddeXhvz2apaPcQiaMs3V1744387096.png"], "explanation_images": ["https://image.prepladder.com/notes/o9j4tTKvn52lYAErzZ741744387415.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Radiological Findings in <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Visible visceral pleural</strong> <strong>edge </strong>as a thin white line. <strong>(Option B)</strong></li>\n<li><strong>Absent lung markings </strong>peripheral to this line.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Pneumothorax Visible visceral pleura\" data-author=\"\" data-hash=\"9507\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/o9j4tTKvn52lYAErzZ741744387415.jpg\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The affected side is <strong>radiolucent </strong>compared to the opposite side.</li>\n<li><strong>Collapsed lung </strong>on the affected side. <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"IM611 &lt;span class=\" custommeta\"=\"\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\"/>Pneumothorax collapsed lung\" data-author=\"\" data-hash=\"9509\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/tTT8sqheLKI5OoK9eLF51744387538.jpg\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contralateral <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> </strong>shift especially in massive pneumothoraces (tension pneumothorax).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"IM612 &lt;span class=\" custommeta\"=\"\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\"/>Pneumothorax Contralateral <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift\" data-author=\"\" data-hash=\"9513\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/WcbkJiqgXlPMQgP51jxl1744387674.jpg\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> of the affected side is pushed down. <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"IM613 &lt;span class=\" custommeta\"=\"\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\"/>Pneumothorax <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">Diaphragm</span> pushed down\" data-author=\"\" data-hash=\"9515\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ctfGHM5QgvPxMYsRkdmj1744387863.jpg\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The<strong> supine</strong> <span class=\"customMeta\" data-dictid=\"5c71603ac81692777197e2aa1e7fd3\">radiograph</span> shows the<strong> deep <span class=\"customMeta\" data-dictid=\"2a56f52a921692777199df43853eba\">sulcus</span> sign.</strong></li>\n<li>It shows a <strong>deep <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle</strong> extending towards the hypochondrium.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Deep &lt;span class=\" custommeta\"=\"\" data-dictid=\"2a56f52a921692777199df43853eba\"/>sulcus sign\" data-author=\"\" data-hash=\"9500\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ddeXhvz2apaPcQiaMs3V1744387096.png\" /&gt;</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Light’s Index </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Light’s Criteria </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is used to measure the size of pneumothorax.</li>\n<li>Treatment approaches for primary <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> (PTX) are influenced by the size of the pneumothorax.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Light’s criteria is used to identify exudates from transudates in pleural effusions.</li>\n<li>An <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> is classified as an <span class=\"customMeta\" data-dictid=\"2df02c8a091692777187db6df500a1\">exudate</span> if it meets any of the following criteria:\n\t\t\t\t<ul>\n<li>A pleural-to-serum protein ratio &gt;0.5</li>\n<li>A pleural-to-serum <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> ratio &gt;0.6</li>\n<li>A pleural <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> level greater than two-thirds of the upper limit of normal for serum.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male comes to the emergency department after a fall from height. He developed shortness of breath, tachypnea, and chest pain since the fall. A chest X-ray was taken shown below. What would be the pathophysiology for the development of this condition?", "options": [{"label": "A", "text": "Rupture of apical pleural blebs", "correct": false}, {"label": "B", "text": "Preexisting COPD", "correct": false}, {"label": "C", "text": "Blunt trauma to the chest", "correct": true}, {"label": "D", "text": "Iatrogenic injury", "correct": false}], "correct_answer": "C. Blunt trauma to the chest", "question_images": ["https://image.prepladder.com/notes/X9qj98S3PhzJnTaef8Oa1744384457.png"], "explanation_images": ["https://image.prepladder.com/notes/3O0gXOrElROj9No4hOoe1744384565.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding normal pleural fluid characteristics is accurate?", "options": [{"label": "A", "text": "Normal pleural fluid typically contains over 3,000 WBCs/mm³.", "correct": false}, {"label": "B", "text": "The glucose level in normal pleural fluid is typically lower than that of plasma.", "correct": false}, {"label": "C", "text": "Normal pleural fluid pH ranges from 7.60 to 7.64.", "correct": true}, {"label": "D", "text": "Lactate dehydrogenase (LDH) levels in normal pleural fluid are similar to those in plasma.", "correct": false}], "correct_answer": "C. Normal pleural fluid pH ranges from 7.60 to 7.64.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pleural anatomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Normal pleural fluid characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Appearance</strong>: Clear <span class=\"customMeta\" data-dictid=\"e0c336554f16927772018d95c26ac1\">ultrafiltrate</span> of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> from the <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> pleura.</li>\n<li><strong>pH Level</strong>: Ranges from 7.60 to 7.64. <strong>(Option C)</strong></li>\n<li><strong>Protein Content</strong>: Less than 2% (1-2 g/dL).</li>\n<li><strong>White Blood Cells</strong>: Fewer than 1,000 WBCs per cubic millimetre. <strong>(Option A ruled out)</strong></li>\n<li><strong>Glucose Level</strong>: Comparable to that of plasma. <strong>(Option B ruled out)</strong></li>\n<li><strong>Lactate <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">Dehydrogenase</span> (LDH)</strong>: Less than 50% of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> levels. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient with Parkinson's disease has been experiencing fluctuations in his motor function, To help manage these \"on-off\" features, new medication to his treatment regimen. However, the patient later presented with respiratory distress, chest discomfort, and diminished breath sounds on examination. Which medication is likely to be the possible cause of these respiratory symptoms?", "options": [{"label": "A", "text": "Amantadine", "correct": false}, {"label": "B", "text": "Levodopa", "correct": false}, {"label": "C", "text": "Bromocriptine", "correct": true}, {"label": "D", "text": "Pramipexole", "correct": false}], "correct_answer": "C. Bromocriptine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:397px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pneumonia (Parapneumonic Effusion)</strong></li>\n<li><strong>Empyema</strong></li>\n<li><strong>Malignancy</strong></li>\n<li><strong>Chylothorax</strong></li>\n<li><strong>Pseudochylothorax</strong></li>\n<li><strong>Autoimmune Diseases</strong></li>\n<li><strong>Drug-Induced Effusions</strong></li>\n<li>Amiodarone</li>\n<li>Methotrexate</li>\n<li>Nitrofurantoin</li>\n<li>Dantrolene</li>\n<li>Hydralazine</li>\n<li><strong>Bromocriptine (Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male who has worked in the shipyard industry presents with shortness of breath and persistent pain in the right lower chest. On examination, there is dullness to percussion and decreased breath sounds on the right side. A CT scan reveals diffuse pleural thickening and nodular masses. A biopsy is performed to confirm the diagnosis. Which immunohistochemical marker is most likely to be positive?", "options": [{"label": "A", "text": "CD-117", "correct": false}, {"label": "B", "text": "Chromogranin", "correct": false}, {"label": "C", "text": "Calretinin", "correct": true}, {"label": "D", "text": "Vimentin", "correct": false}], "correct_answer": "C. Calretinin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early symptoms:</strong></p>\n<ul>\n<li>Chest pain</li>\n<li>Shortness of breath (dyspnea)</li>\n<li>Pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> (fluid buildup in the pleural space)</li>\n</ul>\n<p><strong>Progressive symptoms:</strong></p>\n<ul>\n<li>Chronic cough</li>\n<li>Weight loss</li>\n<li>Fatigue</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decreased breath sounds</li>\n<li>Dullness to percussion</li>\n<li>Pleural thickening</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Immunohistochemical Marker</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2/neu</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breast cancer, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD20</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B-cell lymphomas, (Pre-B cells express CD19 and <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> into B cells, but not <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T-cell lymphomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD68</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histiocytic lesions, Macrophages</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CK7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lung adenocarcinoma, Ovarian cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CK20</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colorectal cancer, Merkel cell carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>S100</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Melanoma, Schwannoma, LCH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GFAP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Astrocytomas, Gliomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PSA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prostate cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TTF-1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lung adenocarcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vimentin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sarcomas, Endometrial cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>p53</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various cancers (e.g., Colon, Breast)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ER/PR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breast cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ki-67</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proliferation marker in many tumours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CD117 (c-kit)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrointestinal stromal tumours (GIST)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HMB-45</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Melanoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synaptophysin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neuroendocrine tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromogranin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neuroendocrine tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ALP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone-forming tumours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Desmin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle tumours (e.g., Rhabdomyosarcoma)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 63-year-old female with metastatic adenocarcinoma of the lung presents with worsening dyspnea and a moderate-sized left-sided pleural effusion. After therapeutic thoracentesis reveals exudative fluid with low glucose levels and positive cytology for malignant cells, her symptoms improve, but the effusion is expected to reaccumulate. What is the most appropriate next step for long-term symptomatic relief?", "options": [{"label": "A", "text": "Insertion of a small indwelling pleural catheter", "correct": true}, {"label": "B", "text": "Serial therapeutic thoracentesis", "correct": false}, {"label": "C", "text": "Tube thoracostomy without a sclerosing agent", "correct": false}, {"label": "D", "text": "Initiation of diuretics and oxygen therapy", "correct": false}], "correct_answer": "A. Insertion of a small indwelling pleural catheter", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Malignant Pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">Effusion</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Second most common cause of <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> pleural effusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Cancers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lung carcinoma, breast carcinoma, and <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> (responsible for ~75% of cases).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dyspnea</strong>, which is often disproportionate to the size of the effusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exudative pleural fluid</strong> with possible <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels in cases of high tumour burden.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cytology</strong> of pleural fluid (initial step).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thoracoscopy</strong>: If <span class=\"customMeta\" data-dictid=\"f3b9227a231692777185b5c30d8602\">cytology</span> is -ve &amp; <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> is suspected, <span class=\"customMeta\" data-dictid=\"578924165416927772007f75a6c4f5\">thoracoscopy</span> is the next step, often paired with <span class=\"customMeta\" data-dictid=\"8126bfda4a1692777195ede6823750\">pleurodesis</span> via pleural abrasion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Alternative Biopsy</strong>: If <span class=\"customMeta\" data-dictid=\"578924165416927772007f75a6c4f5\">thoracoscopy</span> is not feasible, a CT- or ultrasound-guided needle <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> of pleural thickening or nodules can be performed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treatment is mostly<strong> symptomatic</strong>, as pleural effusions indicate <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> disease and <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> is generally not possible.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"c92aa64edb16927771867805a38cc6\">dyspnea</span> impairs the patient’s quality of life and is relieved by <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> thoracentesis, further interventions include:</li>\n</ul>\n<ul>\n<li>Insertion of a small <span class=\"customMeta\" data-dictid=\"3d7fbfbd7f1692777190bde80be811\">indwelling</span> catheter. <strong>(Option A)</strong></li>\n<li>Tube <span class=\"customMeta\" data-dictid=\"0e733c2a0916927772001a6cd08d35\">thoracostomy</span> with a <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> agent (e.g., <span class=\"customMeta\" data-dictid=\"d0f202322516927771863db87b76e7\">doxycycline</span> 500 mg). <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A resident physician is preparing to perform a thoracentesis on a patient with a large pleural effusion. The patient is seated, and the procedure is to be performed under ultrasound guidance. Which of the following steps is crucial for the correct execution of the thoracentesis procedure?", "options": [{"label": "A", "text": "Insert the needle below the lower rib to avoid injury", "correct": false}, {"label": "B", "text": "Perform the procedure at the 2nd intercostal space in the midclavicular line", "correct": false}, {"label": "C", "text": "Ensure the patient is in a supine position for optimal access", "correct": false}, {"label": "D", "text": "Insert the needle above the upper border of the lower rib in the targeted intercostal space", "correct": true}], "correct_answer": "D. Insert the needle above the upper border of the lower rib in the targeted intercostal space", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/hNL8YRBoO4yT406C31vY1744382453.png", "https://image.prepladder.com/notes/wl5MJjh7v76HDqSQOMjc1744382509.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Thoracentesis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"IM605 Thoracentesis\" data-author=\"\" data-hash=\"9456\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/hNL8YRBoO4yT406C31vY1744382453.png\"/></p>\n<p> </p>\n<p><img alt=\"Thoracentesis\" data-author=\"\" data-hash=\"9459\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/wl5MJjh7v76HDqSQOMjc1744382509.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diagnostic</strong>: Unexplained effusions, suspected infections or malignancies, <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> vs. noncardiac causes.</li>\n<li><strong>Therapeutic</strong>: <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">Symptomatic</span> relief in large effusions, <span class=\"customMeta\" data-dictid=\"8126bfda4a1692777195ede6823750\">pleurodesis</span> preparation, <span class=\"customMeta\" data-dictid=\"cfa3ed6a1b1692777187669bb2c495\">empyema</span> drainage, fluid reaccumulation (e.g., <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> hemothorax).</li>\n<li><strong>Dual Role</strong>: <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">Parapneumonic</span> effusions may require both <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> <span class=\"customMeta\" data-dictid=\"f6faa0fe721692777200ce00d3091f\">thoracentesis</span> to prevent complications and improve outcomes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Absolute</strong>: <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">Bleeding</span> disorders, active infection at the <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> site.</li>\n<li><strong>Relative</strong>: Mechanical ventilation, severe <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> instability, previous infections or surgeries causing adhesions (may limit fluid removal).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conducted in a <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> environment, the procedure is usually carried out between the <strong>6th &amp; 8th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> spaces </strong><strong>(Option B)</strong>, <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> the <strong>midaxillary line</strong> for <strong>supine</strong> patients and the <strong>posterior mid-scapular line</strong> for those <strong>seated</strong>.</li>\n<li>The needle is being put above the <strong>upper border </strong>of the lower rib. <strong>(Option A)</strong></li>\n<li><strong>Guidance</strong>: Ultrasound-guided for improved accuracy and safety.</li>\n<li><strong>Steps</strong>: Skin prep → local anaesthesia → <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> → fluid <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> for diagnosis or relief.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding, infection, pneumothorax,<strong> post-expansion <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema</strong> (if rapid fluid removal).</p>\n<p>Pneumothorax risk is higher in ventilated patients; and may require chest tube placement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman presents with shortness of breath and cough. Chest X-ray shows a left-sided pleural effusion. Thoracentesis reveals the following findings. Using Light's criteria, which statement is true regarding this pleural effusion? Pleural fluid protein: 4.0 g/dL Serum protein: 6.8 g/dL Pleural fluid LDH: 280 U/L Serum LDH: 450 U/L", "options": [{"label": "A", "text": "It is definitely transudative.", "correct": false}, {"label": "B", "text": "It meets the criteria for an exudative effusion.", "correct": true}, {"label": "C", "text": "It cannot be classified without further testing.", "correct": false}, {"label": "D", "text": "It is likely due to congestive heart failure.", "correct": false}], "correct_answer": "B. It meets the criteria for an exudative effusion.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ZX0ZkM7vhy07yDKhGcKI1746007254.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Radiological Investigation</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ellis curve\" data-author=\"Doc. MUDr. Jan Šprindrich CSc.\" data-hash=\"11455\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ZP_fluidothorax_(9).jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ZX0ZkM7vhy07yDKhGcKI1746007254.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray:</strong></p>\n<ul>\n<li><strong>200 mL</strong> of fluid is needed for <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> on the <span class=\"customMeta\" data-dictid=\"ea1ec2d35e16927771962a17599e25\">posteroanterior</span> (PA) view.</li>\n<li><strong>50 mL</strong> of fluid may lead to <span class=\"customMeta\" data-dictid=\"6fd1f7611516927771836db4e712a1\">blunting</span> of the <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> view.</li>\n<li>A <strong>homogeneous opacity</strong> with <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of the<strong> <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle</strong> is typical.</li>\n<li>This appearance is marked by a <strong>curved upper border</strong>, known as the <strong>Ellis S-shaped curve</strong>.</li>\n<li>Obliteration of cardiophrenic angle<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasound: </strong>More effective than <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> in detecting fluid presence, showing a clear <strong>hypoechoic space</strong> indicative of <strong>transudate</strong> and moving densities suggesting exudate.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pleural Fluid Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Light's Criteria</strong></p>\n</td>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Differentiates transudative from <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> pleural effusions based on <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> and protein levels in pleural fluid.</p>\n<ul>\n<li>An <strong>exudative pleural effusion</strong> meets at least<strong> one</strong> of the following:\n\n\t\t\t\t<ol>\n<li>Pleural fluid protein/serum protein &gt; 0.5</li>\n<li>Pleural fluid LDH/serum <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt; 0.6</li>\n<li>Pleural fluid <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> exceeds two-thirds of the normal upper limit for serum.</li>\n</ol>\n</li>\n<li>~25% of transudates may be misidentified as exudates.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> criteria are <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> but a transudative condition is suspected, measure protein difference; if &gt;31 g/L (3.1 g/dL), likely transudative.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Tests for <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">Exudative</span> Effusions</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance description</li>\n<li>Glucose level</li>\n<li>Differential cell count</li>\n<li>Microbiologic studies</li>\n<li>Cytology</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If<strong> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> &lt;60 mg/dL</strong> Consider:</p>\n<ul>\n<li>Malignancy</li>\n<li>Bacterial infections (empyema)</li>\n<li><strong>Rheumatoid pleuritis</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Standard Peculiarities </strong></p>\n</td>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Heart Failure</strong>: <strong>NT-proBNP</strong> level &gt; 1500 pg/mL indicates <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> due to congestive heart failure</li>\n<li><strong>Parapneumonic Effusion</strong>: Key criteria include:</li>\n</ul>\n<ul>\n<li>Loculated pleural fluid</li>\n<li><strong>Pleural fluid pH &lt; 7.20</strong></li>\n<li>Pleural fluid <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt; 3.3 mmol/L <strong>(&lt; 60 mg/dL)</strong></li>\n<li>Positive <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">Gram</span> <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> or culture results</li>\n<li>Presence of visible pus</li>\n</ul>\n<ul>\n<li><strong>Tuberculous Pleuritis</strong>: Diagnosis confirmed by high TB markers in pleural fluid <strong>(adenosine <span class=\"customMeta\" data-dictid=\"8da63c3e5316927771852b78bac0ba\">deaminase</span> </strong>&gt; 40 IU/L<strong> </strong>or i<strong>nterferon γ </strong>&gt; 140 pg/mL)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old female with a known diagnosis of metastatic mesothelioma presents with worsening dyspnea and right-sided chest pain that is constant. Chest imaging is given below. What clinical finding is most likely to be present?", "options": [{"label": "A", "text": "Hyperresonance to percussion", "correct": false}, {"label": "B", "text": "Egophony at the superior aspect of the effusion", "correct": true}, {"label": "C", "text": "Increased tactile fremitus", "correct": false}, {"label": "D", "text": "Bronchial breath sounds over the effusion", "correct": false}], "correct_answer": "B. Egophony at the superior aspect of the effusion", "question_images": ["https://image.prepladder.com/notes/klAU3U3ZD1NmPIh925La1744382011.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical findings of Pleural effusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cough, fever, and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> signs depending on the underlying cause.</li>\n<li><strong>Pleurisy</strong>, marked by sharp, <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain during breathing or coughing, occurs with active <strong>pleural <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> </strong>but typically subsides once the <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> forms.</li>\n<li>Constant pain, however, is often associated with <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> conditions like mesothelioma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dullness on percussion. <strong>(Option A ruled out)</strong></li>\n<li>Decreased breath sounds. <strong>(Option D ruled out)</strong></li>\n<li>Diminished <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> and vocal fremitus. <strong>(Option C ruled out)</strong></li>\n<li><strong>Egophony</strong> is most pronounced at the upper part of the effusion. <strong>(Option B)</strong></li>\n<li><strong>Pleural Rubs</strong> can be heard during active <span class=\"customMeta\" data-dictid=\"b87b1e14ea16927771958a0a07abd8\">pleurisy</span> and may be confused with <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> crackles.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>History and <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Focus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Comprehensive history to explore potential causes of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> effusions.</li>\n<li>Assess for comorbidities, medications, <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> disease indicators, and <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk factors.</li>\n</ul>\n<ul>\n<li><strong>Congestive Heart Failure</strong>: Suspected with <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> distension, S3 heart sound, and <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> oedema.</li>\n<li><strong>Liver Cirrhosis</strong>: Considered with signs such as <span class=\"customMeta\" data-dictid=\"a1146fb9d8169277718250cf1224a8\">ascites</span> and <span class=\"customMeta\" data-dictid=\"43fe690e2616927771834a8d4a4ec1\">caput</span> medusae.</li>\n<li><strong>Primary TB</strong>: Cachexia, cough, hemoptysis, extreme breathlessness, night sweats, evening rise in temperature.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with dyspnea and pleuritic chest pain. A chest X-ray shows a pleural effusion. Pleural fluid analysis reveals elevated protein and LDH levels. Which of the following conditions is the likely cause of this exudative pleural effusion?", "options": [{"label": "A", "text": "Urinothorax", "correct": false}, {"label": "B", "text": "Esophageal rupture", "correct": true}, {"label": "C", "text": "Congestive heart failure", "correct": false}, {"label": "D", "text": "Nephrotic syndrome", "correct": false}], "correct_answer": "B. Esophageal rupture", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of pleural effusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tranudative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Exudative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Both</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congestive <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> <strong>(Option C)</strong></li>\n<li>Cirrhosis</li>\n<li>Nephrotic syndrome <strong>(Option D)</strong></li>\n<li>Peritoneal dialysis</li>\n<li>SVC obstruction</li>\n<li>Myxedema</li>\n<li>Urinothorax <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malignancies</li>\n<li>Tuberculosis</li>\n<li>Pneumonia</li>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> <strong>(Option B)</strong></li>\n<li>Pancreatic disease</li>\n<li>Collagen <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases:</li>\n</ul>\n<ul>\n<li>Rheumatoid pleuritis</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</li>\n<li>Sjögren syndrome</li>\n<li>Wegener Granulomatosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary embolism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs induced</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nitrofurantoin</li>\n<li>Dantrolene</li>\n<li>Methysergide</li>\n<li>Bromocriptine</li>\n<li>Procarbazine</li>\n<li>Amiodarone</li>\n<li>Dasatinib</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 27 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 93 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "During the discharge of a COVID patient who was treated with steroids and remdesivir, which of the following will you inform him about? Repeat RT-PCR after 7 days of discharge Watch for the persistence of Anosmia Watch for headache and nasal discharge Monitor glucose levels Watch for Sinusitis like symptoms", "options": [{"label": "A", "text": "1, 3 and 4", "correct": false}, {"label": "B", "text": "2, 3 and 4", "correct": false}, {"label": "C", "text": "3, 4 and 5", "correct": true}, {"label": "D", "text": "1,2,3,4 and 5", "correct": false}], "correct_answer": "C. 3, 4 and 5", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 3, 4 and 5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman with hysteria who was hyperventilating developed carpo-pedal spasms. What could be the likely cause for this?", "options": [{"label": "A", "text": "Respiratory acidosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": false}, {"label": "C", "text": "Respiratory alkalosis", "correct": true}, {"label": "D", "text": "Metabolic alkalosis", "correct": false}], "correct_answer": "C. Respiratory alkalosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dizziness</li>\n<li>Mental confusion</li>\n<li>Paresthesias</li>\n<li>Circumoral numbness</li>\n<li>Seizures (severe cases)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> cerebral blood flow</li>\n<li>From rapid ↓ PaCO<sub>2</sub></li>\n<li>May occur without hypoxemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chest tightness/pain</li>\n<li>Palpitations</li>\n<li>Arrhythmias</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> changes</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> vasoconstriction</li>\n<li>↓ ionized <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> effects</li>\n<li>Bohr effect on O<sub>2</sub> delivery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuromuscular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Carpopedal spasms</strong></li>\n<li>Tetany</li>\n<li>Muscle twitching</li>\n<li>Weakness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>From ↓ ionized calcium</li>\n<li>Enhanced nerve excitability</li>\n<li>Similar to hypocalcemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↑ pH</li>\n<li>↓ PaCO<sub>2</sub></li>\n<li>↓ Ionized calcium</li>\n<li>↓ K+, ↓ PO<sub>4</sub></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute: ↓ HCO<sub>3</sub>- by 2 mEq/L per 10 mmHg ↓ PaCO<sub>2</sub></li>\n<li>Chronic: ↓ HCO<sub>3</sub>- by 4-5 mEq/L per 10 mmHg ↓ PaCO<sub>2</sub></li>\n<li>Electrolyte shifts into cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Underlying Disease:</strong></p>\n<ul>\n<li>Treat primary condition</li>\n<li>Address anxiety if present</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> if present</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Hyperventilation Syndrome:</strong></p>\n<ul>\n<li>Reassurance</li>\n<li>Rebreathing techniques</li>\n<li>Paper bag breathing if needed</li>\n<li>β-blockers if needed</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primary focus on the underlying cause</li>\n<li>Avoid sedatives for anxiety</li>\n<li>Monitor during mechanical ventilation</li>\n<li>Adjust <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> settings if needed</li>\n<li>Regular monitoring of blood gases</li>\n<li>Address psychological factors</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic woman is admitted due to persistent vomiting. She gives a history of consuming food from outside. On evaluation, her blood pressure is 90/60 mmHg. Her arterial blood gas (ABG) report shows the following findings. What is the cause of her ABG findings? pH - 7.52 HCO 3 - 30 meq/L PaCO 2 - 20 mmHg Na- 123 mEq/L K- 3.2 mEq/L CI- 67 mEq/L", "options": [{"label": "A", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "B", "text": "Persistent vomiting", "correct": true}, {"label": "C", "text": "Septic shock", "correct": false}, {"label": "D", "text": "Renal tubular acidosis", "correct": false}], "correct_answer": "B. Persistent vomiting", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man with chronic renal failure on dialysis presents with sudden collapse to the casualty with laboured breathing. ECG shows tall, tented T waves. What is the most likely acid-base imbalance that can be seen in this patient?", "options": [{"label": "A", "text": "pH-7.14, pCO2-20 mmHg, HCO3- 5 mEq/L", "correct": true}, {"label": "B", "text": "pH-7.14, pCO2-20 mmHg, HCO3- 34 mEq/L", "correct": false}, {"label": "C", "text": "pH-7.54, pCO2- 34 mmHg, HCO3- 27 mEq/L", "correct": false}, {"label": "D", "text": "pH-7.4, pCO2- 40 mmHg, HCO3- 27 mEq/L", "correct": false}], "correct_answer": "A. pH-7.14, pCO2-20 mmHg, HCO3- 5 mEq/L", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primary <strong>decrease in HCO<sub>3</sub>⁻</strong> or increase in H⁺ ions</li>\n<li>Characterized by <strong>↓ pH and ↓ HCO<sub>3</sub>⁻</strong></li>\n<li>Compensatory mechanism: ↓ PaCO<sub>2</sub> through <span class=\"customMeta\" data-dictid=\"e07ff4a5ce1692777189b9e95326f3\">hyperventilation</span> (Kussmaul breathing)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (AG &gt; 12 mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (AG 6-12 mEq/L)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>(Mnemonic: MUDPILES)</strong></p>\n<ul>\n<li><strong>M</strong>: Methanol</li>\n<li><strong>U</strong>: <strong>Uremia (Renal failure) </strong></li>\n<li><strong>D</strong>: <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> (DKA)<strong> </strong></li>\n<li><strong>P</strong>: Paraldehyde, Phenformin, <span class=\"customMeta\" data-dictid=\"e2c0074e9c1692777196b2028a4274\">Propylene</span> glycol</li>\n<li><strong>I</strong>: Iron tablets, Isoniazid</li>\n<li><strong>L</strong>: <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis</li>\n<li><strong>E</strong>: <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">Ethylene</span> glycol</li>\n<li><strong>S</strong>: Salicylates (late phase)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>(Mnemonic: HARD UP)</strong></p>\n<ul>\n<li><strong>H</strong>: <span class=\"customMeta\" data-dictid=\"9f3f3ebd8c16927771891dc68e6fcf\">Hyperalimentation</span> (TPN)</li>\n<li><strong>A</strong>: Acetazolamide</li>\n<li><strong>R</strong>: <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> Acidosis</li>\n<li><strong>D</strong>: Diarrhea</li>\n<li><strong>U</strong>: Ureteral diversion</li>\n<li><strong>P</strong>: Pancreatic fistula</li>\n<li>GIT fistulas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General Features:</strong></p>\n<ul>\n<li>Lethargy</li>\n<li>Confusion</li>\n<li>Fatigue</li>\n<li>Nausea/vomiting</li>\n<li><strong>Deep, rapid breathing (Kussmaul)</strong></li>\n</ul>\n<p><strong>Specific Features:</strong></p>\n<ul>\n<li>DKA: Fruity breath, polyuria, polydipsia</li>\n<li>Uremia: Itching, volume overload</li>\n<li>Lactic acidosis: Shock, hypotension</li>\n<li>Toxic ingestion: Visual disturbances (methanol), <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> crystals (ethylene glycol)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child with AIDS presented with a fever and productive cough. On auscultation, bronchial breath sounds and crepitations were heard in the right infra-scapular region. Chest x-ray showed right lower lobe consolidation. The CD4 count was 55 cells/mm3. What is the most common causative organism for this condition?", "options": [{"label": "A", "text": "Pneumocystis jirovecii", "correct": false}, {"label": "B", "text": "Streptococcus pneumonia", "correct": true}, {"label": "C", "text": "Staphylococcus aureus", "correct": false}, {"label": "D", "text": "Mycoplasma", "correct": false}], "correct_answer": "B. Streptococcus pneumonia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Community-Acquired <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> (CAP)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Atypical Pneumonia</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Outpatients</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hospitalised Patients</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes M.pneumoniae C.pneumoniae, and <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common causes:</strong></p>\n<p><strong>S.pneumoniae</strong>, M.pneumoniae</p>\n<p>H. influenzae, C.pneumoniae, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> viruses (influenza, RSV).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-ICU</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICU Patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar pathogens to outpatients, plus <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathogens include S.pneumoniae, S. aureus (including MRSA), <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species, <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> bacilli, and H. influenzae.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staphylococcus aureus (MRSA)</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It can cause CAP, often complicating <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> infections.</li>\n<li>Community-acquired <span class=\"customMeta\" data-dictid=\"fdcadd75c416927771935379e47ef6\">MRSA</span> (CA-MRSA) has emerged as a significant cause of <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> pneumonia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumococcal Pneumonia</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Higher risk in elderly patients, and those with comorbidities like dementia, heart failure, <span class=\"customMeta\" data-dictid=\"75a3b02a801692777184b9cb7f0c0a\">cerebrovascular</span> disease, alcoholism, smoking, COPD, and <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CA-MRSA Pneumonia</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More likely in patients with prior skin infections or following <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> illnesses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enterobacteriaceae</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common in patients recently hospitalized, those treated with antibiotics, or those with comorbidities like alcoholism, heart failure, or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudomonas aeruginosa</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Found in patients with severe structural lung diseases such as bronchiectasis, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> fibrosis, or advanced COPD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Legionella Infection</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with risk factors like diabetes, hematologic malignancies, cancer, severe <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease, HIV, smoking, male gender, and recent travel (air conditioners, showers, hotels, cruise ships). It is an important cause of <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> pneumonia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, nocturnal cough, breathlessness, and wheezing for 4 weeks. The absolute eosinophil count is &amp;gt;5000/µL. Chest x-ray shows a miliary pattern. What is the likely diagnosis?", "options": [{"label": "A", "text": "Bronchial asthma", "correct": false}, {"label": "B", "text": "Miliary tuberculosis", "correct": false}, {"label": "C", "text": "Tropical pulmonary eosinophilia", "correct": true}, {"label": "D", "text": "Hypersensitivity pneumonitis", "correct": false}], "correct_answer": "C. Tropical pulmonary eosinophilia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9ZN7mzs3e5EMSNou7Nz91746439170.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic smoker presented with shortness of breath, bilateral pitting pedal edema, and abdominal distension. On examination, jugular venous pulse was found to be elevated and liver was palpable 8 cm below the costal margin. An abnormality in which of the following structures is responsible for the patient’s symptoms?", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": true}], "correct_answer": "D. 4", "question_images": ["https://image.prepladder.com/notes/4Zj1tigzOtzPHFWhEZWU1747045928.png"], "explanation_images": [], "explanation": "<p>Correct Answer D - 4\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Acid-base imbalance is suspected in a patient. Which of the following would you use to determine it? Arterial pH Venous pH Venous pO2 Venous pCO2", "options": [{"label": "A", "text": "1,2", "correct": true}, {"label": "B", "text": "1,2,3", "correct": false}, {"label": "C", "text": "1,2,4", "correct": false}, {"label": "D", "text": "1,2,3,4", "correct": false}], "correct_answer": "A. 1,2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - 1,2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the pathology from the given flow-volume loop:", "options": [{"label": "A", "text": "Fixed distal airway obstruction", "correct": false}, {"label": "B", "text": "Fixed central airway obstruction", "correct": true}, {"label": "C", "text": "Variable intrathoracic obstruction", "correct": false}, {"label": "D", "text": "Variable extra thoracic obstruction", "correct": false}], "correct_answer": "B. Fixed central airway obstruction", "question_images": ["https://image.prepladder.com/notes/Pft5IWKQFiGHCAmCb2QO1747045521.png"], "explanation_images": ["https://image.prepladder.com/content/DNMIKujp5XA8QIYZWo531745565492.png"], "explanation": "<p>Correct Answer B - Fixed central &lt;span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\"&gt;airway&lt;/span&gt; obstruction</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Loop Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Expiratory Curve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inspiratory Curve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Example Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symmetrical, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symmetrical, rounded</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Healthy lungs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obstructive (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scooped (concave)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>COPD, asthma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Restrictive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Narrow, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Narrow, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary fibrosis, pleural effusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fixed Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flattened (box-like)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flattened (box-like)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tracheal stenosis, large goiter</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Variable Extrathoracic <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flattened</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vocal cord dysfunction, laryngeal tumor</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Variable Intrathoracic <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flattened</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tracheomalacia, <span class=\"customMeta\" data-dictid=\"7cabf0723c1692777183971e234185\">bronchogenic</span> tumor</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female patient with class II pulmonary hypertension presents with a negative vasoreactive test. Which of the following is used in the next step of management?", "options": [{"label": "A", "text": "Iloprost", "correct": false}, {"label": "B", "text": "Ambrisentan", "correct": true}, {"label": "C", "text": "Nifedipine", "correct": false}, {"label": "D", "text": "Epoprostenol", "correct": false}], "correct_answer": "B. Ambrisentan", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man presents with a cough with yellowish sputum. Auscultation revealed bronchial breath sounds. He is hemodynamically stable and not confused. On examination, his respiratory rate is 20/min, and his blood pressure is 110/70 mmHg. Lab reports show urea levels of 44 mg/dL. What is the next best step in the management of this patient?", "options": [{"label": "A", "text": "Given antibiotics and send the patient home", "correct": false}, {"label": "B", "text": "Admit to ICU without mechanical ventilation", "correct": false}, {"label": "C", "text": "Admit to ICU with invasive mechanical ventilation", "correct": false}, {"label": "D", "text": "Consider admission in a non-ICU setting", "correct": true}], "correct_answer": "D. Consider admission in a non-ICU setting", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CURB-65</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>C</strong>) Confusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>U</strong>) Urea: <span class=\"customMeta\" data-dictid=\"eeb0ec7e661692777183f957a8794b\">BUN</span> &gt;19mg/dL (&gt;7 mmol/L)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>R</strong>) <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> rate ≥30/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>B</strong>) <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">Blood Pressure</span> – <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP ≤90 mmHg or diastolic BP ≤60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>65</strong>) Age ≥65 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came with hypoxemia and a normal alveolar-arterial oxygen gradient. What can be the cause?", "options": [{"label": "A", "text": "Right-to-left shunt", "correct": false}, {"label": "B", "text": "Ventilation/perfusion mismatch", "correct": false}, {"label": "C", "text": "Hypoventilation", "correct": true}, {"label": "D", "text": "Alveolar membrane damage", "correct": false}], "correct_answer": "C. Hypoventilation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of fever for the past 4 days and sudden onset of breathlessness was admitted to ICU as he was deteriorating. He was unresponsive to the incremental flow rate of oxygen and his oxygen saturation was progressively decreasing. A chest x-ray was ordered and the findings are shown in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Atelectasis", "correct": false}, {"label": "B", "text": "Mediastinitis", "correct": false}, {"label": "C", "text": "Pulmonary fibrosis", "correct": false}, {"label": "D", "text": "ARDS", "correct": true}], "correct_answer": "D. ARDS", "question_images": ["https://image.prepladder.com/content/CDbQauhz3glnM8DwUbqJ1746096745.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents to the emergency department with the following arterial blood gas (ABG) results: pH 7.55, PaCO 2 40 mmHg, HCO 3 - 32 mEq/L. Which of the following conditions is most likely responsible for these findings?", "options": [{"label": "A", "text": "Metabolic acidosis", "correct": false}, {"label": "B", "text": "Metabolic alkalosis", "correct": true}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Respiratory alkalosis", "correct": false}], "correct_answer": "B. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following findings from a pleural fluid aspirate will suggest an exudative pleural effusion? Normal values Total S. Protein: 6-8 gm% S.LDH: 140-280 IU S. glucose: 140-200", "options": [{"label": "A", "text": "Pleural: Serum protein ratio &amp;gt; 0.5, pleural: Serum LDH ratio &amp;gt; 0.6 or pleural LDH &amp;gt; ⅔ of serum LDH", "correct": true}, {"label": "B", "text": "Pleural fluid protein = 4.5 gm% and glucose = 30 mg%", "correct": false}, {"label": "C", "text": "Pleural fluid LDH = 90IU and glucose = 30 mg%", "correct": false}, {"label": "D", "text": "Pleural fluid protein = 3.5gm% and glucose = 90 mg%", "correct": false}], "correct_answer": "A. Pleural: Serum protein ratio &gt; 0.5, pleural: Serum LDH ratio &gt; 0.6 or pleural LDH &gt; ⅔ of serum LDH", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Radiological investigation</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray:</strong></p>\n<ul>\n<li><strong>200 mL</strong> of fluid is needed for <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> on the <span class=\"customMeta\" data-dictid=\"ea1ec2d35e16927771962a17599e25\">posteroanterior</span> (PA) view.</li>\n<li><strong>50 mL</strong> of fluid may lead to <span class=\"customMeta\" data-dictid=\"6fd1f7611516927771836db4e712a1\">blunting</span> of the <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> view.</li>\n<li>A <strong>homogeneous opacity</strong> with <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of the<strong> <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle</strong> is typical.</li>\n<li>This appearance is marked by a <strong>curved upper border</strong>, known as the <strong>Ellis S-shaped curve</strong>.</li>\n<li>Obliteration of cardiophrenic angle<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound: </strong>More effective than <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> in detecting fluid presence, showing a clear <strong>hypoechoic space</strong> indicative of <strong>transudate</strong> and moving densities suggesting exudate.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pleural fluid Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Light's Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiates transudative from <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> pleural effusions based on <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> and protein levels in pleural fluid.</p>\n<ul>\n<li>An <strong>exudative pleural effusion</strong> meets at least<strong> one</strong> of the following:\n\n\t\t\t\t<ol>\n<li>Pleural fluid protein/serum protein &gt; 0.5</li>\n<li>Pleural fluid LDH/serum <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt; 0.6</li>\n<li>Pleural fluid <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> exceeds two-thirds of the normal upper limit for serum.</li>\n</ol>\n</li>\n<li>~25% of transudates may be misidentified as exudates.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> criteria are <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> but a transudative condition is suspected, measure protein difference; if &gt;31 g/L (3.1 g/dL), likely transudative.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Additional Tests for <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">Exudative</span> Effusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Appearance description</li>\n<li>Glucose level, If<strong> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> &lt;60 mg/dL</strong> Consider:\n\t\t\t\t<ul>\n<li>Malignancy</li>\n<li>Bacterial infections (empyema)</li>\n<li>Rheumatoid pleuritis</li>\n</ul>\n</li>\n<li>Differential cell count</li>\n<li>Microbiologic studies</li>\n<li>Cytology</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Standard Peculiarities </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Heart Failure</strong>: <strong>NT-proBNP</strong> level &gt; 1500 pg/mL indicates <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> due to congestive heart failure</li>\n<li><strong>Parapneumonic Effusion</strong>: Key criteria include:\n\t\t\t\t<ul>\n<li>Loculated pleural fluid</li>\n<li><strong>Pleural fluid pH &lt; 7.20</strong></li>\n<li>Pleural fluid <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt; 3.3 mmol/L <strong>(&lt; 60 mg/dL) ( Option B, C)</strong></li>\n<li>Positive <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">Gram</span> <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> or culture results</li>\n<li>Presence of visible pus</li>\n</ul>\n</li>\n<li><strong>Tuberculous Pleuritis</strong>: Diagnosis confirmed by high TB markers in pleural fluid <strong>(adenosine <span class=\"customMeta\" data-dictid=\"8da63c3e5316927771852b78bac0ba\">deaminase</span> </strong>&gt; 40 IU/L<strong> </strong>or i<strong>nterferon γ </strong>&gt; 140 pg/mL)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following patient has presented after chest trauma. On examination, crepitus is felt. The clinical diagnosis is?", "options": [{"label": "A", "text": "Subcutaneous emphysema", "correct": true}, {"label": "B", "text": "Gas gangrene", "correct": false}, {"label": "C", "text": "Acute tubular necrosis", "correct": false}, {"label": "D", "text": "SVC syndrome", "correct": false}], "correct_answer": "A. Subcutaneous emphysema", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following imaging tests should be performed to confirm a diagnosis of pulmonary embolism in a patient?", "options": [{"label": "A", "text": "Doppler echocardiography", "correct": false}, {"label": "B", "text": "CT pulmonary angiography", "correct": true}, {"label": "C", "text": "Ventilation perfusion scan of lungs", "correct": false}, {"label": "D", "text": "MR pulmonary angiography", "correct": false}], "correct_answer": "B. CT pulmonary angiography", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/7mZQzYdjWQpJNcwpmz1X1747902284.png", "https://image.prepladder.com/content/PpDTCMHyrT9NDDgOdpS51745902837.png", "https://image.prepladder.com/content/dY8BgnvPkbUz6Ekh5x7T1745902837.png", "https://image.prepladder.com/notes/9a18lbkwDQnXUpC8hn581747902443.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Evaluation</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>PE symptoms are nonspecific, often leading to excessive use of CT <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> angiograms. Age-adjusted d-dimer testing is recommended for patients over 50 years with low-to-moderate PE probability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>D-Dimer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A sensitive but <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">nonspecific</span> test for PE. Elevated levels indicate possible PE but can also occur with conditions like MI, pneumonia, or sepsis. Normal d-dimer helps rule out PE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electrocardiogram (ECG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common findings include <strong>sinus tachycardia(most common) </strong>and the <strong>S1Q3T3 sign (most specific)</strong> (S wave in lead I, Q wave in lead III, inverted T wave in lead III). T-wave <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> in V1 to V4 suggests RV strain or ischemia.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"IM596 Pulmonary Embolism ECG\" data-author=\"R.W.Koster\" data-hash=\"13140\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pulm_embolism.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/7mZQzYdjWQpJNcwpmz1X1747902284.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Venous Ultrasonography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uses <strong>loss of <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> compressibility</strong> as a key indicator for diagnosing DVT, which is associated with PE. Doppler <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> can assess <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> dynamics.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often normal but may show specific signs like Westermark’s sign (focal oligemia), Hampton’s <span class=\"customMeta\" data-dictid=\"cc997dd837169277718990ed8944ed\">hump</span> (wedge-shaped pleural density), or Palla’s sign (enlarged <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sleedaniel\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:AP_Chest_X-Ray.tif?page=1\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/content/PpDTCMHyrT9NDDgOdpS51745902837.png\" width=\"415\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Chest <span class=\"customMeta\" data-dictid=\"5c71603ac81692777197e2aa1e7fd3\">radiograph</span> demonstrating <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> oligemia<strong> (Westermark’s sign) </strong>in the <span class=\"customMeta\" data-dictid=\"e9046e11bd1692777197e166e5418f\">right lung</span> (area between white arrowheads) and a prominent right <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <strong>(Palla’s sign)</strong> (black arrow).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hampton_hump_bei_schwerer_Lungenembolie_-_Roe_Thorax.jpg\" data-tags=\"\" height=\"415\" src=\"https://image.prepladder.com/content/dY8BgnvPkbUz6Ekh5x7T1745902837.png\" width=\"498\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>The chest <span class=\"customMeta\" data-dictid=\"5c71603ac81692777197e2aa1e7fd3\">radiograph</span> demonstrates a wedge-shaped <span class=\"customMeta\" data-dictid=\"a8eadab50316927771948be0cc91ca\">opacity</span> (arrow) in the right middle <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> consistent with <strong>Hampton hump.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest CT with Contrast</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The primary <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> test. It offers high-resolution visualisation of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vasculature. RV <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> on CT indicates a higher risk of mortality.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lung Scanning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A second-line test, mostly for patients who can’t tolerate contrast. High-probability <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> scans (two or more <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> defects) strongly suggest PE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Magnetic Resonance (MR) Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MR <span class=\"customMeta\" data-dictid=\"8a7362882e1692777201ef793c3fd4\">venography</span> with <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">gadolinium</span> can diagnose DVT when <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> is inconclusive, though <strong>MR <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">angiography</span> (Option D)</strong> is less reliable for smaller PEs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Echocardiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is <strong>not reliable (Option A)</strong> for directly diagnosing PE but useful for detecting mimicking conditions. <strong>McConnell’s sign</strong> (RV-free wall hypokinesis) is an <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> sign of PE.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PIM085 McConnell sign\" data-author=\"Gunjan Choudhary, Arushi A. Malik, Dwight Stapleton, Pratap c Reddy\" data-hash=\"13141\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/McConnell-sign-McConnell-sign-akinesis-of-the-free-wall-of-the-right-ventricle-with_fig6_309337048\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/9a18lbkwDQnXUpC8hn581747902443.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Angiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Identifies <span class=\"customMeta\" data-dictid=\"603b3d38051692777190701f192c2a\">intraluminal</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defects or abrupt vessel occlusion.</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was admitted to the ICU 48 hours after an accident in which he sustained a fracture of the femur. The oxygen saturation in the rebreathing unit was 100% but his SpO2 remained at 60%. The patient is in a state of confusion. Diffuse petechiae are noted on examination. Chest radiograph showed lung fields to be clear. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Fat embolism", "correct": true}, {"label": "C", "text": "ARDS", "correct": false}, {"label": "D", "text": "Occult pneumothorax", "correct": false}], "correct_answer": "B. Fat embolism", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/3TIfJH2acvVl8bt3hMf41747902191.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blunt trauma</strong>: Accounts for 90% of cases, especially involving <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> fractures.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong>:</p>\n<ul>\n<li>Acute pancreatitis</li>\n<li>Diabetes mellitus</li>\n<li>Burns</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> surgeries</li>\n<li>Liposuction</li>\n<li>Cardiopulmonary bypass</li>\n<li>Decompression sickness</li>\n<li>Parenteral <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> infusion</li>\n<li>Sickle cell crisis</li>\n<li>Pathologic fractures</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increased risk factors</strong> (in trauma patients):</p>\n<ul>\n<li>Age 30 years or younger</li>\n<li>Closed <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> fracture</li>\n<li>Multiple long-bone fractures</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients affected by COVID-19, which of the following patterns is frequently observed in chest CT scans?", "options": [{"label": "A", "text": "Interlobular septal thickening", "correct": false}, {"label": "B", "text": "Air bronchograms", "correct": false}, {"label": "C", "text": "Ground glass opacity", "correct": true}, {"label": "D", "text": "Crazy paving pattern", "correct": false}], "correct_answer": "C. Ground glass opacity", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/SJVXrCIjD1ishLASdXwr1747901941.png", "https://image.prepladder.com/content/QfbxUQG9YLve64ERM2ac1745843869.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CO-RADS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Suspicion Level </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CT findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically inadequate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or non-infectious abnormalities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormalities consistent with infections other than Covid-19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indeterminate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unclear whether <span class=\"customMeta\" data-dictid=\"2d364aeaf7169277718529fa58f6ea\">covid-19</span> is present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormalities suspicious for covid-19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 5 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very high</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typical covid-19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 6 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PCR+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presented with tachypnea and mental confusion. His blood sugar is 350mg/dl, pH-7.2, HCO3-10, pCO2-30. What is the metabolic abnormality?", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": true}, {"label": "C", "text": "Respiratory alkalosis", "correct": false}, {"label": "D", "text": "Respiratory acidosis", "correct": false}], "correct_answer": "B. Metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient being discussed has come in for medical evaluation following an injury to the chest. During the examination, the presence of crepitus is detected. Based on these findings, what is the likely clinical diagnosis?", "options": [{"label": "A", "text": "Subcutaneous emphysema", "correct": true}, {"label": "B", "text": "Gas gangrene", "correct": false}, {"label": "C", "text": "Acute tubular necrosis", "correct": false}, {"label": "D", "text": "Hyperbaric decompression sickness", "correct": false}], "correct_answer": "A. Subcutaneous emphysema", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Subcutaneous emph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the Berlin definition, which of the following is not a characteristic of moderate ARDS?", "options": [{"label": "A", "text": "200 &amp;lt; PaO2/FiO2 =&amp;lt;300mm/Hg with PEEP Is moderate", "correct": true}, {"label": "B", "text": "Bilateral interstitial infiltrates", "correct": false}, {"label": "C", "text": "Symptom onset within a week", "correct": false}, {"label": "D", "text": "No cardiac failure in echocardiography", "correct": false}], "correct_answer": "A. 200 &lt; PaO2/FiO2 =&lt;300mm/Hg with PEEP Is moderate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 200 &amp;lt; PaO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; =&amp;lt;300mm/Hg with &lt;span class=\"customMeta\" data-dictid=\"9abcb9edc11692777195dac40cd470\"&gt;PEEP&lt;/span&gt; I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is a direct cause of Acute Respiratory Distress Syndrome (ARDS)?", "options": [{"label": "A", "text": "Pneumonia", "correct": true}, {"label": "B", "text": "Fat embolism syndrome following femur shaft fracture", "correct": false}, {"label": "C", "text": "Sepsis", "correct": false}, {"label": "D", "text": "Transfusion-related lung injury", "correct": false}], "correct_answer": "A. Pneumonia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Pneu\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Causes of Direct Injury (Air-Lung Interface)</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Causes of <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">Indirect</span> Injury (Blood-Lung Interface)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inhalation of toxic gases and chemicals</p>\n</td>\n<td>\n<p>Sepsis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aspiration of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> contents</p>\n</td>\n<td>\n<p>Fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> syndrome</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Near-drowning</p>\n</td>\n<td>\n<p>Transfusion-related lung injury</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>High-pressure mechanical ventilation</p>\n</td>\n<td>\n<p>Pancreatitis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Radiation therapy</p>\n</td>\n<td>\n<p>Drug-induced lung injury</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inhalation of smoke or <span class=\"customMeta\" data-dictid=\"d4226a4b2e169277719459bb9339d6\">particulate</span> matter</p>\n</td>\n<td>\n<p>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</p>\n</td>\n<td>\n<p>Connective tissue diseases (e.g., <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis, scleroderma)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumonia (severe cases)</p>\n</td>\n<td>\n<p>Cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chemical pneumonitis</p>\n</td>\n<td>\n<p>Near-drowning</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inhalation of harmful fumes (e.g., <span class=\"customMeta\" data-dictid=\"3c268a141b1692777184336bc40100\">chlorine</span> gas)</p>\n</td>\n<td>\n<p>Inhalation of harmful fumes (e.g., <span class=\"customMeta\" data-dictid=\"3c268a141b1692777184336bc40100\">chlorine</span> gas)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year patient working in a factory for the past 20 years presents with breathlessness. HRCT chest shows pleural thickening and fibrosis. Diagnosis is?", "options": [{"label": "A", "text": "Asbestosis", "correct": true}, {"label": "B", "text": "Coal worker pneumoconiosis", "correct": false}, {"label": "C", "text": "Silicosis", "correct": false}, {"label": "D", "text": "Berylliosis", "correct": false}], "correct_answer": "A. Asbestosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The flow-volume curve of a patient after spirometry is given below. The most likely diagnosis in this patient is:", "options": [{"label": "A", "text": "Asbestosis", "correct": false}, {"label": "B", "text": "COPD", "correct": true}, {"label": "C", "text": "Myasthenia gravis", "correct": false}, {"label": "D", "text": "Vocal cord paralysis", "correct": false}], "correct_answer": "B. COPD", "question_images": ["https://image.prepladder.com/content/TRgds4DVLdshbGr02Ud31746792453.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spirometry/PFTs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Best initial test</li>\n<li>IOC</li>\n<li>Obstructive pattern\n\t\t\t\t<ul>\n<li>Reversible with short-acting β2-agonists (SABAs)</li>\n</ul>\n</li>\n<li>Findings:\n\t\t\t\t<ul>\n<li>FEV1/FVC &lt; 70%</li>\n<li>↓ FEV1</li>\n<li>Normal or ↓ FVC</li>\n<li><strong>↑ Residual Volume (RV) </strong></li>\n<li><strong>↑ Total Lung Capacity (TLC)</strong></li>\n<li>Normal or ↑ Diffusing Capacity of Lung for Carbon Monoxide (DLCO)</li>\n</ul>\n</li>\n<li>Reversibility:\n\t\t\t\t<ul>\n<li>Increase in FEV1 ≥ 12% and &gt;200 mL with SABA (albuterol)</li>\n</ul>\n</li>\n<li>PFTs between exacerbations: Often normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Methacholine Challenge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Tests for bronchial hyperresponsiveness</li>\n<li>Positive if ≥20% decrease in FEV1</li>\n<li>Sensitive but not specific</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arterial blood gas </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Early\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> (↓ PaCO2, ↑ pH) due to hyperventilation</li>\n</ul>\n</li>\n<li>Late\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> due to muscle fatigue (normalizing PaCO2, normalizing pH, ↓ PaO2)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Normal appearance to <span class=\"customMeta\" data-dictid=\"301f9a675d16927771892fb39029d3\">hyperinflation</span> with <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> of the diaphragm</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 46-year-old chronic alcoholic male presents to the OPD with fever, headache, shortness of breath, chest pain, and productive cough with red currant jelly sputum for the last two days. On examination, there was bronchial breathing on the right side, increased vocal fremitus, increased vocal resonance, and a dull note on percussion. The patient’s plain radiograph is shown below. Which is the most likely causative agent?", "options": [{"label": "A", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "B", "text": "Klebsiella pneumoniae", "correct": true}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "D", "text": "Haemophilus influenza", "correct": false}], "correct_answer": "B. Klebsiella pneumoniae", "question_images": ["https://image.prepladder.com/content/HhbpqL68lRH92jkT1bph1746791573.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition in the following X-ray.", "options": [{"label": "A", "text": "Hydropneumothorax", "correct": true}, {"label": "B", "text": "Pleural effusion", "correct": false}, {"label": "C", "text": "Pericardial effusion", "correct": false}, {"label": "D", "text": "Pneumothorax", "correct": false}], "correct_answer": "A. Hydropneumothorax", "question_images": ["https://image.prepladder.com/content/8EXkkWxMNGIBz4xT9JZC1746788822.png"], "explanation_images": ["https://image.prepladder.com/content/b2QO2aJae6Frr97t6FfR1746788890.png", "https://image.prepladder.com/content/tvByJcv97r0ND6uHir8D1746788917.png", "https://image.prepladder.com/content/KgQJnDQGfs1yAUNW8nrl1746788932.png", "https://image.prepladder.com/content/xum8xZExUVhZbnBg6POv1746788949.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient presented with chronic projectile vomiting and weight loss. What is the expected metabolic abnormality to be seen here?", "options": [{"label": "A", "text": "Hypokalemic hypochloremic metabolic alkalosis with hyponatremia", "correct": true}, {"label": "B", "text": "Hypokalemic hypochloremic metabolic alkalosis with hypernatremia", "correct": false}, {"label": "C", "text": "Hypokalemic hypochloremic metabolic alkalosis with hypercalcemia", "correct": false}, {"label": "D", "text": "Hypokalemic hypochloremic metabolic acidosis with hyponatremia", "correct": false}], "correct_answer": "A. Hypokalemic hypochloremic metabolic alkalosis with hyponatremia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of pneumonia develops pleural effusion. What is the expected finding in the pleural analysis for parapneumonic effusion?", "options": [{"label": "A", "text": "Pleural protein/plasma protein ratio less than 0.5", "correct": false}, {"label": "B", "text": "Pleural LDH less than 2/3rd of plasma LDH", "correct": false}, {"label": "C", "text": "Pleural pH less than 7.2", "correct": true}, {"label": "D", "text": "Pleural LDH less than 0.6 of plasma LDH", "correct": false}], "correct_answer": "C. Pleural pH less than 7.2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parapneumonic effusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition: </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> is a pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> that occurs in association with bacterial pneumonia, lung abscess, or bronchiectasis.</li>\n<li>These effusions develop in about 40-60% of patients with bacterial pneumonia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types:</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parapneumonic effusions can be categorized into three stages: simple (uncomplicated), complicated, and empyema.\n\t\t\t\t<ul>\n<li><strong>Simple <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> effusions</strong>, the pleural fluid is <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> and can resolve with <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy alone.</li>\n<li><strong>Complicated <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> effusions</strong> contain bacteria and require <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> in addition to antibiotics.</li>\n<li><strong>Empyema</strong> represents the most advanced stage where frank <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> is present in the pleural space.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">Parapneumonic</span> Effusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Serous</li>\n<li>PMN++, <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> fluid (negative bacterial culture)</li>\n<li>pH &gt;7.3, <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &lt;500 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &gt;80 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &gt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complicated <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">Parapneumonic</span> Effusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Turbid</li>\n<li>PMN++, bacterial culture may be + or -</li>\n<li><strong>pH &lt;7.1,</strong> <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt;1000 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt;40 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &lt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Empyema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Pus</li>\n<li>PMN++, bacterial culture positive or negative</li>\n<li>pH &lt;7.1, <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt;1000 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt;40 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &lt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management: </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Drain with antibiotics; small-bore drains (10-14 gauge) are often preferable. Consider thoracoscopic <span class=\"customMeta\" data-dictid=\"980a3fc15c1692777185d2c3e2e17f\">decortication</span> if these fail.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old man presents to the emergency department with respiratory distress and hypotension following a trauma. He has subcutaneous emphysema, and there is an absence of air entry into the right side of the lungs. What is the next best step?", "options": [{"label": "A", "text": "Start IV fluids with a large bore cannula", "correct": false}, {"label": "B", "text": "Needle decompression into the 5 th intercostal space anterior to the midaxillary line", "correct": true}, {"label": "C", "text": "Take the patient to the ICU and intubate him", "correct": false}, {"label": "D", "text": "Start positive pressure ventilation", "correct": false}], "correct_answer": "B. Needle decompression into the 5 th intercostal space anterior to the midaxillary line", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VXrt8qJsOCJ5wHRA1a361746510689.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>TENSION PNEUMOTHORAX</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>D/t ‘one-way valve’ air leaks from the lung or chest wall.</li>\n<li>Air is sucked into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> without any escape, collapsing and compressing the affected lung.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> shifts to the opposite side, reducing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> return and compressing the opposite lung, leading to decreased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output and function. This can result in sudden death.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Penetrating Chest Trauma.</strong></li>\n<li><strong>Blunt Chest Trauma </strong>with parenchymal lung injury and persistent air leak.</li>\n<li>Iatrogenic Lung Injury (e.g., central venepuncture)</li>\n<li>Mechanical Positive-Pressure Ventilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Tachypnea and Tachycardia</strong></li>\n<li>Hyper-resonance and <strong>Decreased/Absent Breath Sounds</strong></li>\n<li>Resonant <span class=\"customMeta\" data-dictid=\"4818bebdf31692777195cc835c12d4\">Percussion</span> with severe mediastinal/tracheal shift</li>\n<li>Cyanosis and Hypotension</li>\n<li>Chest Pain</li>\n<li>Distended Neck Veins</li>\n<li><strong>Subcutaneous <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Emergency Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> is a clinical diagnosis, and treatment should never be delayed by waiting for radiological confirmation.</li>\n<li><strong>Immediate <span class=\"customMeta\" data-dictid=\"367e80b0381692777200c1327c5238\">Thoracocentesis</span> (needle): Wide bore needle (typically a 20- or 22-gauge) in the 5th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space in the safety triangle.</strong></li>\n<li>Decompression should be performed in the \"safe triangle.\"\n\t\t\t\t<ul>\n<li><strong>Safe <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> Boundaries</strong>:\n\t\t\t\t\t<ul>\n<li>Posterior: <span class=\"customMeta\" data-dictid=\"12ad4210e4169277719111f356b7ba\">Latissimus</span> dorsi</li>\n<li>Anterior: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> border of the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> major</li>\n<li>Inferior: A line drawn perpendicularly from the <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> to the back, just <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the mid-axillary line.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"586\" src=\"https://image.prepladder.com/content/VXrt8qJsOCJ5wHRA1a361746510689.png\" width=\"588\"/></p>\n<ul>\n<li>In critical situations, a finger <span class=\"customMeta\" data-dictid=\"0e733c2a0916927772001a6cd08d35\">thoracostomy</span> can be done in the same location.</li>\n<li>Nasal Oxygen for support.</li>\n<li>Intercostal Tube Placement (ICT) once stable and confirmed by chest X-ray.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Additional Care </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Antibiotics and analgesics for treatment.</li>\n<li>Ventilator Support with IPPV in severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 53-year-old woman underwent hip replacement surgery. A week after the surgery, the patient developed swelling of the legs associated with pain on palpation. Her heart rate is 70 beats per min. There is no history of hemoptysis or significant weight loss. There is no previous history of pulmonary embolism. What is the risk of developing pulmonary embolism in the patient based on Well’s score?", "options": [{"label": "A", "text": "Low", "correct": false}, {"label": "B", "text": "High", "correct": true}, {"label": "C", "text": "Moderate", "correct": false}, {"label": "D", "text": "Cannot comment without d-dimer values", "correct": false}], "correct_answer": "B. High", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:459px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical signs of deep-vein thrombosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alternative diagnosis is less likely than PE</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart rate &gt;100 beats/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immobilization &gt;3 days or surgery in previous 4 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>History of deep-vein <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> or <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemoptysis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malignancy (with treatment within 6 months) or palliative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:334px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;6.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.0 - 6.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;2.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The arterial blood gas analysis findings of a patient are as follows: pH=7.30, HCO3=10 mEq/L, paCO2= 30 mmHg, which is suggestive of a partially compensated metabolic acidosis. What is the mechanism for the secondary disorder?", "options": [{"label": "A", "text": "Hypoventilation causing decreased CO2 washout", "correct": true}, {"label": "B", "text": "Hyperventilation causing decreased CO2 washout", "correct": false}, {"label": "C", "text": "Increased tubular reabsorption of HCO3-", "correct": false}, {"label": "D", "text": "Increased excretion of H+", "correct": false}], "correct_answer": "A. Hypoventilation causing decreased CO2 washout", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient who is a known case of COPD presented with acute exacerbation and is admitted to the ICU. Which of the following statements is correct with regards to the initial management of this patient?", "options": [{"label": "A", "text": "Non-invasive PPV should be given", "correct": true}, {"label": "B", "text": "Invasive PPV should be given", "correct": false}, {"label": "C", "text": "IV corticosteroids should be administered", "correct": false}, {"label": "D", "text": "Permissive hypercapnia is allowed", "correct": false}], "correct_answer": "A. Non-invasive PPV should be given", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Purpose/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Arterial blood gases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assess severity of hypoxaemia, hypercapnia, acidaemia; guide oxygen therapy and ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Identify complications such as pneumonia, pneumothorax, or pleural effusion.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Oxygen Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administer<strong> controlled oxygen at 24% or 28%</strong> to maintain PaO2 &gt; 8 kPa (60 mmHg) or SaO2 &gt; 90%.</li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gas monitoring to adjust therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Safe for mild to moderate <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis; helps reduce <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> need and mortality.</li>\n<li>Not suitable for patients unable to protect their airway.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Bronchodilators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Use nebulised short-acting β2-agonists (e.g., salbutamol, terbutaline) with anticholinergics (e.g., ipratropium).</li>\n<li>If oxygen sensitivity is a concern, use compressed air for nebulisation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administer oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> (30 mg for 10 days) to reduce symptoms and improve lung function.Reduces frequency and severity of exacerbations.</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> for repeated courses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Antibiotic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Indicated for increased <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> purulence, volume, or breathlessness.</li>\n<li>Use simple regimens (aminopenicillin, tetracycline, macrolide); <span class=\"customMeta\" data-dictid=\"dd4d53634b1692777184851322327e\">co-amoxiclav</span> in areas with β-lactamase organisms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Consider if there is a <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> cause, no prior <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, or if <span class=\"customMeta\" data-dictid=\"0e4135f3bc1692777193047657d8c5\">NIV</span> has failed/contraindicated.</li>\n<li>Decisions should involve the patient, family, and GP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Additional Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diuretics for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> oedema.</li>\n<li>Limited evidence for <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> aminophylline; consider <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> risk.</li>\n<li>Doxapram may be used short-term for low <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When you are posted as an intern in the emergency department, a 67 year old man with a known case of diabetic and CKD for 15 yrs is brought to you with complaints of persistent cough, shortness of breath, fever, fatigue, and chest pain. He has been tested positive for COVID 19. Which of the following features will prompt you to get this patient admitted to a dedicated COVID health center? A. Respiratory rate of 33/min B. SpO 2 88% C. Multiple comorbidities D. Chest pain E. Age", "options": [{"label": "A", "text": "A &amp;amp; B only", "correct": false}, {"label": "B", "text": "A, B, C &amp;amp; E only", "correct": true}, {"label": "C", "text": "A, B, &amp;amp; C only", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. A, B, C &amp; E only", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qKVvaQ2MNVNnPJuaWGxl1745842724.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Asymptomatic or Presymptomatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>No symptoms</li>\n<li>SARS-CoV-2 test positive</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms like fever, cough, taste or smell changes</li>\n<li>No dyspnea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>LRTI (lower <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection)</li>\n<li><strong>Oxygen saturation: &gt;94%</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Oxygen saturation: &lt;94%</strong></li>\n<li><strong>Respiratory rate: &gt;30/min</strong></li>\n<li>Lung <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> &gt;50%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Critical disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Respiratory failure</li>\n<li>Shock</li>\n<li>Multi-organ failure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Respiratory rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Oxygen <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage I </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild cough, throat pain, fever, diarrhoea, <span class=\"customMeta\" data-dictid=\"cc8a35010816927771819ba9cf19d8\">anosmia</span> or taste changes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Shortness of breath (dyspnea)</strong></li>\n<li>Coagulation starts (heparin has to be started)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&gt;24 breaths per min</li>\n<li><strong>&gt;30 breaths per minute (severe illness)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&lt;94%</li>\n<li><strong>&lt;90% (severe illness)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage III </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ARDS (Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome)</li>\n<li>Sepsis</li>\n<li>MODS (multi-organ <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> syndrome)</li>\n<li>Cardiogenic shock</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intubation needed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intubation needed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "High anion gap acidosis with low bicarbonate levels is seen in all of the following conditions except:", "options": [{"label": "A", "text": "Renal tubular acidosis", "correct": true}, {"label": "B", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "C", "text": "Lactic acidosis", "correct": false}, {"label": "D", "text": "Salicylate poisoning", "correct": false}], "correct_answer": "A. Renal tubular acidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (MUDPILES)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-anion gap (USED PART)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>M</strong>ethanol poisoning</li>\n<li><strong>U</strong>remia: AKI, CKD</li>\n<li><strong>D</strong>iabetic <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> <strong>(Option B)</strong></li>\n<li><strong>P</strong>aracetamol poisoning</li>\n<li><strong>I</strong>ron and isoniazid</li>\n<li><strong>L</strong>actic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> <strong>(Option C)</strong></li>\n<li><strong>E</strong>thylene <span class=\"customMeta\" data-dictid=\"7451dcad4f1692777188609e12be1d\">glycol</span> poisoning</li>\n<li><strong>S</strong>alicylate <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> <strong>(Option D) </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>U</strong>: <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> / Ureterenterostomy</li>\n<li><strong>S</strong>: Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> Fistula, <strong>S</strong>pironolactone and K-sparing diuretics, <strong>S</strong>aline <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> (rapid infusion)</li>\n<li><strong>E</strong>: Extra Chloride</li>\n<li><strong>D</strong>: Diarrhea</li>\n<li><strong>P</strong>: Pancreatic fistula</li>\n<li><strong>A</strong>: Addison, Acetazolamide</li>\n<li><strong>R: <span class=\"customMeta\" data-dictid=\"9ff00b798416927771974cced89037\">RTA</span> (Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> )</strong></li>\n<li><strong>T</strong>: Tenofovir, Topiramate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reduced <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap: </strong>Multiple <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> and <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">nephrotic</span> syndrome</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be your subsequent course of action for the patient, who has been intubated and his X-ray as depicted in the radiograph?", "options": [{"label": "A", "text": "Suction", "correct": false}, {"label": "B", "text": "Chest physiotherapy", "correct": false}, {"label": "C", "text": "Start antibiotics and send and samples for culture", "correct": false}, {"label": "D", "text": "Ultrasound-guided aspiration", "correct": true}], "correct_answer": "D. Ultrasound-guided aspiration", "question_images": ["https://image.prepladder.com/content/3gmrBjrLBmDXUs7AJxgp1745841862.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old individual who is a chronic smoker came with complaints of recurrent episodes of coughing up blood without any accompanying symptoms of fever or weight loss. On chest x-ray there were no abnormalities seen, and the sputum test is also negative for acid-fast bacilli (AFB). Which of the following options could be the next effective diagnostic test?", "options": [{"label": "A", "text": "MRI", "correct": false}, {"label": "B", "text": "CT", "correct": true}, {"label": "C", "text": "Fiberoptic bronchoscopy", "correct": false}, {"label": "D", "text": "Bronchography", "correct": false}], "correct_answer": "B. CT", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ownRRB0W9gi8x4w3XqpY1745841407.png", "https://image.prepladder.com/content/KOapY00a2bwf7knvIwR71745841407.png", "https://image.prepladder.com/content/KRhiAwjxzlcWJr0WeC4x1745841407.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions will have an FEV₁/FVC ratio &amp;lt; 0.7 and FEV₁ &amp;lt; 80% of the predicted value along with wheezing in the morning hours and shortness of breath?", "options": [{"label": "A", "text": "Asthma", "correct": true}, {"label": "B", "text": "ILD", "correct": false}, {"label": "C", "text": "IPF", "correct": false}, {"label": "D", "text": "Silicosis", "correct": false}], "correct_answer": "A. Asthma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Diagnostic Tests for Bronchial Asthama</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Spirometry/PFTs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Best initial test</li>\n<li>IOC</li>\n<li>Obstructive pattern\n\t\t\t\t<ul>\n<li>Reversible with short-acting β2-agonists (SABAs)</li>\n</ul>\n</li>\n<li>Findings:\n\t\t\t\t<ul>\n<li><strong>FEV1/FVC &lt; 70%</strong></li>\n<li><strong>↓ FEV1</strong></li>\n<li>Normal or ↓ FVC</li>\n<li>↑ Residual Volume (RV)</li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"b0e95f9af21692777200e8a9faabe7\">Total Lung Capacity</span> (TLC)</li>\n<li>Normal or ↑ Diffusing Capacity of Lung for Carbon Monoxide (DLCO)</li>\n</ul>\n</li>\n<li>Reversibility:\n\t\t\t\t<ul>\n<li>Increase in FEV1 ≥ 12% and &gt;200 mL with SABA (albuterol)</li>\n</ul>\n</li>\n<li>PFTs between exacerbations: Often normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Methacholine Challenge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tests for bronchial hyperresponsiveness</li>\n<li>Positive if ≥20% decrease in FEV1</li>\n<li>Sensitive but not specific</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Arterial blood gas </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Early\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> (↓ PaCO2, ↑ pH) due to hyperventilation</li>\n</ul>\n</li>\n<li>Late\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> due to muscle fatigue (normalizing PaCO2, normalizing pH, ↓ PaO2)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chest X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Normal appearance to <span class=\"customMeta\" data-dictid=\"301f9a675d16927771892fb39029d3\">hyperinflation</span> with <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> of the diaphragm</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man came with complaints of fever and cough for 3 days. On examination, creatinine is 1.5 and BUN is 45. Chest-x ray shows infiltrates in the right lung and patchy infiltrates in the left lung. A nasopharyngeal swab shows only Rhinovirus. The patient is shifted to the ICU. Which antibiotics are suitable for this patient?", "options": [{"label": "A", "text": "Amoxicillin + Clavulanic acid", "correct": false}, {"label": "B", "text": "Azithromycin", "correct": false}, {"label": "C", "text": "Ceftriaxone + Azithromycin", "correct": true}, {"label": "D", "text": "Piptaz + Ciprofloxacin", "correct": false}], "correct_answer": "C. Ceftriaxone + Azithromycin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CURB-65</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>C</strong>) Confusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>U</strong>) Urea: <span class=\"customMeta\" data-dictid=\"eeb0ec7e661692777183f957a8794b\">BUN</span> &gt;19mg/dL (&gt;7 mmol/L)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>R</strong>) <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> rate ≥30/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>B</strong>) <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">Blood Pressure</span> - <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP ≤90 mmHg or diastolic BP ≤60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>65</strong>) Age ≥65 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old bedridden patient develops sudden onset breathlessness and chest pain . CTPA was done. Which of the following non-invasive investigations will be useful to confirm the etiology of this presentation?", "options": [{"label": "A", "text": "D dimer", "correct": false}, {"label": "B", "text": "MRI", "correct": false}, {"label": "C", "text": "Coagulogram", "correct": false}, {"label": "D", "text": "Doppler", "correct": true}], "correct_answer": "D. Doppler", "question_images": ["https://image.prepladder.com/content/fwAiIVwFivdgZns2U2Qf1692710087.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old woman is being evaluated for daytime sleepiness and memory loss which have been present for the past 1 year. Her BMI is 43, her BP is 170/98 mmHg. In an awake state, ABG shows pO2 70 mmHg, pCO2 53 mmHg, HCO3 33 mmol/L. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Obesity Hypoventilation Syndrome", "correct": true}, {"label": "B", "text": "Central Sleep Apnea", "correct": false}, {"label": "C", "text": "Narcolepsy", "correct": false}, {"label": "D", "text": "Obstructive sleep Apnea", "correct": false}], "correct_answer": "A. Obesity Hypoventilation Syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\"&gt;Obesity&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\"&gt;Hypoventilation&lt;/span&gt; Syndrome (OHS)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with daytime sleepiness and impaired concentration and memory. On examination his BMI is 41 kg/m2, BP is 160/100 mm Hg. His awake ABG analysis is given: PaO 2 = 66mm Hg PaCO 2 = 50 mm Hg HCO 3 = 28 mEq/L What is the most likely diagnosis?", "options": [{"label": "A", "text": "Obstructive sleep apnea", "correct": false}, {"label": "B", "text": "Narcolepsy", "correct": false}, {"label": "C", "text": "Obesity hypo-ventilation syndrome", "correct": true}, {"label": "D", "text": "Central sleep apnea", "correct": false}], "correct_answer": "C. Obesity hypo-ventilation syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\"&gt;Obesity&lt;/span&gt; hypo-v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following medical conditions with their corresponding descriptions: A Caplan syndrome 1 Initially observed in coal workers B Asbestosis 2 Presents with a characteristic \"crazy pavement\" appearance C Mesothelioma 3 Affects the pleura D Sarcoidosis 4 Exhibits the presence of pleural effusion", "options": [{"label": "A", "text": "A-1, B-4, C-3, D-2", "correct": true}, {"label": "B", "text": "A-4, B-2, C-3, D-1", "correct": false}, {"label": "C", "text": "A-3, B-4, C-2, D-1", "correct": false}, {"label": "D", "text": "A-2, B-4, C-3, D-1", "correct": false}], "correct_answer": "A. A-1, B-4, C-3, D-2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - A-1, B-4, C-3, D-2</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Caplan syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Initially observed in coal workers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Asbestosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Exhibits the presence of pleural effusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Mesothelioma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Affects the pleura</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">D</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Sarcoidosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Presents with a characteristic \"crazy pavement\" appearance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which membrane channel is mainly affected in Cystic fibrosis?", "options": [{"label": "A", "text": "Sodium", "correct": false}, {"label": "B", "text": "Chloride", "correct": true}, {"label": "C", "text": "Calcium", "correct": false}, {"label": "D", "text": "Potassium", "correct": false}], "correct_answer": "B. Chloride", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Chloride</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CFTR Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Defective chloride/bicarbonate transport</strong></li>\n<li>Located in <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> membranes</li>\n<li>F508del (phenylalanine is replaced) <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> most common (~70%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Airway Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Depleted periciliary fluid layer</li>\n<li>Thick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> accumulation</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"d90d813c741692777193a2b52ba508\">mucociliary</span> clearance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Infection Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common pathogens: P. aeruginosa, S. aureus</li>\n<li>Chronic bacterial colonization</li>\n<li>Progressive bronchiectasis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Impact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recurrent pneumonia</li>\n<li>Progressive lung damage</li>\n<li>Requires aggressive <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman with obstructive lung disease is currently using salmeterol and tiotropium but continues to experience breathlessness and frequent exacerbations. Given her current situation, which of the following treatments would be most appropriate?", "options": [{"label": "A", "text": "Nebulization with LAMA-LABA", "correct": false}, {"label": "B", "text": "Long-Term Oxygen Therapy (LTOT)", "correct": true}, {"label": "C", "text": "Positive Pressure Ventilation (PPV)", "correct": false}, {"label": "D", "text": "Pneumococcal Vaccine", "correct": false}], "correct_answer": "B. Long-Term Oxygen Therapy (LTOT)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The chest X-ray shows right-sided white-out lung and contralateral tracheal deviation. In which of the following conditions is this seen?", "options": [{"label": "A", "text": "Pneumothorax", "correct": false}, {"label": "B", "text": "Consolidation", "correct": false}, {"label": "C", "text": "Collapse", "correct": false}, {"label": "D", "text": "Thoracic mass", "correct": true}], "correct_answer": "D. Thoracic mass", "question_images": ["https://image.prepladder.com/notes/bUrAigJ9D9rMikQocm3E1747663849.png"], "explanation_images": ["https://image.prepladder.com/notes/i89ikiVMMUFGmAx2qzPl1747663929.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 year old shipbuilding worker presents with dyspnea. He has been working in this industry for the past 25 years. Which is the most specific malignancy that we can expect in this patient?", "options": [{"label": "A", "text": "Bronchogenic carcinoma", "correct": false}, {"label": "B", "text": "Malignant mesothelioma", "correct": true}, {"label": "C", "text": "Small cell carcinoma of lung", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma of lung", "correct": false}], "correct_answer": "B. Malignant mesothelioma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wmjZSRSFJN0dvZHSLfU61745843643.png", "https://image.prepladder.com/content/GKd7WhC5zEVkx6AC2dFe1745843643.png", "https://image.prepladder.com/content/1gOAdXc21YEn3wxtT8x11745843643.png", "https://image.prepladder.com/content/KlXxAYvPdB1qqzaraO871745843643.png", "https://image.prepladder.com/content/I81xJDClQ669QLZJ8e9Q1745843643.png", "https://image.prepladder.com/content/S4pBggmOT6EslQyCzpQ61745843683.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:742px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mesothelioma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A rare cancer arising from mesothelial cells that most commonly affects the pleura.</li>\n<li>It can also affect the peritoneum, <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">pericardium</span> and <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asbestos: <span class=\"customMeta\" data-dictid=\"9f56633f181692777192f07ed38b1a\">Mesothelioma</span> is the most specific asbestos-associated cancer .</li>\n<li>It is not associated with smoking.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Advanced pleural <span class=\"customMeta\" data-dictid=\"9f56633f181692777192f07ed38b1a\">mesothelioma</span> can cause extensive pleural <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and thickening, making the affected side rigid and immobile.</li>\n<li>Later stages fix the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> in place due to pleural thickening and fibrosis.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift is not a characteristic feature of mesothelioma.</li>\n<li>M/C <span class=\"customMeta\" data-dictid=\"2878159c181692777185d495ce6244\">cytogenetic</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in mesothelioma: <strong>Homozygous <span class=\"customMeta\" data-dictid=\"cf1e8ec6121692777185eba2630061\">deletion</span> of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 9p</strong>, leading to <strong>loss</strong> of tumour <span class=\"customMeta\" data-dictid=\"92427347f51692777199a762a91d21\">suppressor</span> gene- <strong>CDKN2A.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Progressive dyspnea, chest pain, weight loss, chronic cough, hemoptysis.</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"baa424d2de16927771836afd73785b\">breath sounds</span> and <span class=\"customMeta\" data-dictid=\"e452a3bf5716927771867e7ea9b4da\">dullness</span> to <span class=\"customMeta\" data-dictid=\"4818bebdf31692777195cc835c12d4\">percussion</span> (due to pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> or thickening).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT scan:</strong> <strong>Pleural thickening, effusion, or frozen hemithorax</strong> (not causing a <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift in the presence of effusion)</li>\n<li>Confirmed by <strong>biopsy:</strong>\n<ul>\n<li><strong>Epithelioid mesothelioma</strong> shows tubules, nests, or <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> structures with uniform round to <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm.</li>\n<li><strong>Sarcomatoid mesothelioma</strong> consists of spindle-shaped cells resembling fibrosarcoma.</li>\n<li><strong>Biphasic mesothelioma</strong> displays a mixture of both patterns.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Specific</strong> <strong>markers</strong> for mesothelioma:\n\n\t\t\t\t<ul>\n<li>Calretinin.</li>\n<li>Epithelial <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> antigen.</li>\n<li>Cytokeratin.</li>\n<li>Mesothelin.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Yale Rosen\" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"https://www.flickr.com/photos/pulmonary_pathology/3954797985/in/photostream/\" data-tags=\"\" height=\"415\" src=\"https://image.prepladder.com/content/wmjZSRSFJN0dvZHSLfU61745843643.png\" width=\"266\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mesothelioma- Gross</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Malignant_epithelioid_mesothelioma_2-2_-_high_mag.jpg#/media/File:Malignant_epithelioid_mesothelioma_-_high_mag.jpg\" data-tags=\"\" height=\"286\" src=\"https://image.prepladder.com/content/GKd7WhC5zEVkx6AC2dFe1745843643.png\" width=\"192\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mesothelioma- H &amp; E stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Malignant_epithelioid_mesothelioma_2-2_-_high_mag.jpg#/media/File:Malignant_epithelioid_mesothelioma_-_calretinin_-_intermed_mag.jpg\" data-tags=\"\" height=\"207\" src=\"https://image.prepladder.com/content/1gOAdXc21YEn3wxtT8x11745843643.png\" width=\"335\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mesothelioma- Calretinin stain</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Mesothelioma - sarcomatoid. Case study, Radiopaedia.org (Accessed on 06 Dec 2024) https://doi.org/10.53347/rID-8705\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/mesothelioma-sarcomatoid#image-317742\" data-tags=\"\" height=\"380\" src=\"https://image.prepladder.com/content/KlXxAYvPdB1qqzaraO871745843643.png\" width=\"460\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Coarse, partially calcified right pleural plaques, accompanied by massive right pleural effusion, causing total <span class=\"customMeta\" data-dictid=\"e9046e11bd1692777197e166e5418f\">right lung</span> collapse and mass effect.</p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Leong P, Mesothelioma. Case study, Radiopaedia.org (Accessed on 06 Dec 2024) https://doi.org/10.53347/rID-26805\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/mesothelioma-23#image-5530797\" data-tags=\"\" height=\"390\" src=\"https://image.prepladder.com/content/I81xJDClQ669QLZJ8e9Q1745843643.png\" width=\"549\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Lobulated pleural soft tissue mass encasing the right lung. Associated <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the right 3rd rib anteriorly.</p>\n<p>Calcified <span class=\"customMeta\" data-dictid=\"e9d028795c169277719520dc71ae4b\">pleural plaques</span> were noted bilaterally, indicating previous <span class=\"customMeta\" data-dictid=\"92cc1e1acb1692777182aee908c1fd\">asbestos</span> exposure.</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Criterion that differentiates exudative from transudative pleural effusion?", "options": [{"label": "A", "text": "Low protein in pleural fluid", "correct": false}, {"label": "B", "text": "High protein in pleural fluid", "correct": true}, {"label": "C", "text": "Low sugar in pleural fluid", "correct": false}, {"label": "D", "text": "High sugar in pleural fluid", "correct": false}], "correct_answer": "B. High protein in pleural fluid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pleural fluid Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Light's Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiates transudative from <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> pleural effusions based on LDH and protein levels in pleural fluid.</p>\n<ul>\n<li>An <strong>exudative pleural effusion</strong> meets at least<strong> one</strong> of the following:\n\n\t\t\t\t<ol>\n<li>Pleural fluid protein/serum protein &gt; 0.5</li>\n<li>Pleural fluid LDH/serum LDH &gt; 0.6</li>\n<li>Pleural fluid LDH exceeds two-thirds of the normal upper limit for serum.</li>\n</ol>\n</li>\n<li>~25% of transudates may be misidentified as exudates.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> criteria are <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> but a transudative condition is suspected, measure protein difference; if &gt;31 g/L (3.1 g/dL), likely transudative.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common cause of death in idiopathic pulmonary fibrosis?", "options": [{"label": "A", "text": "Respiratory failure", "correct": true}, {"label": "B", "text": "Pulmonary edema", "correct": false}, {"label": "C", "text": "Cancer", "correct": false}, {"label": "D", "text": "PAH", "correct": false}], "correct_answer": "A. Respiratory failure", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\"&gt;Respiratory&lt;/span&gt; failu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with acute epigastric pain and an increase in serum lipase levels. Three days after stabilization, a chest X-ray is obtained. What is the most common pathology behind the chest X-ray findings?", "options": [{"label": "A", "text": "Increased PCWP", "correct": false}, {"label": "B", "text": "Pulmonary thromboembolism", "correct": false}, {"label": "C", "text": "Non cardiogenic pulmonary edema", "correct": true}, {"label": "D", "text": "Aspiration pneumonitis", "correct": false}], "correct_answer": "C. Non cardiogenic pulmonary edema", "question_images": ["https://image.prepladder.com/content/Kq6BqFfqwhfvuihJOjq11724848011.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Non-cardiogenic &lt;span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\"&gt;pulmonary&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">Pancreatitis</span> with Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Edema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute epigastric pain, elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> lipase, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (due to increased <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> permeability)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiated from <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (increased PCWP), <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (more sudden <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> compromise), and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> (associated with a history of aspiration)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> can lead to non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, a common <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> in severe cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the expected finding in a patient with the following CXR?", "options": [{"label": "A", "text": "Kussmaul breathing", "correct": false}, {"label": "B", "text": "Paradoxical breathing", "correct": true}, {"label": "C", "text": "Apneustic breathing", "correct": false}, {"label": "D", "text": "Bronchial breathing", "correct": false}], "correct_answer": "B. Paradoxical breathing", "question_images": ["https://image.prepladder.com/content/FEgbdCnlICIyt6ljpFFn1724847956.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\"&gt;Paradoxical&lt;/span&gt; breathing\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Flail Chest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple rib fractures with a free-floating <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> segment, leading to <span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\">paradoxical</span> movement of the chest during respiration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Expected <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paradoxical breathing: inward movement of the <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> segment during inspiration and outward during expiration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiated from Kussmaul (metabolic acidosis), Apneustic (brainstem injury), and <span class=\"customMeta\" data-dictid=\"34dad10d7b16927771834e0d2b774a\">Bronchial breathing</span> (lung consolidation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paradoxical breathing is directly <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to the loss of <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> stability due to rib fractures in <span class=\"customMeta\" data-dictid=\"3dec14fe921692777202dc55958a46\">flail</span> chest</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient presents with recurrent lung infections and CXR is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Kartagener syndrome", "correct": true}, {"label": "B", "text": "Cystic fibrosis", "correct": false}, {"label": "C", "text": "Digeorge syndrome", "correct": false}, {"label": "D", "text": "Down syndrome", "correct": false}], "correct_answer": "A. Kartagener syndrome", "question_images": ["https://image.prepladder.com/content/fQTrJp8ZwP6p07KLcRgi1724847486.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Kartag\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Kartagener syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dextrocardia (situs inversus), chronic sinusitis, bronchiectasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmed by CXR showing <span class=\"customMeta\" data-dictid=\"dad4b8efe11692777186757f861421\">dextrocardia</span> and clinical symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distinguishing Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"35a2ef94341692777198d9bf1cd98e\">situs</span> <span class=\"customMeta\" data-dictid=\"db022f35d816927771903c9a398884\">inversus</span> and <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> lung infections</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with wheezing that improves with as-needed use of albuterol. Spirometry shows FEV1 ranging from 70% to 83%, and the patient experiences nighttime chest tightening twice a week. What is the most appropriate treatment?", "options": [{"label": "A", "text": "Continue with albuterol", "correct": false}, {"label": "B", "text": "Replace with salmeterol twice daily", "correct": false}, {"label": "C", "text": "Start Tab prednisolone", "correct": false}, {"label": "D", "text": "Add an inhaled corticosteroid", "correct": true}], "correct_answer": "D. Add an inhaled corticosteroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ir1UrJ70nZ1LRFD0CA4B1724847345.png"], "explanation": "<p>Correct Option D - Add an inh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman with a history of chronic obstructive pulmonary disease (COPD) presents with increased breathlessness, cough, and sputum production over the last two days. She appears distressed and has a respiratory rate of 28 breaths per minute. Her oxygen saturation is 88% on room air. Which of the following management strategies is most appropriate for her immediate treatment?", "options": [{"label": "A", "text": "Initiate high-flow oxygen therapy to maintain oxygen saturation above 95%", "correct": false}, {"label": "B", "text": "Start nebulised bronchodilator therapy with salbutamol and ipratropium", "correct": true}, {"label": "C", "text": "Begin intravenous glucocorticoids immediately", "correct": false}, {"label": "D", "text": "Order a chest X-ray before any treatment is provided", "correct": false}], "correct_answer": "B. Start nebulised bronchodilator therapy with salbutamol and ipratropium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arterial blood gases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess severity of hypoxaemia, hypercapnia, acidaemia; guide oxygen therapy and ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identify complications such as pneumonia, pneumothorax, or pleural effusion. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Oxygen Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer<strong> controlled oxygen at 24% or 28%</strong> to maintain PaO2 &gt; 8 kPa (60 mmHg) or SaO2 &gt; 90%. <strong>(Option A ruled out)</strong></li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gas monitoring to adjust therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bronchodilators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Use nebulised short-acting β2-agonists (e.g., salbutamol, terbutaline) with anticholinergics (e.g., ipratropium).</li>\n<li>If oxygen sensitivity is a concern, use compressed air for nebulisation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> (30 mg for 10 days) to reduce symptoms and improve lung function.Reduces frequency and severity of exacerbations.</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> for repeated courses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibiotic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicated for increased <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> purulence, volume, or breathlessness.</li>\n<li>Use simple regimens (aminopenicillin, tetracycline, macrolide); <span class=\"customMeta\" data-dictid=\"dd4d53634b1692777184851322327e\">co-amoxiclav</span> in areas with β-lactamase organisms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Safe for mild to moderate <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis; helps reduce <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> need and mortality.</li>\n<li>Not suitable for patients unable to protect their airway.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanical Ventilation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consider if there is a <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> cause, no prior <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, or if <span class=\"customMeta\" data-dictid=\"0e4135f3bc1692777193047657d8c5\">NIV</span> has failed/contraindicated.</li>\n<li>Decisions should involve the patient, family, and GP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> oedema.</li>\n<li>Limited evidence for <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> aminophylline; consider <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> risk.</li>\n<li>Doxapram may be used short-term for low <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 46-year-old diabetic patient presented with fever, malaise, and a productive cough. His chest X-ray is given below. Which of the following statements is incorrect?", "options": [{"label": "A", "text": "Patchy infiltrates as seen in pyogenic pneumonia", "correct": true}, {"label": "B", "text": "Interstitial infiltrates as seen in Mycoplasma pneumonia", "correct": false}, {"label": "C", "text": "Hilar lymphadenopathy with infiltrates as seen in malignancy", "correct": false}, {"label": "D", "text": "Aspiration pneumonia is more common in the upper segment of the lower lobe and posterior segment of the upper lobe", "correct": false}], "correct_answer": "A. Patchy infiltrates as seen in pyogenic pneumonia", "question_images": ["https://image.prepladder.com/content/Vd7rxzD4LJIvWkosnM971741867128.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old man presented with weight loss, decreased appetite, and iron deficiency anemia. Chest x-ray was done and given below. What is the diagnosis?", "options": [{"label": "A", "text": "Lung metastasis", "correct": true}, {"label": "B", "text": "Bronchogenic carcinoma", "correct": false}, {"label": "C", "text": "Miliary tuberculosis", "correct": false}, {"label": "D", "text": "Mesothelioma", "correct": false}], "correct_answer": "A. Lung metastasis", "question_images": ["https://image.prepladder.com/content/UKi7ohKDCwEOsCZy8JWv1745843277.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient comes to your clinic with an 8-month history of shortness of breath and non-productive cough. He has smoked half a pack of cigarettes for the past 30 years. On physical examination, clubbing is seen and fine crackles are heard on both sides during inspiration. You perform pulmonary function tests and it shows an FEV1/FVC ratio of 92%. The CT scan of the chest is shown below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Bronchial asthma", "correct": false}, {"label": "B", "text": "Pulmonary fibrosis", "correct": true}, {"label": "C", "text": "Pulmonary tuberculosis", "correct": false}, {"label": "D", "text": "Chronic obstructive pulmonary disease", "correct": false}], "correct_answer": "B. Pulmonary fibrosis", "question_images": ["https://image.prepladder.com/notes/R6rsBFzzAMLvZkK1Tzei1747901834.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Histological Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Associated Clinical Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usual Interstitial Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Idiopathic Pulmonary Fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desquamative Interstitial Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desquamative Interstitial Pneumonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute Interstitial Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hamman-Rich Syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bronchiolitis Obliterans Organizing Pneumonia (BOOP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryptogenic Organizing Pneumonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Specific Interstitial Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Specific Interstitial Pneumonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory Bronchiolitis-Associated Lung Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory Bronchiolitis-Associated Interstitial Lung Disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old diabetic man presents after a fall. He is having a high fever, cough and breathing difficulty and appears confused. CXR shows lobar consolidation. Labs show elevated BUN and creatinine. Which is the most appropriate management?", "options": [{"label": "A", "text": "Inpatient management with levofloxacin", "correct": true}, {"label": "B", "text": "Inpatient management with ceftriaxone", "correct": false}, {"label": "C", "text": "Discharge home on Amoxicillin with Clavulanic acid", "correct": false}, {"label": "D", "text": "Discharge home on Azithromycin", "correct": false}], "correct_answer": "A. Inpatient management with levofloxacin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Status </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Regimen </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>No comorbidities or risk factors for <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> resistance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination therapy with <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">Amoxicillin</span> + either <span class=\"customMeta\" data-dictid=\"f5744538d81692777191ebc73a4466\">Macrolide</span> or Doxycycline</p>\n<p>OR</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monotherapy with Doxycycline</p>\n<p>OR</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monotherapy with a Macrolide</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>With comorbidities ± Risk factors for <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> resistance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination therapy with:</p>\n<p>Amoxicillin /clavulanate or a <span class=\"customMeta\" data-dictid=\"626f0bd24b1692777184b5820daf5c\">Cephalosporin</span> +</p>\n<p>Macrolide or Doxycycline</p>\n<p>OR</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monotherapy with <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"f4975edd0b1692777203b54cf45c2d\">fluoroquinolone</span> (levofloxacin)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic cigarette smoker has now joined a construction company. His pulmonary function test results are given below. What is the most likely diagnosis for this patient? Initial lung volumes were: FEV1-0.9L FVC-1.9L FEV1/FVC-0.4 After bronchodilation: FEV1-1.9L FVC-3.9L FEV1/FVC-0.4", "options": [{"label": "A", "text": "Vascular disease with bronchodilator reversibility", "correct": false}, {"label": "B", "text": "Restrictive lung disease with bronchodilator reversibility", "correct": false}, {"label": "C", "text": "Restrictive lung disease without bronchodilator reversibility", "correct": false}, {"label": "D", "text": "Obstructive disease with bronchodilator reversibility", "correct": true}], "correct_answer": "D. Obstructive disease with bronchodilator reversibility", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/iH6QdJFnahWnjdsLpCjK1745326232.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old female patient weighing 60 kg is on mechanical ventilation for ARDS secondary to urosepsis. The respiratory parameters are as follows: tidal volume – 360 mL; frequency – 30 breaths/min; PEEP - 5 cm of H2O; and FiO2-90%. The arterial blood gas findings are as follows; paO2-50 mmHg; paCO2-38 mmHg; and pH-7.38. What is the next step?", "options": [{"label": "A", "text": "Reduce FiO2", "correct": false}, {"label": "B", "text": "Increase tidal volume", "correct": false}, {"label": "C", "text": "Increase respiratory rate", "correct": false}, {"label": "D", "text": "Increase PEEP", "correct": true}], "correct_answer": "D. Increase PEEP", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child presented with recurrent respiratory infections with thickened sputum. Chest X-ray showed bronchial wall thickening. He has been suffering from steatorrhea since birth. Which of the following is the first differential diagnosis?", "options": [{"label": "A", "text": "Hyaline membrane disease", "correct": false}, {"label": "B", "text": "Cystic fibrosis", "correct": true}, {"label": "C", "text": "Alpha 1 anti-trypsin deficiency", "correct": false}, {"label": "D", "text": "Malabsorption syndrome", "correct": false}], "correct_answer": "B. Cystic fibrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\"&gt;Cystic&lt;/span&gt; fibrosis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organ System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> plugging</li>\n<li>Bronchiectasis</li>\n<li>Chronic inflammation</li>\n<li>Submucosal <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> hypertrophy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic productive cough</li>\n<li>Recurrent infections</li>\n<li>Progressive dyspnea</li>\n<li>Digital clubbing</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Obstructive pattern on PFTs</li>\n<li>Bronchiectasis on CT</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pancreatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Duct obstruction</li>\n<li>Acinar cell destruction</li>\n<li>Fibrosis</li>\n<li>Fat replacement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malabsorption</li>\n<li>Steatorrhea</li>\n<li>Failure to thrive</li>\n<li>Fat-soluble vitamin deficiency</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low fecal elastase</li>\n<li>Elevated fecal fat</li>\n<li>Low vitamins A, D, E, K</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sweat Glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> transport</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> structure</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Salty-tasting skin</li>\n<li>Heat intolerance</li>\n<li>Salt depletion</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated sweat chloride</li>\n<li>&gt;60 mEq/L diagnostic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hepatobiliary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> plugging</li>\n<li>Focal <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> cirrhosis</li>\n<li>Multilobular cirrhosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neonatal cholestasis</li>\n<li>Portal hypertension</li>\n<li>Gallstones</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated liver enzymes</li>\n<li>Ultrasound changes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient with a history of smoking a pack of cigarettes for the past 15 years presents with hemoptysis. Chest X-ray shows a 3cm upper lobe mass near the apex of the lung. What is the next best step for managing this patient?", "options": [{"label": "A", "text": "Bronchoscopy", "correct": false}, {"label": "B", "text": "CT-guided biopsy", "correct": true}, {"label": "C", "text": "Sputum cytology", "correct": false}, {"label": "D", "text": "Sputum for AFB", "correct": false}], "correct_answer": "B. CT-guided biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- CT-guided &lt;span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\"&gt;biopsy&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Evaluation for Suspected Lung Mass</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Methods</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sputum Cytology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Non-invasive initial <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</li>\n<li>Most useful for central lesions<strong> (Option C Ruled Out)</strong></li>\n<li>Higher yield in large, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tumors</li>\n<li>Low sensitivity due to high tissue variability</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CT Chest</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contrast-enhanced</li>\n<li>Extension to upper <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> (adrenal level)</li>\n<li>Sensitivity: 55%, Specificity: 81%</li>\n<li>Identifies tumor location, extent, and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</li>\n<li>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> ≥1cm in short <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> considered suspicious</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PET/PET-CT</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Higher accuracy than CT (Sensitivity: 80%, Specificity: 88%)</li>\n<li>Identifies <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity and potential metastases</li>\n<li>Reduces futile thoracotomies</li>\n<li>Helpful in identifying <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> post-therapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Invasive <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">Staging</span> &amp; <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> Methods</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CT-Guided <span class=\"customMeta\" data-dictid=\"d2f68167161692777200f27aa61366\">Transthoracic</span> Biopsy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Preferred for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> lesions (Option A)</strong></li>\n<li>High <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy</li>\n<li>Minimally Invasive</li>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> (especially in emphysematous patients)</li>\n<li>Contraindicated if high <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk or severe emphysema</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>EBUS-TBNA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CP-EBUS: <span class=\"customMeta\" data-dictid=\"9ddd195e9a1692777197bb3f135c2e\">Real-time</span> <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> of mediastinal/hilar nodes</li>\n<li>RP-EBUS: For smaller/peripheral lesions</li>\n<li>Navigation <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> for mapped approach</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endoscopic-TBNA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Samples through <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall</li>\n<li>Accesses stations 2, 4, 7, 8, 9</li>\n<li>Sensitivity: 89%, Specificity: 100%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mediastinoscopy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used after negative needle technique</li>\n<li>Samples para-tracheal nodes</li>\n<li>Sensitivity: 78%, Specificity: 100%</li>\n<li>Mortality risk: 0.08%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>VATS/RATS</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>For <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> sampling</li>\n<li>Full <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> during lung resection</li>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> approach</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cancer Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Additional Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Small Cell Lung Cancer (NSCLC) - Adenocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral/Outer regions of lung</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CT-guided needle biopsy</li>\n<li>PET-CT scan</li>\n<li>Blood tests for tumor markers (CEA)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Molecular testing (EGFR, ALK, ROS1)</li>\n<li>MRI brain (for staging)</li>\n<li>Pulmonary function tests</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>NSCLC - <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">Squamous</span> Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central/Main bronchi</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bronchoscopy with biopsy</li>\n<li>Chest CT with contrast</li>\n<li>Sputum cytology</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mediastinoscopy</li>\n<li>Bone scan (if symptoms)</li>\n<li>PD-L1 testing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Small Cell Lung Cancer (SCLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central regions, rapid spread</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CT chest/abdomen/pelvis</li>\n<li>Bronchoscopy</li>\n<li>Blood tests (ProGRP, NSE)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MRI brain (mandatory)</li>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> biopsy</li>\n<li>Nuclear medicine scans</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Large Cell Carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Any location</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>PET-CT scan</li>\n<li>Core needle biopsy</li>\n<li>Immunohistochemistry</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Molecular profiling</li>\n<li>EBUS-TBNA</li>\n<li>Liquid biopsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carcinoid Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually central airways</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Octreotide scan</li>\n<li>Bronchoscopy with biopsy</li>\n<li>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> 5-HIAA</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chromogranin A levels</li>\n<li>MIBG scan</li>\n<li>Endoscopic ultrasound</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a cause of exudative pleural effusion?", "options": [{"label": "A", "text": "Heart failure", "correct": false}, {"label": "B", "text": "Liver failure", "correct": false}, {"label": "C", "text": "Rheumatoid arthritis", "correct": true}, {"label": "D", "text": "Nephrotic syndrome", "correct": false}], "correct_answer": "C. Rheumatoid arthritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- &lt;span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\"&gt;Rheumatoid&lt;/span&gt; arthritis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of pleural effusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tranudative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Exudative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Both</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Congestive <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> <strong>(Option A)</strong></p>\n</li>\n<li>\n<p>Cirrhosis</p>\n</li>\n<li>\n<p>Liver failure <strong>(Option B)</strong></p>\n</li>\n<li>\n<p>Nephrotic syndrome <strong>(Option D)</strong></p>\n</li>\n<li>\n<p>Peritoneal dialysis</p>\n</li>\n<li>\n<p>SVC obstruction</p>\n</li>\n<li>\n<p>Myxedema</p>\n</li>\n<li>\n<p>Urinothorax</p>\n</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Malignancies</p>\n</li>\n<li>\n<p>Tuberculosis</p>\n</li>\n<li>\n<p>Pneumonia</p>\n</li>\n<li>\n<p>Esophageal perforation</p>\n</li>\n<li>\n<p>Pancreatic disease</p>\n</li>\n<li>\n<p>Rheumatoid <span class=\"customMeta\" data-dictid=\"fa734f0ec81692777195c12e3e6a7c\">pleuritis</span> <strong>(Option C)</strong></p>\n</li>\n<li>\n<p>Collagen <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases:</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</p>\n</li>\n<li>\n<p>Sjögren syndrome</p>\n</li>\n<li>\n<p>Wegener Granulomatosis</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary embolism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs induced</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Nitrofurantoin</p>\n</li>\n<li>\n<p>Dantrolene</p>\n</li>\n<li>\n<p>Methysergide</p>\n</li>\n<li>\n<p>Bromocriptine</p>\n</li>\n<li>\n<p>Procarbazine</p>\n</li>\n<li>\n<p>Amiodarone</p>\n</li>\n<li>\n<p>Dasatinib</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which medical condition is a ground-glass appearance observed on high-resolution computed tomography (HRCT)?", "options": [{"label": "A", "text": "Asbestosis", "correct": false}, {"label": "B", "text": "Silicosis", "correct": true}, {"label": "C", "text": "Anthracosis", "correct": false}, {"label": "D", "text": "Bagassosis", "correct": false}], "correct_answer": "B. Silicosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old chronic smoker came to the medicine outpatient department with complaints of upper chest discomfort and drooping of an eyelid. He also complained of pain radiating to the upper arm and a tingling sensation in the 4th and 5th digits of his right hand. The chest X-ray is given below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Pancoast tumor", "correct": true}, {"label": "B", "text": "Superior vena cava obstruction", "correct": false}, {"label": "C", "text": "Upper lobe pneumonia", "correct": false}, {"label": "D", "text": "Aspergilloma", "correct": false}], "correct_answer": "A. Pancoast tumor", "question_images": ["https://image.prepladder.com/notes/EVxUnxu11NqJHF0t4zuf1745918070.png"], "explanation_images": ["https://image.prepladder.com/notes/EVxUnxu11NqJHF0t4zuf1745918070.png", "https://image.prepladder.com/notes/2dkdau5sNewHh4BOnQXh1745918070.png", "https://image.prepladder.com/notes/EBlrYnc3hk8YG58uuw7c1745918071.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the lung disease?", "options": [{"label": "A", "text": "Hypersensitivity pneumonitis", "correct": false}, {"label": "B", "text": "Sarcoidosis", "correct": false}, {"label": "C", "text": "Acute respiratory distress syndrome", "correct": false}, {"label": "D", "text": "Bronchiectasis", "correct": true}], "correct_answer": "D. Bronchiectasis", "question_images": ["https://image.prepladder.com/content/mCsC35raENmkg3jBhvaw1745930500.png"], "explanation_images": ["https://image.prepladder.com/content/dyRrnmCBIy5vzRuMm5Re1745930548.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Loop Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Expiratory Curve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inspiratory Curve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Example Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symmetrical, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symmetrical, rounded</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Healthy lungs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstructive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scooped (concave)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>COPD, asthma, bronchiectasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Restrictive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Narrow, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Narrow, peaked</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary fibrosis, pleural effusion, ARDS</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fixed Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened (box-like)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened (box-like)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tracheal stenosis, a large goiter</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">Extrathoracic</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vocal cord dysfunction, laryngeal tumour</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">Intrathoracic</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tracheomalacia, <span class=\"customMeta\" data-dictid=\"7cabf0723c1692777183971e234185\">bronchogenic</span> tumor</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient who is a known case of COPD presents to the emergency department with dyspnea. The arterial blood gas report is as follows: pH: 7.28 pCO 2 : 60 mmHg HCO 3 : 28 meq/L Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Inadequately compensated respiratory acidosis", "correct": true}, {"label": "B", "text": "Fully compensated respiratory acidosis", "correct": false}, {"label": "C", "text": "Fully compensated respiratory alkalosis", "correct": false}, {"label": "D", "text": "Inadequately compensated metabolic alkalosis", "correct": false}], "correct_answer": "A. Inadequately compensated respiratory acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not cause central cyanosis?", "options": [{"label": "A", "text": "Methemoglobinemia", "correct": false}, {"label": "B", "text": "Pulmonary arteriovenous fistula", "correct": false}, {"label": "C", "text": "High altitude", "correct": false}, {"label": "D", "text": "Hypothermia", "correct": true}], "correct_answer": "D. Hypothermia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common pulmonary manifestation of SLE?", "options": [{"label": "A", "text": "Shrinking lung syndrome", "correct": false}, {"label": "B", "text": "Pleuritis", "correct": true}, {"label": "C", "text": "Intra alveolar hemorrhage", "correct": false}, {"label": "D", "text": "Interstitial inflammation", "correct": false}], "correct_answer": "B. Pleuritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Pleu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options is not typically observed in allergic bronchopulmonary aspergillosis?", "options": [{"label": "A", "text": "Low serum IgE levels", "correct": true}, {"label": "B", "text": "Cough", "correct": false}, {"label": "C", "text": "Wheezing", "correct": false}, {"label": "D", "text": "Central bronchiectasis", "correct": false}], "correct_answer": "A. Low serum IgE levels", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Low &lt;span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\"&gt;serum&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\"&gt;IgE&lt;/span&gt; lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options best represents 'very severe COPD' according to the GOLD criteria?", "options": [{"label": "A", "text": "FEV1/FVC &amp;lt;0.7 and FEV1&amp;lt;30%", "correct": true}, {"label": "B", "text": "FEV1/FVC &amp;lt;0.7 and FEV1&amp;lt;70%", "correct": false}, {"label": "C", "text": "FEV1/FVC &amp;lt;0.7 and FEV1&amp;lt;50%", "correct": false}, {"label": "D", "text": "Both a and c", "correct": false}], "correct_answer": "A. FEV1/FVC &lt;0.7 and FEV1&lt;30%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - FEV1/FVC &amp;lt;0.7 and FEV1&amp;lt;30%:</p>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Mild COPD</strong></p>\n</td>\n<td>\n<p>FEV1/ FVC&lt;0.7</p>\n</td>\n<td>\n<p>FEV1≥80%</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Moderate COPD</strong></p>\n</td>\n<td>\n<p>FEV1/ <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> &lt;0.7</p>\n</td>\n<td>\n<p>FEV1 = 50-80%</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Severe COPD</strong></p>\n</td>\n<td>\n<p>FEV1/ <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> &lt;0.7</p>\n</td>\n<td>\n<p>FEV1 = 30-50%</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Very sever COPD</strong></p>\n</td>\n<td>\n<p>FEV1/ <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> &lt;0.7</p>\n</td>\n<td>\n<p>FEV1 &lt;30%</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following features are true about Allergic Broncho Pulmonary Aspergillosis? Distal bronchiectasis Serum precipitins to Aspergillus Increased lgE Levels Seen in asthmatics", "options": [{"label": "A", "text": "1,2,3 only", "correct": false}, {"label": "B", "text": "2,3,4 only", "correct": true}, {"label": "C", "text": "1,3,4 only", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. 2,3,4 only", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 2,3,4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Why is COVID-19 a major global concern despite influenza spreading faster than COVID-19?", "options": [{"label": "A", "text": "Median incubation period is more in influenza", "correct": false}, {"label": "B", "text": "Reproductive number for COVID-19 is 2-2.5", "correct": true}, {"label": "C", "text": "Serial interval is 5-6 days in influenza", "correct": false}, {"label": "D", "text": "Reproductive number for Influenza is higher", "correct": false}], "correct_answer": "B. Reproductive number for COVID-19 is 2-2.5", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\"&gt;Reproductive&lt;/span&gt; number for &lt;span class=\"customMeta\" data-dictid=\"2d364aeaf7169277718529fa58f6ea\"&gt;COVID-19&lt;/span&gt; is 2-2.5\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In good pasture syndrome , which organ is involved apart from lung?", "options": [{"label": "A", "text": "Kidney", "correct": true}, {"label": "B", "text": "Liver", "correct": false}, {"label": "C", "text": "Spleen", "correct": false}, {"label": "D", "text": "Heart", "correct": false}], "correct_answer": "A. Kidney", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - K\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the clinical diagnosis for a patient who experiences sudden and severe respiratory distress after undergoing internal jugular vein catheterization?", "options": [{"label": "A", "text": "Pneumothorax", "correct": true}, {"label": "B", "text": "Sepsis", "correct": false}, {"label": "C", "text": "ARDS", "correct": false}, {"label": "D", "text": "Infective endarteritis", "correct": false}], "correct_answer": "A. Pneumothorax", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Pneumoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a causative agent of Farmer's Lung?", "options": [{"label": "A", "text": "Thermophilic Actinomycetes", "correct": true}, {"label": "B", "text": "Aspergillus Fumigatus", "correct": false}, {"label": "C", "text": "Actinobacter", "correct": false}, {"label": "D", "text": "Aspergillus Flavus", "correct": false}], "correct_answer": "A. Thermophilic Actinomycetes", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Thermophilic A\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Occupational Lung Disease</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Causative Agents</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Asbestosis</p>\n</td>\n<td>\n<p>Asbestos fibers</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Silicosis</p>\n</td>\n<td>\n<p>Silica dust</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Coal Worker's Pneumoconiosis</p>\n</td>\n<td>\n<p>Coal dust</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Byssinosis</p>\n</td>\n<td>\n<p>Cotton dust</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Farmer's Lung</p>\n</td>\n<td>\n<p>Thermophilic actinomycetes</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hypersensitivity Pneumonitis</p>\n</td>\n<td>\n<p>Organic dusts, fungi, bacteria</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Berylliosis</p>\n</td>\n<td>\n<p>Beryllium</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Occupational Asthma</p>\n</td>\n<td>\n<p>Various chemicals, fumes, dusts, and allergens</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Occupational Bronchitis</p>\n</td>\n<td>\n<p>Irritants such as gases, fumes, and particulates</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mesothelioma</p>\n</td>\n<td>\n<p>Asbestos fibers</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of infertility in individuals with Kartagener's syndrome?", "options": [{"label": "A", "text": "Oligospermia", "correct": false}, {"label": "B", "text": "Asthenospermia", "correct": true}, {"label": "C", "text": "Undescended testes", "correct": false}, {"label": "D", "text": "Epididymis obstruction", "correct": false}], "correct_answer": "B. Asthenospermia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Asth\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Aspect</strong></p>\n</td>\n<td>\n<p>Kartagener's syndrome</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n<td>\n<p>A rare autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder characterized by the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> structure and function of cilia, leading to impaired <span class=\"customMeta\" data-dictid=\"d90d813c741692777193a2b52ba508\">mucociliary</span> clearance.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Underlying Cause</strong></p>\n</td>\n<td>\n<ul>\n<li>Defects in the structure or function of <span class=\"customMeta\" data-dictid=\"dde20abeb61692777186a8685c0683\">dynein</span> arms, which are responsible for <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> movement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td>\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> infections</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media</li>\n<li>Conductive hearing loss</li>\n<li>Kartagener's triad: <span class=\"customMeta\" data-dictid=\"35a2ef94341692777198d9bf1cd98e\">Situs</span> inversus, chronic sinusitis, and bronchiectasis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is commonly used for treating community-acquired pneumonia in the outpatient setting?", "options": [{"label": "A", "text": "Vancomycin", "correct": false}, {"label": "B", "text": "Ceftriaxone", "correct": false}, {"label": "C", "text": "Azithromycin", "correct": true}, {"label": "D", "text": "Streptomycin", "correct": false}], "correct_answer": "C. Azithromycin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UxYBsRJqX6L5SwVC01g71712037334.png"], "explanation": "<p>Correct Option C - Azith\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">No Comorbidities or</p>\n<p style=\"text-align: center;\">Not received <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> in last 3 months</p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Macrolides (Clarithromycin / Azithromycin) Or</p>\n<p style=\"text-align: center;\">Doxycycline (If macrolides is not available)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Co-morbid condition or</p>\n<p style=\"text-align: center;\">Taken Antibiotics in last 3 months</p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Moxifloxacin or</p>\n<p style=\"text-align: center;\">b <span class=\"customMeta\" data-dictid=\"0b43fd49d81692777191faa843061b\">Lactam</span> + Macrolides</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The arterial blood gas findings of a patient are pH = 7.12, pCO 2 = 50, HCO 3 = 28 . What is the diagnosis?", "options": [{"label": "A", "text": "Respiratory acidosis with metabolic compensation", "correct": true}, {"label": "B", "text": "Metabolic acidosis with respiratory compensation", "correct": false}, {"label": "C", "text": "Respiratory alkalosis with metabolic compensation", "correct": false}, {"label": "D", "text": "Metabolic alkalosis with respiratory compensation", "correct": false}], "correct_answer": "A. Respiratory acidosis with metabolic compensation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Respiratory &lt;span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\"&gt;acidosis&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\"&gt;metabolic&lt;/span&g\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Acid-Base Disorder</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>pH</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Primary Imbalance</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Compensatory Response</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Respiratory Acidosis</p>\n</td>\n<td>\n<p>Low</p>\n</td>\n<td>\n<p>Increased pCO<sub>2</sub></p>\n</td>\n<td>\n<p>Renal Compensation (Increased <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">Bicarbonate</span> reabsorption)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Respiratory Alkalosis</p>\n</td>\n<td>\n<p>High</p>\n</td>\n<td>\n<p>Decreased pCO<sub>2</sub></p>\n</td>\n<td>\n<p>Renal Compensation (Decreased <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">Bicarbonate</span> reabsorption)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Metabolic Acidosis</p>\n</td>\n<td>\n<p>Low</p>\n</td>\n<td>\n<p>Decreased Bicarbonate</p>\n</td>\n<td>\n<p>Respiratory Compensation (Hyperventilation)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Metabolic Alkalosis</p>\n</td>\n<td>\n<p>High</p>\n</td>\n<td>\n<p>Increased Bicarbonate</p>\n</td>\n<td>\n<p>Respiratory Compensation (Hypoventilation)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Among the following choices, which organism is the most probable cause of ventilator-associated pneumonia?", "options": [{"label": "A", "text": "Clostridium", "correct": false}, {"label": "B", "text": "Moraxella catarrhalis", "correct": false}, {"label": "C", "text": "Acinetobacter", "correct": true}, {"label": "D", "text": "Hemophilus", "correct": false}], "correct_answer": "C. Acinetobacter", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On performing a pulmonary function test, reduction in FEV1/FVC is characteristic of:", "options": [{"label": "A", "text": "Restrictive disease", "correct": false}, {"label": "B", "text": "Obstructive disease", "correct": true}, {"label": "C", "text": "Normal lung function", "correct": false}, {"label": "D", "text": "Interstitial lung disease", "correct": false}], "correct_answer": "B. Obstructive disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Obstructiv\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Forced <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">Expiratory</span> Volume in 1 second (FEV1)</p>\n</td>\n<td>\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Forced <span class=\"customMeta\" data-dictid=\"187bb6b3f61692777201956c59ce72\">Vital Capacity</span> (FVC)</p>\n</td>\n<td>\n<p>Decreased (may be normal or slightly decreased)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>FEV1/FVC Ratio</p>\n</td>\n<td>\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Peak <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">Expiratory</span> Flow Rate (PEFR)</p>\n</td>\n<td>\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Total Lung Capacity (TLC)</p>\n</td>\n<td>\n<p>Normal or increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Residual Volume (RV)</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity (FRC)</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tidal Volume (TV)</p>\n</td>\n<td>\n<p>Normal or slightly decreased</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old HIV positive man presents with fever for 3 weeks, dry cough an significant weight loss . His chest x-ray is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Staphylococcal pneumonia", "correct": false}, {"label": "B", "text": "Pneumococcal pneumonia", "correct": false}, {"label": "C", "text": "Tuberculosis", "correct": false}, {"label": "D", "text": "Pneumocystis jirovecii pneumonia", "correct": true}], "correct_answer": "D. Pneumocystis jirovecii pneumonia", "question_images": ["https://image.prepladder.com/content/aQktnPWYOA9U7w4P9Olr1712048427.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"af71e1cffa16927771950a5fb2c281\"&gt;Pneumocystis&lt;/span&gt; jirovecii &lt;span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\"&gt;pneumonia&lt;/span&gt; (PJP)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nasal polyps are commonly associated with which of the following?", "options": [{"label": "A", "text": "Intrinsic asthma", "correct": true}, {"label": "B", "text": "Brittle asthma", "correct": false}, {"label": "C", "text": "Extrinsic asthma", "correct": false}, {"label": "D", "text": "Exercise - induced asthma", "correct": false}], "correct_answer": "A. Intrinsic asthma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with metastasis to the brain?", "options": [{"label": "A", "text": "Lung cancer", "correct": true}, {"label": "B", "text": "Hepatocellular carcinoma", "correct": false}, {"label": "C", "text": "Prostate cancer", "correct": false}, {"label": "D", "text": "Breast cancer", "correct": false}], "correct_answer": "A. Lung cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Lung\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year patient working in a factory for the past 20 years presents with breathlessness. HRCT chest shows pleural thickening and fibrosis . Diagnosis is?", "options": [{"label": "A", "text": "Asbestosis", "correct": true}, {"label": "B", "text": "Coal worker pneumoconiosis", "correct": false}, {"label": "C", "text": "Silicosis", "correct": false}, {"label": "D", "text": "Berylliosis", "correct": false}], "correct_answer": "A. Asbestosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is shown in the image below?", "options": [{"label": "A", "text": "Pleural effusion", "correct": false}, {"label": "B", "text": "Pneumothorax", "correct": true}, {"label": "C", "text": "Consolidation", "correct": false}, {"label": "D", "text": "Cavity", "correct": false}], "correct_answer": "B. Pneumothorax", "question_images": ["https://image.prepladder.com/content/2ujAIWejCM7Wxhx9lSHq1712036165.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Pneumoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "N95 respirator is used for:", "options": [{"label": "A", "text": "Droplet precautions", "correct": false}, {"label": "B", "text": "Airborne precautions", "correct": true}, {"label": "C", "text": "Contact precautions", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. Airborne precautions", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"5a986778421692777180f5f9dd3ea8\"&gt;Airborne&lt;/span&gt; precau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common presentation of inhalational anthrax?", "options": [{"label": "A", "text": "Atypical pneumonia", "correct": false}, {"label": "B", "text": "Haemorrhagic mediastinitis", "correct": true}, {"label": "C", "text": "Lung abscess", "correct": false}, {"label": "D", "text": "Broncho-pulmonary pneumonia", "correct": false}], "correct_answer": "B. Haemorrhagic mediastinitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Haemorrhag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis based on the image given below ?", "options": [{"label": "A", "text": "Pulmonary tuberculosis", "correct": false}, {"label": "B", "text": "Chronic obstructive pulmonary disease", "correct": false}, {"label": "C", "text": "Bronchial asthma", "correct": false}, {"label": "D", "text": "Bronchiectasis", "correct": true}], "correct_answer": "D. Bronchiectasis", "question_images": ["https://image.prepladder.com/content/PTT7I0tNLYn2JWgPKWGo1711702408.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Bronch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man presents with a sudden onset of severe headache, dizziness, breathlessness, and blurring of vision while trekking on a mountain at an altitude of 5000 meters . He is unable to climb any further. Which of the following develops at high-altitude?", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": false}, {"label": "B", "text": "Respiratory alkalosis", "correct": true}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Metabolic acidosis", "correct": false}], "correct_answer": "B. Respiratory alkalosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\"&gt;Respiratory&lt;/span&gt; alk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with chronic complaints of a productive cough in the morning . The expectoration is yellow, foul smelling and increases on turning from left to right side. Which of the following lung diseases is likely to be present ?", "options": [{"label": "A", "text": "Lung cancer", "correct": false}, {"label": "B", "text": "Bronchiectasis", "correct": true}, {"label": "C", "text": "Bronchial asthma", "correct": false}, {"label": "D", "text": "Pulmonary embolism", "correct": false}], "correct_answer": "B. Bronchiectasis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Bronch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient with a history of chronic smoking presents with the complaint of dysphagia . Out of the following, which type of lung cancer is most likely to be found in this patient?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": true}, {"label": "B", "text": "Adenocarcinoma", "correct": false}, {"label": "C", "text": "Large cell carcinoma", "correct": false}, {"label": "D", "text": "Bronchogenic carcinoma", "correct": false}], "correct_answer": "A. Squamous cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Squamou\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Squamous cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adenocarcinoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Small cell / <span class=\"customMeta\" data-dictid=\"3d2453376b16927771947134f6a67d\">oat</span> cell </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Large cell </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key to remember </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smoking</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>SSS - Smoking Sq, Small</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gender</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common in male and female</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Location</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central - squamous, small</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Genetics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Loss of</p>\n<ul>\n<li>chr3</li>\n<li>chr17p</li>\n<li>p53</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gain of function of</p>\n<ul>\n<li>EGFR 1</li>\n<li>ALK</li>\n<li>KRAS</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"17cb05d8871692777184bff4fa9ea6\">chr</span> 3p</p>\n<p>Almost all</p>\n<p> </p>\n<p>L myc amplification</p>\n<p> </p>\n<p>P53 inact</p>\n<p>RB inact</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>KRAS</strong>- KPL tumors:</p>\n<ul>\n<li>Colon</li>\n<li>Pancreatic</li>\n<li>Lung cancer</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Precancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CIS <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (common with every <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell ca)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>AAH</strong></p>\n<p><strong>AIS </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neuroendocrine</p>\n<p>DIPNEH</p>\n<p>Diffuse <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> hyperplasia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Markers </strong></p>\n<p>IHC</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>P40 is the best marker</p>\n<p>p63</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mnemonic: all A and I</p>\n<p>NAPSIN A</p>\n<p>MUC I</p>\n<p>TTF I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Synaptophysin</p>\n<p>Chromogranin</p>\n<p>Bombesin</p>\n<p>NSE</p>\n<p>CD56</p>\n<p>CD57</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PNS (Para <span class=\"customMeta\" data-dictid=\"c82360aadd16927771936d67fa30a4\">neoplastic</span> syndrome)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypercalcemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Migratory thrombophlebitis</p>\n<ul>\n<li>Itis - inflammation</li>\n<li>Thrombus - clot</li>\n<li>Phlebo - vein</li>\n<li>Awara - <span class=\"customMeta\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\">migratory</span> (mnemonic)</li>\n</ul>\n<p>Trousseau phenomenon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>SIADH- syndrome of inappropriate <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> secretion</li>\n<li>Cushing’s syndrome</li>\n<li>Lambert eaton syndrome</li>\n</ul>\n<p>Most aggressive Lung cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gynaecomastia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trousseau phenomenon</p>\n<ul>\n<li>Lung adeno</li>\n<li>PANCREATIC adenocarcinoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Kartagener syndrome is associated with defects in which of the following structures?", "options": [{"label": "A", "text": "Microvilli", "correct": false}, {"label": "B", "text": "Microtubules", "correct": false}, {"label": "C", "text": "Cilia", "correct": true}, {"label": "D", "text": "Microfilaments", "correct": false}], "correct_answer": "C. Cilia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 103 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Suspecting Fat Embolism Syndrome (FES), which diagnostic test is used to detect fat in this condition?", "options": [{"label": "A", "text": "Chest CT", "correct": false}, {"label": "B", "text": "Bronchoalveolar lavage (BAL)", "correct": true}, {"label": "C", "text": "Intracranial Doppler ultrasonography", "correct": false}, {"label": "D", "text": "Head CT", "correct": false}], "correct_answer": "B. Bronchoalveolar lavage (BAL)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest Radiographs</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increasing <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infiltrates within 24-48 hours post onset.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Head CT (non-contrast)</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> petechial haemorrhages in white matter, reflecting <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Helical chest CT</strong>:</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It may appear normal if <span class=\"customMeta\" data-dictid=\"acd7af7f74169277718736b038fb02\">embolic</span> particles lodge in <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> beds.</li>\n<li><strong>Ground-glass opacities</strong> and <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">nodular</span> opacities are common findings in trauma, indicating fat embolism.</li>\n<li>Ground-glass opacities involving over 75% of lung <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> with <span class=\"customMeta\" data-dictid=\"b1357efd5116927771859dfba380e7\">consolidation</span> indicate severe disease.</li>\n</ul>\n<img alt=\" Fat &lt;span class=\" custommeta\"=\"\" data-dictid=\"1c07a1135f1692777187f547678386\"/>embolism CT crazy paving pattern.jpg\" data-author=\"\" data-hash=\"9420\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/LD405xrVuTrWbviL1apc1744377265.png\" /&gt;\n\t\t\t<p>HRCT image demonstrates <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities and <span class=\"customMeta\" data-dictid=\"acc571bff61692777190b2fc43f406\">interlobular</span> septal thickening resulting in the crazy-paving pattern. Note the sharp margins between the parenchymal abnormalities and areas of normal lung (white arrows) with areas of lobular sparing (black arrows).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intracranial <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> Ultrasonography</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects cerebral microembolic signals up to 4 days post-injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transesophageal <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">Echocardiography</span> (TEE)</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visualises <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> release during long-bone <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> repair surgeries.</li>\n<li>Associated with increased <span class=\"customMeta\" data-dictid=\"72421e3a581692777197a98d00066c\">right heart</span> and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> pressures; correlation with <span class=\"customMeta\" data-dictid=\"b5af7cd5041692777202854ae4fa54\">FES</span> development is unclear.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bronchoalveolar <span class=\"customMeta\" data-dictid=\"b625b3e881169277719169ef4e1af3\">Lavage</span> (BAL)</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The presence of <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> inclusions (≤5% fat-containing macrophages) is nonspecific; raising the threshold to 30% may increase <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o woman presents with sudden shortness of breath and pleuritic chest pain. She had a total hip replacement 10 days ago. O/E, she is tachycardic with low oxygen levels. What is the most likely cause of her symptoms?", "options": [{"label": "A", "text": "Fat embolism", "correct": false}, {"label": "B", "text": "Tumor emboli", "correct": false}, {"label": "C", "text": "Air emboli", "correct": false}, {"label": "D", "text": "Pulmonary embolism", "correct": true}], "correct_answer": "D. Pulmonary embolism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most PE originates from <span class=\"customMeta\" data-dictid=\"712bb2d2b716927771867d5505033c\">deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</span> (DVT) in the lower limbs.</strong></p>\n<p>Other rare causes include:</p>\n<ul>\n<li>Septic <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> (from <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> affecting the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> or <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> valves).</li>\n<li>Fat <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> (after fractures of long bones, e.g., femur). <strong>(Option A)</strong></li>\n<li>Tumour <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> (e.g., choriocarcinoma). <strong>(Option B)</strong></li>\n<li>Air <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> (In <span class=\"customMeta\" data-dictid=\"5d900ab2aa16927771879830c57e31\">ENT</span> and neurosurgeries commonly) <strong>(Option C)</strong></li>\n<li>Amniotic fluid <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> (after delivery).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PE occurs when a <span class=\"customMeta\" data-dictid=\"40d68b98721692777183c42090e023\">blood clot</span> (thrombus) travels to the lungs, <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> in the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery.</p>\n<p><strong>Impaired Gas Exchange:</strong></p>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"04f89c4775169277718128d3461838\">anatomic</span> and <span class=\"customMeta\" data-dictid=\"e6a317ff3c16927771956fee0e76ed\">physiologic</span> dead space due to decreased gas exchange.</li>\n<li>Hypoxemia and<strong> increased alveolar-arterial </strong>oxygen <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> result from poor ventilation-perfusion matching.</li>\n</ul>\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance:</strong></p>\n<ul>\n<li>Vascular <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> by the <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> and release of vasoconstricting agents like serotonin.</li>\n<li>Causes ventilation-perfusion mismatch even in areas away from the embolus.</li>\n</ul>\n<p><strong>Pulmonary Hypertension</strong>: <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">Blockage</span> of the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> increases pressure, leading to strain on the right heart.</p>\n<p><strong>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> (RV) Dysfunction</strong>:</p>\n<ul>\n<li>RV <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and failure due to increased afterload.</li>\n<li>RV microinfarction can occur with large PE, leading to elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">troponin</span> and brain <span class=\"customMeta\" data-dictid=\"bd16654d3e169277719371077d7a8c\">natriuretic</span> peptide.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding causes of DVT is true?", "options": [{"label": "A", "text": "Factor V Leiden increases the effectiveness of activated protein C.", "correct": false}, {"label": "B", "text": "Prothrombin gene mutation decreases the concentration of prothrombin in the blood.", "correct": false}, {"label": "C", "text": "Cancer increases the risk of DVT fourfold compared to the general population.", "correct": true}, {"label": "D", "text": "Pregnancy reduces the risk of venous stasis.", "correct": false}], "correct_answer": "C. Cancer increases the risk of DVT fourfold compared to the general population.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors of Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> Thrombosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inherited Thrombophilia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genetic mutations that enhance <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> formation, such as:</p>\n<ul>\n<li><strong>Factor V Leiden</strong>: Causes resistance to activated protein C, impairing its clot-regulating function. <strong>(Option A)</strong></li>\n<li><strong>Prothrombin gene mutation</strong>: Increases <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> levels, promoting <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> formation. <strong>(Option B)</strong></li>\n<li><strong>Deficiencies</strong>: Rare deficiencies in anticoagulants like antithrombin, protein C, and protein S.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Antiphospholipid <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> syndrome</strong>: An <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> disorder leading to an increased risk of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> and arterial thrombosis.</li>\n<li><strong>Cancer: The risk of <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> is about fourfold that of the general population, </strong>with approximately 15% of <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> cases <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to malignancies. <strong>(Option C)</strong></li>\n<li><strong>Surgery</strong>: Major orthopaedic, abdominal, or neurological surgeries elevate <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> risk.</li>\n<li><strong>Pregnancy</strong>: <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> and a <span class=\"customMeta\" data-dictid=\"10345c29581692777189fda022382d\">hypercoagulable state</span> during pregnancy increase <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> risk, especially postpartum. <strong>(Option D)</strong></li>\n<li><strong>Immobility</strong>: Prolonged <span class=\"customMeta\" data-dictid=\"63b27629261692777182cc4d582eca\">bed rest</span> or long-distance travel can lead to <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> stasis, contributing to <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> development.</li>\n<li><strong>Other Conditions</strong>: Obesity, smoking, hypertension, COPD, <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, use of estrogen-based contraceptives, hormone replacement therapy, and trauma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Age</strong>: The <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> rises with advancing age.</li>\n<li><strong>Sex</strong>: Females are at higher risk due to pregnancy and hormone use.</li>\n<li><strong>Ethnicity:</strong> May influence <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> risk.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62 y/o hypertensive woman with a history of recent surgery presents with sudden onset of dyspnea and chest pain. ABG analysis reveals hypoxemia. A CT angiogram confirms the presence of a pulmonary embolism. What describes changes in the lung in this condition?", "options": [{"label": "A", "text": "Increased pulmonary compliance", "correct": false}, {"label": "B", "text": "Decreased alveolar-arterial oxygen gradient", "correct": false}, {"label": "C", "text": "Increased physiologic dead space", "correct": true}, {"label": "D", "text": "Improved gas exchange efficiency", "correct": false}], "correct_answer": "C. Increased physiologic dead space", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o man presents with chest pain and dyspnea. A CT scan shows multiple pulmonary emboli. He is diagnosed with right ventricular dysfunction secondary to the emboli. Which of the following best explains the cause of the same?", "options": [{"label": "A", "text": "Left ventricular failure", "correct": false}, {"label": "B", "text": "Microinfarctions of the right ventricle", "correct": true}, {"label": "C", "text": "Decreased pulmonary vascular resistance", "correct": false}, {"label": "D", "text": "Improved coronary perfusion", "correct": false}], "correct_answer": "B. Microinfarctions of the right ventricle", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemodynamics in <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> (PE)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Dysfunction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PE increases resistance in the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> arteries due to:\n\t\t\t\t<ul>\n<li>Mechanical <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> by the embolus.</li>\n<li>Substances like <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> trigger vasoconstriction.</li>\n</ul>\n</li>\n<li>This increases strain on the right ventricle, potentially causing <strong>right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> failure.</strong></li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> may develop due to increased <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PE can cause <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> by increasing pressure in the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> arteries.</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"5d2315cb971692777202c942aa4319\">wall tension</span> increases and there is <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of the right ventricle.</li>\n<li>Emboli can lead to <strong>microinfarctions in the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> due to increased pressure, leading to RV dysfunction. (Option B)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58 y/o woman with a history of DVT presents to the hospital with sudden onset chest pain, tachycardia, and cyanosis. She is diagnosed with a massive pulmonary embolism. What is the most likely clinical finding that indicates acute cor pulmonale?", "options": [{"label": "A", "text": "Loud S1 heart sound", "correct": false}, {"label": "B", "text": "Jugular venous distention", "correct": true}, {"label": "C", "text": "Bradycardia", "correct": false}, {"label": "D", "text": "Elevated blood pressure", "correct": false}], "correct_answer": "B. Jugular venous distention", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"4534214488169277718575e08a9bc0\">Cor</span> Pulmonale in Massive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Thromboembolism</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"4534214488169277718575e08a9bc0\">cor</span> pulmonale refers to right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> due to a sudden rise in <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> pressure, often <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by massive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Massive PE occurs when a large <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> obstructs a portion of the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> results in a rapid increase in <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance, which the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> must overcome.</li>\n<li>The sudden pressure <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> causes right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> and impaired pumping efficiency.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden collapse or syncope</li>\n<li>Severe shortness of breath</li>\n<li>Hypotension and <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> <strong>(Options C and D)</strong></li>\n<li><strong>Elevated <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure (JVP)</strong></li>\n<li>Cyanosis</li>\n<li>Signs of right <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> and a prominent <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> component of the <span class=\"customMeta\" data-dictid=\"ddbe945c10169277719841fa6a7fa2\">second heart sound</span> (P2). <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Computed <span class=\"customMeta\" data-dictid=\"8d4f2a375b1692777200f41db641bc\">tomography</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">angiography</span> (CTPA)- <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> diagnosis</p>\n\t\t\t \n\n\t\t\t<p><strong>Echocardiography:</strong></p>\n<ul>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> dilation</li>\n<li>A small left ventricle</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> in the right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery.</li>\n<li>The <strong>McConnell sign </strong>indicates specific right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> dysfunction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62 y/o male presents to the emergency with a history of prolonged immobility after recent hip surgery. His vital signs are as follows: respiratory rate of 28 bpm, heart rate of 110 bpm, and blood pressure of 90/60 mmHg. D-dimer is 900 mg/dl, and CTPA shows filling defects. What is the most common symptom associated with this condition?", "options": [{"label": "A", "text": "Syncope", "correct": false}, {"label": "B", "text": "Pleuritic chest pain", "correct": false}, {"label": "C", "text": "Unexplained dyspnea", "correct": true}, {"label": "D", "text": "Hemoptysis", "correct": false}], "correct_answer": "C. Unexplained dyspnea", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> - Clinical Features and Vitals Examination</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vital Signs </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unexplained dyspnea</li>\n<li>Pleuritic chest pain</li>\n<li>Hemoptysis</li>\n<li>Syncope</li>\n<li>Apprehension.</li>\n<li>Crushing central chest pain</li>\n<li>Calf cramps</li>\n</ul>\n<p>Severe <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Embolism:</p>\n<ul>\n<li>Sudden collapse of the patient.</li>\n<li>Severe hypotension</li>\n<li>Cyanosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heart Rate: ↑</li>\n<li>Respiratory Rate: ↑</li>\n<li>Blood Pressure: ↓</li>\n<li>Oxygen Saturation: ↓ (hypoxemia)</li>\n<li>Temperature: ↑ (low-grade fever)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62 y/o woman with a history of breast cancer is treated with chemotherapy. She presents with swelling and localised tenderness in her right leg. She was recently hospitalised for surgery and has been bedridden for the past three weeks. Examination shows pitting edema confined to the right leg, but no collateral veins and no previous DVT history. What is the patient's risk for DVT based on the Wells Criteria?", "options": [{"label": "A", "text": "DVT unlikely", "correct": false}, {"label": "B", "text": "Low probability", "correct": false}, {"label": "C", "text": "Moderate probability", "correct": false}, {"label": "D", "text": "High probability", "correct": true}], "correct_answer": "D. High probability", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Wells Criteria for Prediction of DVT</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Active cancer (patient either receiving treatment for cancer within the previous 6 months or currently receiving <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> treatment)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Paralysis, paresis, or recent cast <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> of the lower extremities</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Recently bedridden for ≥ 3 days, or <span class=\"customMeta\" data-dictid=\"e79ce088c716927771923a3bad7ab7\">major surgery</span> within the previous 12 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Localized <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> along the deep <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> system</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Entire leg swelling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Calf <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at least 3 cm larger than that on the <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> side (measured 10 cm below <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> tuberosity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pitting oedema confined to the <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> leg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Collateral <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> veins (non-varicose)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Previously documented DVT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Alternative diagnosis at least as likely as DVT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>-2</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Wells scoring system</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> unlikely if Score ≤1 </strong><strong>(Option A)</strong></p>\n<p><strong>Deep <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">Thrombosis</span> is likely if the Score &gt;1</strong></p>\n<p><strong>(Or)</strong></p>\n<p><strong>-2 to 0: Low <span class=\"customMeta\" data-dictid=\"f52ac1410416927771969ba21fcb63\">probability</span> </strong><strong>(Option B)</strong></p>\n<p><strong>1 to 2 points: Moderate <span class=\"customMeta\" data-dictid=\"f52ac1410416927771969ba21fcb63\">probability</span> </strong><strong>(Option C)</strong></p>\n<p><strong>3 to 8 points: High Probability</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65y/o man presents to the emergency department with a sudden onset of pleuritic chest pain, dyspnea, and mild hypotension. His echocardiogram shows right ventricular (RV) dysfunction, but his systemic arterial pressure remains normal. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Immediate anticoagulation and observation", "correct": false}, {"label": "B", "text": "Fibrinolytic therapy", "correct": false}, {"label": "C", "text": "Catheter-directed thrombolysis", "correct": true}, {"label": "D", "text": "Surgical embolectomy", "correct": false}], "correct_answer": "C. Catheter-directed thrombolysis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pulmonary Infarction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Submassive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> (PE)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicates a small PE, causing severe pleuritic pain due to <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> near pleural nerves.</li>\n<li>Pain may <span class=\"customMeta\" data-dictid=\"f4a826ea4916927771977e2f55c16f\">radiate</span> to the right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> or <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> area, mimicking <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> emergencies.</li>\n<li>Can result from thrombotic or nonthrombotic causes (e.g., fat embolism, tumour embolism, bone marrow, air embolism).</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> findings: <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> wedge-shaped opacity, enlarged <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery, or regional <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> oliguria.</li>\n<li>Typically treated with observation and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> such as a CT <span class=\"customMeta\" data-dictid=\"fa1da4abca1692777181b5898561f7\">angiogram</span> to confirm diagnosis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accounts for 20–25% of PE cases, characterised by right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> (RV) <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> but normal <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> arterial pressure.</li>\n<li>Common signs: dyspnea, hypotension, syncope, <span class=\"customMeta\" data-dictid=\"72421e3a581692777197a98d00066c\">right heart</span> failure, and elevated <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> biomarkers like troponin.</li>\n<li>Can deteriorate clinically if untreated; associated with increased risk of heart failure.</li>\n<li>Fibrinolytic therapy lowers the rate of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> of PE. It helps by dissolving clots, reducing <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension, and addressing deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> sources.</li>\n<li>Standard <span class=\"customMeta\" data-dictid=\"51021a109516927772009e1d66fee2\">tPA</span> dosing is 100 mg over 2 hours, with lower doses (50 mg over 2 hours) reducing <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risks. Major <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk is the risk of <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> haemorrhage.</li>\n<li>Pharmacomechanical catheter-directed therapy uses <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> <span class=\"customMeta\" data-dictid=\"c3bbd691781692777203582ec44b8c\">fragmentation</span> with low-dose <span class=\"customMeta\" data-dictid=\"7e7b9c1b1816927772000af22608df\">thrombolysis</span> (e.g., 24 mg <span class=\"customMeta\" data-dictid=\"fcf301c929169277718150daaaafc4\">alteplase</span> over 12 hours) to decrease RV dilation, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension, and lower <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> risks.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o male with a history of recent surgery presents with acute onset dyspnea and pleuritic chest pain. His ECG findings show sinus tachycardia. Which of the following investigations would most directly confirm the diagnosis of pulmonary embolism (PE)?", "options": [{"label": "A", "text": "Chest X-ray", "correct": false}, {"label": "B", "text": "Ventilation-perfusion (V/Q) scan", "correct": false}, {"label": "C", "text": "CT pulmonary angiogram", "correct": true}, {"label": "D", "text": "D-Dimer", "correct": false}], "correct_answer": "C. CT pulmonary angiogram", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0TlGAWKnO6kyRNIT0dlF1744376436.png", "https://image.prepladder.com/notes/FtuGNG3qt23B54u4ddgj1745578739.png", "https://image.prepladder.com/notes/6HlhgvBnfo7hiaG5UeS91746007811.gif"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Evaluation</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PE symptoms are nonspecific, often leading to excessive use of CT <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> angiograms. Age-adjusted d-dimer testing is recommended for patients over 50 years with low-to-moderate PE probability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D-Dimer</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A sensitive but <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">nonspecific</span> test for PE. Elevated levels indicate possible PE but can also occur with conditions like MI, pneumonia, or sepsis. Normal d-dimer helps rule out PE. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrocardiogram (ECG)</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common findings include <strong>sinus tachycardia(most common) </strong>and the <strong>S1Q3T3 sign(most specific)</strong> (S wave in lead I, Q wave in lead III, inverted T wave in lead III).</li>\n<li>T-wave <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> in V1 to V4 suggests RV strain or ischemia.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pulmonary &lt;span class=\" custommeta\"=\"\" data-dictid=\"1c07a1135f1692777187f547678386\"/>Embolism ECG\" data-author=\"R.W.Koster\" data-hash=\"11296\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pulm_embolism.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/cTET8Ts7JIrrqGAo86gu1745578676.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous Ultrasonography</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uses loss of <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"9c8c556f3816927771841f3a22c4d9\">compressibility</span> as a key indicator for diagnosing DVT, which is associated with PE.</li>\n<li>Doppler <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> can assess <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> dynamics.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest X-ray</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often normal but may show specific signs like Westermark’s sign (focal oligemia), Hampton’s <span class=\"customMeta\" data-dictid=\"cc997dd837169277718990ed8944ed\">hump</span> (wedge-shaped pleural density), or Palla’s sign (enlarged <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery).</p>\n<img alt=\"IM597 Palla sign and Westermark sign.png\" data-author=\"\" data-hash=\"9408\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/0TlGAWKnO6kyRNIT0dlF1744376436.png\">\n<p><strong>Chest <span class=\"customMeta\" data-dictid=\"5c71603ac81692777197e2aa1e7fd3\">radiograph</span> demonstrating <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"173996283316927771945c3fb6ec0e\">oligemia</span> (Westermark’s sign) in the <span class=\"customMeta\" data-dictid=\"e9046e11bd1692777197e166e5418f\">right lung</span> (area between white arrowheads) and a prominent right <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (Palla’s sign) (black arrow).</strong></p>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hamptons Hump\" data-author=\"Hellerhoff\" data-hash=\"11297\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hampton_hump_bei_schwerer_Lungenembolie_-_Roe_Thorax.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/FtuGNG3qt23B54u4ddgj1745578739.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>The chest <span class=\"customMeta\" data-dictid=\"5c71603ac81692777197e2aa1e7fd3\">radiograph</span> demonstrates a wedge-shaped <span class=\"customMeta\" data-dictid=\"a8eadab50316927771948be0cc91ca\">opacity</span> (arrow) in the right middle <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> consistent with Hampton hump.</strong></p>\n</img></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest CT with Contrast</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <strong>primary <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> test</strong>. It offers high-resolution visualisation of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vasculature.</li>\n<li>RV <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> on CT indicates a higher risk of mortality.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lung Scanning</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <strong>second-line test</strong>, mostly for patients who can’t tolerate contrast. High-probability <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> scans (two or more <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> defects) strongly suggest PE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> (MR) Imaging</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MR <span class=\"customMeta\" data-dictid=\"8a7362882e1692777201ef793c3fd4\">venography</span> with <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">gadolinium</span> can diagnose <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> when <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> is inconclusive, though MR <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">angiography</span> is less reliable for smaller PEs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Echocardiography</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is <strong>not reliable</strong> for directly diagnosing PE but useful for detecting mimicking conditions. <strong>McConnell’s sign</strong> (RV-free wall hypokinesis) is an <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> sign of PE.</p>\n<figure class=\"caption_element\"><img alt=\"Mc-Colonnel Sign\" data-author=\"Shafiq Q, Assaly R, Kanjwal Y\" data-hash=\"11460\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:McConnell-Sign-in-a-Patient-with-Massive-Acute-Pulmonary-Embolism-201097.f1.ogv\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/6HlhgvBnfo7hiaG5UeS91746007811.gif\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary Angiography</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifies <span class=\"customMeta\" data-dictid=\"603b3d38051692777190701f192c2a\">intraluminal</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defects or abrupt vessel occlusion.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 y/o woman with a history of atrial fibrillation presents to the ED with sudden onset dyspnea and sharp chest pain. Her chest X-ray reveals a wedge-shaped opacity in the right middle lobe as shown. She exhibits signs of hypotension, tachycardia, and altered mental status. Which of the following is the most appropriate initial management?", "options": [{"label": "A", "text": "Initiation of oral anticoagulation", "correct": false}, {"label": "B", "text": "Starting her on intravenous unfractionated heparin", "correct": false}, {"label": "C", "text": "Administration of thrombolytic therapy", "correct": true}, {"label": "D", "text": "Performing a surgical embolectomy", "correct": false}], "correct_answer": "C. Administration of thrombolytic therapy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/FtuGNG3qt23B54u4ddgj1745578739.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> (PE) Treatment </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Stratification</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemodynamic instability, right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> (RV) dysfunction, and elevated troponins indicate high risk.</li>\n<li>Stable patients with normal RV function have a favourable <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> with <strong>anticoagulation</strong> alone.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anticoagulation</strong> (foundation of treatment):</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Three Major Strategies</strong>:\n\t\t\t\t<ul>\n<li>Parenteral <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> (UFH, LMWH, or fondaparinux).</li>\n<li>Parenteral therapy is followed by novel oral anticoagulants (NOACs) like dabigatran or edoxaban.</li>\n<li>Oral <span class=\"customMeta\" data-dictid=\"e26d71db351692777192bd4e95fc68\">monotherapy</span> with NOACs (rivaroxaban, apixaban).</li>\n</ul>\n</li>\n<li><strong>Unfractionated <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">Heparin</span> (UFH)</strong>: Requires <span class=\"customMeta\" data-dictid=\"c91819a65716927771810b66ea6869\">aPTT</span> monitoring, useful for close control.</li>\n<li><strong>Low-Molecular-Weight <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">Heparin</span> (LMWH)</strong>: Predictable dose-response, no monitoring unless in <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> or CKD.</li>\n<li><strong>Fondaparinux</strong>: A weight-based daily injection, no monitoring needed.</li>\n<li><strong>Warfarin</strong>: <span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\">Vitamin K</span> antagonist, requires INR monitoring (target 2.0–3.0).</li>\n<li><strong>Novel Oral Anticoagulants (NOACs)</strong>: Fixed doses, rapid action, no need for monitoring</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IVC Filters</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Indications</u>: Active <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> preventing <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> despite anticoagulation.</li>\n<li>Retrievable filters are preferred over permanent ones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Massive PE Management</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The treatment of massive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE) involves <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"7e7b9c1b1816927772000af22608df\">thrombolysis</span> (ST) with agents like tPA, typically at a dose of 100 mg over 2 hours, or a <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> dose of 50 mg in patients with contraindications</li>\n<li>Fluid <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> (cautious), <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> for <span class=\"customMeta\" data-dictid=\"a7a960ea3e1692777201d2255a63f1\">vasopressor</span> support, and <span class=\"customMeta\" data-dictid=\"2e641d2bed169277718645b83606b8\">dobutamine</span> for RV inotropy.</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"ffe4e507c91692777186296540a8dc\">ECMO</span> for severe cases as a bridge to <span class=\"customMeta\" data-dictid=\"7e7b9c1b1816927772000af22608df\">thrombolysis</span> or embolectomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrinolysis</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to rapidly reverse RV failure and dissolve clots.</li>\n<li>Systemic regimen: 100 mg <span class=\"customMeta\" data-dictid=\"51021a109516927772009e1d66fee2\">tPA</span> over 2 hours; lower doses (50 mg) may reduce <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacomechanical Catheter-Directed Therapy</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Combines <span class=\"customMeta\" data-dictid=\"7e7b9c1b1816927772000af22608df\">thrombolysis</span> with mechanical <span class=\"customMeta\" data-dictid=\"c3bbd691781692777203582ec44b8c\">fragmentation</span> (ultrasound-facilitated, maceration, suction).</li>\n<li>Lower doses of thrombolytics are used, reducing complications.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Embolectomy</strong>:<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Resurgence due to improved survival.</li>\n<li>Indicated for patients with massive PE when other treatments fail. <strong>(Option D)</strong><strong> </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72 y/o woman presents to the ED with sudden onset dyspnea and chest pain. On examination, she is hypotensive (systolic BP 85 mm Hg), has tachycardia, and exhibits signs of altered consciousness. An echocardiogram shows right ventricular (RV) dysfunction. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Submassive pulmonary embolism", "correct": false}, {"label": "B", "text": "Massive pulmonary embolism", "correct": true}, {"label": "C", "text": "Pneumonia", "correct": false}, {"label": "D", "text": "Myocardial infarction", "correct": false}], "correct_answer": "B. Massive pulmonary embolism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Massive PE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Submassive PE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-massive PE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defined by <strong>systemic hypotension</strong> (systolic <span class=\"customMeta\" data-dictid=\"9e831262a7169277718263c34e2dc1\">arterial pressure</span> &lt; 90 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> or a drop of ≥40 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for at least 15 minutes).</li>\n<li>Associated with <strong>shock</strong> (evidence of tissue hypoperfusion, altered consciousness, oliguria, cold/clammy extremities).</li>\n<li>High <strong>mortality</strong> despite advances in diagnosis and therapy.</li>\n<li>Diagnosis through <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> shows <strong>RV dysfunction</strong> and other clinical signs like <strong>neck <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> distension</strong>.</li>\n<li><strong>Rapid intervention</strong> is critical as 50% die within 30 minutes, and more than 85% within 6 hours of symptom onset.</li>\n<li>Hemodynamic instability; requires immediate supportive measures, thrombolysis, or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normotensive but presents with <strong>right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> (RV) dysfunction</strong> or <span class=\"customMeta\" data-dictid=\"ab373751dc16927771891dcbeef0cf\">hypokinesis</span> confirmed by echocardiography.</li>\n<li>Carries a worse <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> than non-massive PE with normal RV function but better than massive PE.</li>\n<li><strong>RV dysfunction</strong>: Identified through echo with parameters such as RV dilation, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension, and McConnell's sign (akinesia of RV free wall with spared apex).</li>\n<li><strong>Troponin</strong> and <strong>BNP</strong> markers are often elevated; both are useful for risk stratification.</li>\n<li>The role of <strong>thrombolysis</strong> is controversial and patient-specific.</li>\n<li>Anticoagulation is essential.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normotensive and no evidence of RV <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> or hypokinesis.</li>\n<li>Better overall <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> with <strong>lower risk</strong> of mortality and complications.</li>\n<li>Can present with non-specific clinical symptoms but is <strong>stable hemodynamically</strong>.</li>\n<li>Treated mainly with <strong>anticoagulation</strong>, without the need for thrombolytics or more aggressive therapies.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28 y/o man is admitted to the ED following a motorcycle accident resulting in multiple fractures of the right femur and left humerus. Two days post-injury, he developed sudden onset dyspnea, altered mental status, and a petechial rash around his neck and conjunctiva. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute Respiratory Distress Syndrome (ARDS)", "correct": false}, {"label": "B", "text": "Fat Embolism Syndrome (FES)", "correct": true}, {"label": "C", "text": "Pulmonary Embolism (PE)", "correct": false}, {"label": "D", "text": "Deep Vein Thrombosis (DVT)", "correct": false}], "correct_answer": "B. Fat Embolism Syndrome (FES)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Blunt trauma</strong>: Accounts for 90% of cases, especially involving <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Associated conditions</strong>:\n\t\t\t\t<ul>\n<li>Acute pancreatitis</li>\n<li>Diabetes mellitus</li>\n<li>Burns</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> surgeries</li>\n<li>Liposuction</li>\n<li>Cardiopulmonary bypass</li>\n<li>Decompression sickness</li>\n<li>Parenteral <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> infusion</li>\n<li>Sickle cell crisis</li>\n<li>Pathologic fractures</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Increased risk factors</strong> (in trauma patients):\n\t\t\t\t<ul>\n<li>Age 30 years or younger</li>\n<li>Closed <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> fracture</li>\n<li>Multiple long-bone fractures</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28 y/o male presents to the ED after sustaining multiple long bone fractures in a motorcycle accident. Two days post-injury, he exhibits tachypnea, confusion, and a petechial rash on his torso. Which of the following is NOT a part of the diagnostic criteria for the patient's likely condition?", "options": [{"label": "A", "text": "Sudden thrombocytopenia", "correct": false}, {"label": "B", "text": "Elevated white blood cell count", "correct": true}, {"label": "C", "text": "Elevated erythrocyte sedimentation rate (ESR)", "correct": false}, {"label": "D", "text": "Petechial rash", "correct": false}], "correct_answer": "B. Elevated white blood cell count", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> (symptoms and radiologic evidence)</li>\n<li>Cerebral <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> not caused by head injury or other conditions</li>\n<li>Petechial rash</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tachycardia (&gt;110 beats/min)</li>\n<li>Pyrexia (temperature &gt;38.5°C)</li>\n<li>Retinal changes (fat or petechiae)</li>\n<li>Renal dysfunction</li>\n<li>Jaundice</li>\n<li>Acute drop in haemoglobin</li>\n<li>Sudden thrombocytopenia</li>\n<li>Elevated ESR</li>\n<li>Fat macroglobulinemia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents to the emergency department after sustaining multiple long bone fractures in a car accident. Two days later, he developed respiratory distress, confusion, and a petechial rash. His oxygen saturation is dropping, and the medical team begins supportive care, including fluid resuscitation and monitoring. Which of the following is the best option for expanding plasma volume and potentially limiting lung injury in this patient with FES?", "options": [{"label": "A", "text": "Normal saline", "correct": false}, {"label": "B", "text": "Ringer lactate solution", "correct": false}, {"label": "C", "text": "Albumin", "correct": true}, {"label": "D", "text": "Corticosteroids", "correct": false}], "correct_answer": "C. Albumin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supportive Medical Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adequate <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> and ventilation</strong></li>\n<li><strong>Maintain <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> stability</strong> through appropriate fluid resuscitation.</li>\n<li><strong>Hydration</strong>, blood product administration, <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> prophylaxis, and stress <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> prevention are essential.</li>\n<li>Continuous <strong>pulse <span class=\"customMeta\" data-dictid=\"93330fe4e1169277719466ae6a8f18\">oximetry</span> monitoring</strong> in at-risk patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous Fluids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Isotonic crystalloids</strong> (e.g., normal saline, Ringer lactate) are used for initial volume resuscitation.</li>\n<li><strong>Colloids</strong> (e.g., albumin) provide greater <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume expansion, reduce <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> and cerebral oedema, and may bind <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids to limit lung injury.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticosteroids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>May reduce <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> in some cases</li>\n<li><strong>Methylprednisolone</strong> is commonly used for <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> in at-risk patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> of long bone fractures</strong> (within 24 hours) minimizes fat <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> and reduces the risk of FES.</li>\n<li>Techniques like <strong>vacuum or venting during reaming</strong> of bone can decrease fat embolism.</li>\n<li>In high-risk cases, <strong>prophylactic placement of <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> filters</strong> may prevent fat <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> from reaching the heart.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 8 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 72 y/o male, a k/c/o COPD presents to the ED with shortness of breath and confusion. He has been experiencing increased fatigue and worsening dyspnea over the past few days. O/E he has a respiratory rate of 30 bpm. Arterial blood gas analysis shows: PaO2: 58 mmHg, PaCO2: 52 mmHg and pH: 7.2. Which type of respiratory failure is most likely in this patient?", "options": [{"label": "A", "text": "Type 1 Respiratory Failure", "correct": false}, {"label": "B", "text": "Type 2 Respiratory Failure", "correct": true}, {"label": "C", "text": "Type 3 Respiratory Failure", "correct": false}, {"label": "D", "text": "Type 4 Respiratory Failure", "correct": false}], "correct_answer": "B. Type 2 Respiratory Failure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 1 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 2 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hypoxemic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hypercapnic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PaO2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>May be normal or decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PaCO2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Normal or decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &gt; 45 mmHg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Typically normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>&lt; 7.35 due to acidosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>A-a Gradient</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Can be normal (low FiO₂/Patm, hypoventilation) or increased (V/Q mismatch, shunt, <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> defect)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Variable, depending on <span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\">hypoventilation</span> or dead space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> \n\t\t\t<ul>\n<li>V/Q mismatch</li>\n<li>Diffusion defect</li>\n<li>Right-to-left shunt</li>\n<li>Low FiO₂/Patm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hypoventilation</li>\n<li>Respiratory pump failure</li>\n<li>Decreased central drive</li>\n<li>Neuromuscular impairment</li>\n<li>Increased CO₂ production</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Etiologies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>ARDS</li>\n<li>COPD</li>\n<li>Congestive heart failure</li>\n<li>High altitude</li>\n<li>Pneumonia</li>\n<li>Pulmonary embolism</li>\n<li>AV malformation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>CNS depression (e.g., sedatives)</li>\n<li>Neuromuscular diseases (e.g., ALS)</li>\n<li>Chest wall/pleural disorders (e.g., <span class=\"customMeta\" data-dictid=\"3dec14fe921692777202dc55958a46\">flail</span> chest, kyphoscoliosis)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Respiratory Failure type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PaO2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PaCO2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Etiologies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 1 (Hypoxemic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Low oxygen levels without elevated CO2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 50 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &lt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>- Alveolar <span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\">hypoventilation</span> (e.g., <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> hypoventilation)</p>\n<p>- Low FiO2 (high altitudes)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">Diffusion</span> defects (e.g., emphysema)</p>\n<p>- V/Q mismatch (e.g., ARDS, COPD, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"b24d0f484d1692777197ba19e7d777\">Right-to-left shunt</span> (e.g., pneumonia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 2 (Hypercapnic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> with elevated CO2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 50 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &gt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>- <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (e.g., stroke, encephalopathy, ALS)</p>\n<p>- Sedatives (e.g., opiates, alcohol)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">Chest wall</span> abnormalities (e.g., kyphoscoliosis, obesity)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> muscle dysfunction</p>\n<p>- <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> issues (e.g., <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> dysfunction)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 3 (Peri-Operative <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Post-surgical <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure related to impaired breathing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 50 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &lt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>- General anesthesia</p>\n<p>- <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">Supine</span> position</p>\n<p>- Depressed <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> reflex</p>\n<p>- <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> incisions</p>\n<p>- Ascites</p>\n<p>- <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> secretions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 4 (Shock with Hypoperfusion)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Respiratory failure due to shock-induced <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demand</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 50 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &gt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>- High <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demand (e.g., <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock, fever, exercise)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output (e.g., cardiogenic, hypovolemic shock)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 y/o female undergoes elective hip replacement surgery. Postoperatively, she develops shortness of breath and a decreased oxygen saturation level. She reports significant pain at the surgical site and is reluctant to take deep breaths due to discomfort. O/E, her respiratory rate is elevated, and auscultation reveals diminished breath sounds at the bases. A chest X-ray shows areas of atelectasis. What type of respiratory failure is most likely in this patient?", "options": [{"label": "A", "text": "Type 1 Respiratory Failure", "correct": false}, {"label": "B", "text": "Type 2 Respiratory Failure", "correct": false}, {"label": "C", "text": "Type 3 Respiratory Failure", "correct": true}, {"label": "D", "text": "Type 4 Respiratory Failure", "correct": false}], "correct_answer": "C. Type 3 Respiratory Failure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 3 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure </strong></p>\n<p><strong>(Postoperative)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 4 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure </strong></p>\n<p><strong>(Shock-Related) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Respiratory failure due to <span class=\"customMeta\" data-dictid=\"7a5ca69ddf16927771829cd4e4d464\">atelectasis</span> from <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Respiratory failure due to high <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demands from shock</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Atelectasis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demands exceed <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> capacity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Alveolar collapse prevents oxygen from entering the bloodstream</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> system cannot meet oxygen demands (e.g., sepsis, fever).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Etiologies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Pain post-surgery</li>\n<li>Sedative use</li>\n<li>Anesthesia effects</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Sepsis</li>\n<li>Fever</li>\n<li>Cardiac events (e.g., heart attack)</li>\n<li>Blood loss leading to shock</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Often involves supportive measures, pain management, Chest physiotherapy, Incentive spirometry, Continuous positive <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> pressure (CPAP), <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">Intubation</span> and monitoring</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Intubation for <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> support and to reduce <span class=\"customMeta\" data-dictid=\"72d435bfb11692777194f88fdb0bf3\">oxygen consumption</span> during resuscitation.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Respiratory Failure type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PaO2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PaCO2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Etiologies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 1 (Hypoxemic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Low oxygen levels without elevated CO2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 50 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &lt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>- Alveolar <span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\">hypoventilation</span> (e.g., <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> hypoventilation)</p>\n<p>- Low FiO2 (high altitudes)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">Diffusion</span> defects (e.g., emphysema)</p>\n<p>- V/Q mismatch (e.g., ARDS, COPD, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"b24d0f484d1692777197ba19e7d777\">Right-to-left shunt</span> (e.g., pneumonia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 2 (Hypercapnic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> with elevated CO2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 50 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &gt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>- <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (e.g., stroke, encephalopathy, ALS)</p>\n<p>- Sedatives (e.g., opiates, alcohol)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">Chest wall</span> abnormalities (e.g., kyphoscoliosis, obesity)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> muscle dysfunction</p>\n<p>- <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> issues (e.g., <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> dysfunction)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 3 (Peri-Operative <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Post-surgical <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure related to impaired breathing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 50 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &lt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>- General anesthesia</p>\n<p>- <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">Supine</span> position</p>\n<p>- Depressed <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> reflex</p>\n<p>- <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> incisions</p>\n<p>- Ascites</p>\n<p>- <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> secretions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type 4 (Shock with Hypoperfusion)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Respiratory failure due to shock-induced <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demand</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaO2 &lt; 50 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>PaCO2 &gt; 60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>- High <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> demand (e.g., <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock, fever, exercise)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output (e.g., cardiogenic, hypovolemic shock)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 y/o male with h/o pneumonia is admitted to the hospital with severe shortness of breath. O/E, his oxygen saturation is 85%, and arterial blood gas analysis shows: PaO2: 55 mmHg PaCO2: 40 mmHg pH: 7.38 He is anxious and struggling to breathe. What is the most appropriate initial treatment for this patient’s respiratory failure?", "options": [{"label": "A", "text": "Intubation and mechanical ventilation", "correct": false}, {"label": "B", "text": "Noninvasive ventilation (NIV)", "correct": false}, {"label": "C", "text": "Oxygen therapy via a nonrebreathing mask", "correct": true}, {"label": "D", "text": "Continuous positive airway pressure (CPAP)", "correct": false}], "correct_answer": "C. Oxygen therapy via a nonrebreathing mask", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/L02nOV9otWQs4iIC556j1740746862.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure (Hypoxemic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Correct Hypoxemia</u>: Aim to achieve PaO₂ ≥ 60 mmHg or SaO₂ 90-94%.</li>\n<li><u>Oxygen Therapy</u>: Use <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cannula, face mask, nonrebreathing mask, or high-flow <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cannula.</li>\n<li><u>Avoid Oxygen Toxicity</u>: Monitor to avoid excessive oxygen, which may lead to <span class=\"customMeta\" data-dictid=\"6d4575770616927771945ebf87fe75\">oxygen toxicity</span> and CO₂ narcosis.</li>\n<li><u>Refractory Cases</u>: Consider <span class=\"customMeta\" data-dictid=\"75d87604771692777187612563865d\">extracorporeal</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> (ECMO) if <span class=\"customMeta\" data-dictid=\"9f81027f0116927771892823259e5d\">hypoxemia</span> persists despite conventional oxygen therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure (Hypercapnic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Correct <span class=\"customMeta\" data-dictid=\"1f0bd058f91692777189f9a7c1992e\">Hypercapnia</span> and Acidosis</u>: Address the underlying cause and consider <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> support if needed.</li>\n<li><u>Noninvasive <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV):</u> Preferred for conditions like <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> exacerbation, <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, and <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> <span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\">hypoventilation</span> syndrome. <strong>(Option B ruled out)</strong></li>\n<li><u>Ventilatory Support</u>: <span class=\"customMeta\" data-dictid=\"ec62425aa9169277719050edbb4d55\">Intubate</span> and provide <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">mechanical ventilation</span> if severe, with goals to:\n\t\t\t\t<ul>\n<li>Correct <span class=\"customMeta\" data-dictid=\"9f81027f0116927771892823259e5d\">hypoxemia</span> and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis</li>\n<li>Relieve <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> muscle fatigue</li>\n</ul>\n</li>\n<li><u>Mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> Indications</u>: Apnea, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate &gt;30, impaired consciousness, <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> instability, or arterial pH &lt; 7.25.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain management</li>\n<li>Chest physiotherapy</li>\n<li>Incentive spirometry</li>\n<li>Continuous positive <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> pressure (CPAP)</li>\n<li>Intubation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intubation for <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> support</li>\n<li>Reduce <span class=\"customMeta\" data-dictid=\"72d435bfb11692777194f88fdb0bf3\">oxygen consumption</span> during resuscitation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 y/o female presents with h/o wheezing and shortness of breath. A pulmonary function test shows a flow-volume loop with a distinct \"scooped\" appearance during expiration, particularly at lower lung volumes. Which condition does this flow-volume loop most likely represent?", "options": [{"label": "A", "text": "Pulmonary Fibrosis", "correct": false}, {"label": "B", "text": "Asthma", "correct": true}, {"label": "C", "text": "Retrosternal Goiter", "correct": false}, {"label": "D", "text": "Normal", "correct": false}], "correct_answer": "B. Asthma", "question_images": ["https://image.prepladder.com/notes/Lb95R002Mw1osU2j6KmE1746000101.png"], "explanation_images": ["https://image.prepladder.com/notes/Lb95R002Mw1osU2j6KmE1746000101.png", "https://image.prepladder.com/notes/QxJpCviWWAetyPpYWiT91745999917.png", "https://image.prepladder.com/notes/0fecFhYEmUJTBUjHmVTj1745999871.png", "https://image.prepladder.com/notes/6zwM81wwJYB9T2tibLTw1745999743.png", "https://image.prepladder.com/notes/7kcdpOWrURfQU2UAD7VZ1746001270.png", "https://image.prepladder.com/notes/tE6GPv3lsexhsxcBLgcB1746001300.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following diseases with their respective flow volume curves: 1. Asthma a) 2. Extrathoracic Obstruction b) 3. Fixed Obstruction c) 4. Restrictive Airway Disorders d)", "options": [{"label": "A", "text": "1-d, 2-a, 3-c, 4-b", "correct": false}, {"label": "B", "text": "1-a, 2-c, 3-d, 4-b", "correct": false}, {"label": "C", "text": "1-b, 2-d, 3-a, 4-c", "correct": true}, {"label": "D", "text": "1-c, 2-b, 3-d, 4-a", "correct": false}], "correct_answer": "C. 1-b, 2-d, 3-a, 4-c", "question_images": ["https://image.prepladder.com/notes/1GOVMyXa1fGxJ08M4RSn1745999702.png", "https://image.prepladder.com/notes/Lb95R002Mw1osU2j6KmE1746000101.png", "https://image.prepladder.com/notes/QxJpCviWWAetyPpYWiT91745999917.png", "https://image.prepladder.com/notes/0fecFhYEmUJTBUjHmVTj1745999871.png"], "explanation_images": ["https://image.prepladder.com/notes/6zwM81wwJYB9T2tibLTw1745999743.png", "https://image.prepladder.com/notes/Lb95R002Mw1osU2j6KmE1746000101.png", "https://image.prepladder.com/notes/0fecFhYEmUJTBUjHmVTj1745999871.png", "https://image.prepladder.com/notes/1GOVMyXa1fGxJ08M4RSn1745999702.png", "https://image.prepladder.com/notes/QxJpCviWWAetyPpYWiT91745999917.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flow Volume Loops</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal (article)</strong></p>\n<p>A normal flow-volume loop displays <span class=\"customMeta\" data-dictid=\"99caf903791692777180bc28743310\">airflow</span> (in L/second) related to lung volume (in L) during <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> inspiration from <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> volume (RV) and maximum <span class=\"customMeta\" data-dictid=\"2cbabc42d21692777187c451566867\">expiration</span> from <span class=\"customMeta\" data-dictid=\"b0e95f9af21692777200e8a9faabe7\">total lung capacity</span> (TLC).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"B\" data-author=\"\" data-hash=\"11431\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"650\" src=\"https://image.prepladder.com/notes/6zwM81wwJYB9T2tibLTw1745999743.png\" width=\"650\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asthma (Airflow Obstruction): </strong></p>\n<ul>\n<li>Narrowed airways due to smooth muscle <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> and <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> reduce <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> airflow, causing a “scooped” appearance, especially at lower lung volumes.</li>\n<li>Flow may improve after <span class=\"customMeta\" data-dictid=\"16abe8467e16927771837550ea9798\">bronchodilator</span> use.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"B\" data-author=\"\" data-hash=\"11434\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Lb95R002Mw1osU2j6KmE1746000101.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retrosternal <span class=\"customMeta\" data-dictid=\"2aa25c8cad1692777188842dd483eb\">Goiter</span> (Extrathoracic Obstruction): </strong></p>\n<ul>\n<li>Extrathoracic <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> narrowing can limit inspiratory flow, causing <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> of the inspiratory portion of the loop.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"D\" data-author=\"\" data-hash=\"11432\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" height=\"594\" src=\"https://image.prepladder.com/notes/0fecFhYEmUJTBUjHmVTj1745999871.png\" width=\"594\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intrathoracic Fixed Obstruction:</strong></p>\n<ul>\n<li>Fixed <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> within the chest affects both inspiration and expiration, resulting in flattened, plateaued loops on both sides of the flow-volume curve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"A\" data-author=\"\" data-hash=\"11430\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1GOVMyXa1fGxJ08M4RSn1745999702.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Restrictive <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Disorders (e.g., <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Fibrosis): </strong></p>\n<ul>\n<li>High lung <span class=\"customMeta\" data-dictid=\"b45dda9ea71692777197cbb7b1cab1\">recoil</span> pressure increases <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> flow for any given lung volume, producing a loop that is shifted to lower volumes and shows high <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> flow relative to volume.</li>\n<li>Overall lung volumes (TLC, FRC) are <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> due to increased stiffness.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"C\" data-author=\"\" data-hash=\"11433\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/QxJpCviWWAetyPpYWiT91745999917.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old female patient presents with progressive shortness of breath and a persistent dry cough. She has a history of pulmonary fibrosis diagnosed two years ago. Spirometry shows reduced lung volumes. Which of the following is most likely true regarding this patient’s spirometry results?", "options": [{"label": "A", "text": "FVC is likely to be increased.", "correct": false}, {"label": "B", "text": "FEV1/FVC ratio is likely &amp;gt; 80%.", "correct": true}, {"label": "C", "text": "TLC is likely normal or increased.", "correct": false}, {"label": "D", "text": "RV is likely normal or increased.", "correct": false}], "correct_answer": "B. FEV1/FVC ratio is likely &gt; 80%.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/jXTYr1WuQo1UtVDddlkS1746007663.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Normal Value </strong></p>\n<p><strong>(Litres)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tidal Volume (TV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The volume of air inhaled or exhaled in one cycle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>0.5 - 0.7 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Inspiratory Reserve Volume (IRV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Additional air that can be forcibly inhaled after normal inhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1.5 - 3.0 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Expiratory Reserve Volume (ERV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Additional air that can be forcibly exhaled after normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1.0 - 1.5 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Residual Volume (RV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The volume of air remaining in the lungs after maximum exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1.0 - 1.5 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Total Lung Capacity (TLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Maximum volume the lungs can hold (TV + <span class=\"customMeta\" data-dictid=\"9cea17d64b16927771905278e8ea88\">IRV</span> + <span class=\"customMeta\" data-dictid=\"5a6905fdca16927771879daba1b8d2\">ERV</span> + RV)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>4.5 - 6.0 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vital Capacity (VC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Total air that can be exhaled after maximum <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> (TV + <span class=\"customMeta\" data-dictid=\"9cea17d64b16927771905278e8ea88\">IRV</span> + ERV)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>3.0 - 5.0 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity (FRC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The volume of air remaining after normal <span class=\"customMeta\" data-dictid=\"b8e1ca39d61692777187254f3cc140\">exhalation</span> (ERV + RV)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>2.0 - 2.5 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Forced <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">Expiratory</span> Volume in 1 second (FEV1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The volume of air forcefully exhaled in the first second of a forced expiration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>3.0 - 4.0 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Forced <span class=\"customMeta\" data-dictid=\"187bb6b3f61692777201956c59ce72\">Vital Capacity</span> (FVC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Total amount of air exhaled during a forced expiration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>3.5 - 5.0 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Predicted <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">Postoperative</span> FEV1 (PPO FEV1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Postoperative risk assessment <span class=\"customMeta\" data-dictid=\"9f524cc9601692777194d19de23a85\">parameter</span> for <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Varies based on patient's condition</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o man with a history of COPD presents with shortness of breath, cough, and increased sputum production. His arterial blood gas (ABG) analysis shows hypoxemia, and his calculated A-a gradient is elevated. Which of the following is the most likely cause for the elevated A-a gradient in this patient?", "options": [{"label": "A", "text": "Ventilation-perfusion mismatch", "correct": true}, {"label": "B", "text": "Hypoventilation", "correct": false}, {"label": "C", "text": "Reduced cardiac output", "correct": false}, {"label": "D", "text": "Low-inspired oxygen (FiO2)", "correct": false}], "correct_answer": "A. Ventilation-perfusion mismatch", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1 <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Failure Etiologies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal A-a gradient</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased A-a gradient</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Alveolar hypoventilation</li>\n<li>Low atmospheric pressure/ <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> of inspired oxygen</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diffusion defect:</strong> Impaired gas exchange leading to ↓PaO₂ due to thickened alveolar membrane. In <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> and <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">Interstitial</span> Lung disease.</li>\n<li><strong>V/Q mismatch: </strong>Most common cause of Hypoxemia. Occurs when there is an <span class=\"customMeta\" data-dictid=\"2cc844bc9c1692777189739abf1dc5\">imbalance</span> between <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> and perfusion. Examples<strong> </strong>- <strong>COPD, <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">Asthma</span> </strong>pulmonary embolism, ARDS, CHF</li>\n<li>Right to left shunts - Blood bypasses the lungs without gas exchange.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50 y/o male presents with worsening dyspnea. His pulmonary function test reveals a significant reduction in DLCO. Which of the following is the most likely cause for the low DLCO?", "options": [{"label": "A", "text": "Pulmonary hemorrhage", "correct": false}, {"label": "B", "text": "Obesity", "correct": false}, {"label": "C", "text": "Pulmonary fibrosis", "correct": true}, {"label": "D", "text": "Acute Congestive Heart Failure", "correct": false}], "correct_answer": "C. Pulmonary fibrosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/W5v2ixsJNs5X7Ee3Icgg1746007427.png", "https://image.prepladder.com/notes/vztpnmBZA7rgLiOeBUuC1746007480.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffusion Capacity of the Lung for <span class=\"customMeta\" data-dictid=\"bb021d26d3169277718336718849a5\">Carbon Monoxide</span> (DLCO)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The DLCO test measures how much <span class=\"customMeta\" data-dictid=\"44758fcec31692777184e24fa84582\">CO</span> moves from the <span class=\"customMeta\" data-dictid=\"0dd428c12116927771819285c8849c\">alveoli</span> into the red blood cells each minute. This test is vital because it shows how efficiently the lungs can transfer oxygen from the air we breathe into the bloodstream, making it an important tool for diagnosing and <span class=\"customMeta\" data-dictid=\"ebb0986d331692777200ab09e1b2e8\">tracking</span> various lung conditions.</p>\n<p style=\"text-align:center\"><img alt=\"Spirometry\" data-author=\"\" data-hash=\"11456\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/W5v2ixsJNs5X7Ee3Icgg1746007427.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased DLCO</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased DLCO</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases with increased availability of surface area and haemoglobin in capillaries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to the thickened or destruction of the alveolar <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and factors affecting vasculature.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asthma</li>\n<li>Polycythemia</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b0eb48bbf6169277718568c051e6ad\">congestive heart failure</span> <strong>(Option D ruled out)</strong></li>\n<li>Exercise</li>\n<li>Obesity <strong>(Option B ruled out)</strong></li>\n<li>Pulmonary haemorrhage <strong>(Option A ruled out)</strong></li>\n<li>Altitude</li>\n<li>Bronchodilator usage</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (Option C)</strong></li>\n<li>Emphysema</li>\n<li>Pulmonary hypertension</li>\n<li>Anaemia</li>\n<li>COPD</li>\n<li>Bronchiolitis</li>\n<li>Cystic fibrosis</li>\n<li>Pleural effusion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 18 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What is the duration of the longer MDR-TB regimen?", "options": [{"label": "A", "text": "18-20 months", "correct": true}, {"label": "B", "text": "12 months", "correct": false}, {"label": "C", "text": "6-10 months", "correct": false}, {"label": "D", "text": "24-36 months", "correct": false}], "correct_answer": "A. 18-20 months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Additional resistance (e.g., fluoroquinolones)</p>\n<p>Severe pulmonary/extrapulmonary disease</p>\n<p>Previous treatment with second-line drugs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recommended Drugs (Group A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bedaquiline</p>\n<p>Linezolid</p>\n<p>Fluoroquinolone (levofloxacin or moxifloxacin)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Drugs </strong></p>\n<p><strong>(Group B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clofazimine</p>\n<p>Cycloserine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative Drugs </strong></p>\n<p><strong>(Group C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used to replace Group A or B agents when necessary</p>\n<p>Choice based on drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing, resistance levels, previous use, and patient tolerance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>18–20 months</strong> or more, depending on the patient's response</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with a painless swelling in the posterior cervical lymph nodes. There are no systemic symptoms, and a fine-needle aspiration biopsy reveals granulomatous lesions without acid-fast bacilli (AFBs). What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hodgkin’s lymphoma", "correct": false}, {"label": "B", "text": "Metastatic carcinoma", "correct": false}, {"label": "C", "text": "Tuberculous lymphadenitis", "correct": true}, {"label": "D", "text": "Kikuchi’s disease", "correct": false}], "correct_answer": "C. Tuberculous lymphadenitis", "question_images": ["https://image.prepladder.com/notes/g8I2AKf5xMCl4wfZeGOg1745573670.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> TB (Tuberculous Lymphadenitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB presentation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Groups</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HIV-positive individuals, children, and non-Caucasian women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Previously M. bovis; now mainly M. tuberculosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Painless </strong>swelling in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, usually <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> or <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> (historically called scrofula).</li>\n<li><strong>Early disease: <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">Discrete</span> nodes</strong></li>\n<li>Advanced disease: Matted, nontender mass, possible <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> draining <span class=\"customMeta\" data-dictid=\"99368d5fef1692777183ea405bed67\">caseous</span> material.</li>\n<li>Pulmonary disease in &lt;50% of cases.</li>\n<li>Systemic symptoms are uncommon except in HIV-positive patients.</li>\n<li>Non-specific reaction → Matting → Cold <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> → Collar stud <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> → <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (80% yield) or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> biopsy.</strong></li>\n<li>Granulomatous lesions may or may not contain AFBs.</li>\n<li>Cultures are positive in 70–80% of cases.</li>\n<li>HIV-positive patients: Poorly organized or absent granulomas; higher bacterial loads increase <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> yield.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infectious diseases</li>\n<li>Lymphomas</li>\n<li>Metastatic carcinomas</li>\n<li>Rare disorders: Kikuchi’s disease, Kimura’s disease, Castleman’s disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extrapulmonary TB Sites (Descending Order of Frequency)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Lymph nodes</li>\n<li>Pleura</li>\n<li>Genitourinary tract</li>\n<li>Bones and joints</li>\n<li>Meninges</li>\n<li>Peritoneum</li>\n<li>Pericardium</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence of <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">Extrapulmonary</span> TB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in settings with high <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> due to <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread.</li>\n<li>Any organ may be affected, especially in HIV-positive individuals</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with fever, pleuritic chest pain, and dyspnea. Physical examination revealed dullness to percussion and absent breath sounds on the left side. Chest X-ray shows a left-sided pleural effusion. Thoracentesis reveals straw-coloured fluid with a protein concentration of 5 g/dL and a WBC count of 1500/μL with lymphocyte predominance. The acid-fast bacilli (AFB) smear is negative. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Parapneumonic effusion", "correct": false}, {"label": "B", "text": "Tuberculous pleuritis", "correct": true}, {"label": "C", "text": "Malignant pleural effusion", "correct": false}, {"label": "D", "text": "Congestive heart failure", "correct": false}], "correct_answer": "B. Tuberculous pleuritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pleural TB</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">Effusion</span> Characteristics</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Isolated Pleural Effusion: Recent primary TB infection.</li>\n<li>Hypersensitivity to mycobacterial antigens.</li>\n<li>Can occur due to <span class=\"customMeta\" data-dictid=\"2a2420d6bc1692777185ac0cb7e93d\">contiguous</span> parenchymal spread in postprimary TB.</li>\n</ul>\n<ul>\n<li>Asymptomatic: Small effusion, resolves spontaneously.</li>\n<li>Symptomatic: Larger <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> causes fever, pleuritic chest pain, and dyspnea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Exam Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dullness to percussion.</li>\n<li>Absence of breath sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CXR Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reveals pleural effusion.</li>\n<li>Parenchymal lesions in up to one-third of cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thoracentesis Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fluid Color</strong>:<strong> Straw-colored</strong> (sometimes hemorrhagic).</li>\n<li><strong>Exudate: Protein concentration ~4-6 g/dL</strong> (&gt;50% of serum).</li>\n<li><strong>Glucose: Normal to low.</strong></li>\n<li><strong>pH: ~7.3 </strong>(occasionally &lt;7.2).</li>\n<li><strong>WBC: 500–6000/μL</strong> (lymphocyte predominance in later stages).</li>\n<li>Mesothelial Cells: Rare or absent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AFB (Acid-Fast Bacilli)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rarely seen on direct smear.</li>\n<li>Cultures may be negative, especially in early cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adenosine Deaminase</strong>: Useful for screening;<strong> low values exclude TB.</strong></li>\n<li>IFN-γ: Measured directly or through T-cell stimulation.</li>\n<li><strong>Pleural Biopsy: Preferred for diagnosis</strong>; reveals granulomas or positive culture in up to 80% of cases.</li>\n<li><strong>Xpert MTB/RIF Assay</strong>: 75% positivity in pleural biopsy; fluid testing not recommended.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chemotherapy: Rapid response, <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution possible.</li>\n<li>Glucocorticoids: May reduce fever/chest pain but have unproven benefits.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old man presents with a 2-week history of headaches, low-grade fever, irritability, and confusion. On examination, he has neck stiffness and cranial nerve VI palsy. Lumbar puncture reveals a CSF leukocyte count of 800/μL (lymphocyte predominance), protein of 400 mg/dL, and low glucose. AFB smear is negative. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Viral meningitis", "correct": false}, {"label": "B", "text": "Bacterial meningitis", "correct": false}, {"label": "C", "text": "Tuberculous meningitis", "correct": true}, {"label": "D", "text": "Cryptococcal meningitis", "correct": false}], "correct_answer": "C. Tuberculous meningitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TB Meningitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tuberculous <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">Meningitis</span> results from <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread of primary or postprimary TB or <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of a <span class=\"customMeta\" data-dictid=\"3e782ca1981692777199a69e89b274\">subependymal</span> <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> into the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evolves over 1–2 weeks, slower than bacterial meningitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early Symptoms</strong>\n<ul>\n<li>Headache, mild mental changes, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> fever, malaise, anorexia, <span class=\"customMeta\" data-dictid=\"982688ae75169277719041afa70c42\">irritability</span> over several weeks.</li>\n</ul>\n</li>\n<li><strong>Advanced Symptoms</strong>\n<ul>\n<li>Severe headache, confusion, lethargy, altered sensorium, neck rigidity,<strong> <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsies (especially ocular)</strong>. Can progress to coma, hydrocephalus, and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hypertension.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lumbar <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">Puncture</span> Findings (CSF)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>High <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count </strong>(up to 1000/μL), typically <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> predominance</li>\n<li><strong>Protein: 1–8 g/L</strong> (100–800 mg/dL)</li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> concentration</strong></li>\n<li>AFB is rarely seen; repeated <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> punctures increase yield.</li>\n<li><strong>CSF culture <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> in up to 80% (gold standard).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Xpert MTB/RIF Assay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sensitivity up to 80%.</li>\n<li><strong>A negative result does not exclude TB.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CT, MRI: Shows <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">hydrocephalus</span> and <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns or ependyma.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Basal &lt;span class=\" custommeta\"=\"\" data-dictid=\"6c0b28fd161692777184ab502019a8\"/>cistern <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> of TB Meningitis\" data-author=\"Hartung M\" data-hash=\"11292\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/tuberculous-meningitis-13#image-63461192\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/vUkCYGSqWdtkdxtt59pX1745578177.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><strong>Basal <span class=\"customMeta\" data-dictid=\"6c0b28fd161692777184ab502019a8\">cistern</span> enhancement</strong></p>\n<ul>\n<li>In &gt;50% of cases, old <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> lesions or military pattern on CXR.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate treatment with positive Xpert MTB/RIF.</p>\n<ul>\n<li><strong>Chemotherapy </strong>is effective but neurologic sequelae occur in 25% of cases, especially with delayed diagnosis.</li>\n</ul>\n<ul>\n<li><strong>Glucocorticoid Therapy</strong>\n<ul>\n<li><strong>Dexamethasone </strong>reduces mortality and severe disability but may not prevent neurological sequelae.</li>\n<li>Regimen: 0.4 mg/kg/day IV, tapering weekly, followed by oral tapering. WHO recommends tapering over 6–8 weeks.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presents with chronic back pain, fatigue, and weight loss. MRI of the spine reveals destruction of the lower thoracic vertebrae with a paravertebral abscess tracking into the psoas muscle. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pyogenic bacterial osteomyelitis", "correct": false}, {"label": "B", "text": "Spinal tuberculosis", "correct": true}, {"label": "C", "text": "Vertebral metastasis", "correct": false}, {"label": "D", "text": "Disc herniation", "correct": false}], "correct_answer": "B. Spinal tuberculosis", "question_images": ["https://image.prepladder.com/notes/a1nBk2q2VVc9sFyG6Mph1745578311.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Spinal TB (Pott’s Disease)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves lower <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> and upper <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> in adults; and upper <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> spine in children.</p>\n<p>Lesions spread to adjacent <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> and <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> disks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advanced Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collapse of <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> leads to <span class=\"customMeta\" data-dictid=\"67deccee6a16927771911e0dcd1c3c\">kyphosis</span> <strong>(gibbus deformity)</strong>.</li>\n<li>Paravertebral cold abscesses:\n\t\t\t\t<ul>\n<li><strong>Upper spine: </strong>Abscess may<strong> penetrate the <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> as a soft tissue mass.</strong></li>\n<li><strong>Lower spine: </strong>May track to<strong> the inguinal region or <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a <span class=\"customMeta\" data-dictid=\"1ca45620ed1692777196a47f648338\">psoas</span> abscess.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> TB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Imaging (CT/MRI): </strong>Shows characteristic lesions, suggesting TB aetiology.</li>\n<li>Differential Diagnosis: Includes tumours and infections like <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">pyogenic</span> bacterial osteomyelitis.</li>\n<li>Confirmation: <strong>Aspiration or <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> confirms TB</strong> via positive cultures and typical histology.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Paraplegia</strong>: Due to <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord compression; requires emergency <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> if caused by a large abscess.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>TB of Hip and Knee Joints</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hip TB: Affects the head of the femur, causing pain.</li>\n<li>Knee TB: Causes pain and swelling.</li>\n<li>If untreated, joint destruction can occur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis of Joint TB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Synovial Fluid: Thick with high protein concentration and variable cell count.</li>\n<li>Synovial Fluid Culture: Often positive, but <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> and <span class=\"customMeta\" data-dictid=\"d32dc89c331692777200bf9c4a62dc\">tissue culture</span> may be required.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chemotherapy: Effective for most cases.</li>\n<li>Surgery: This may be needed in severe cases with joint or vertebral destruction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman presents with a history of pelvic pain, menstrual irregularities, and frequent urination over the past few months. She reports that her symptoms have worsened and she experiences occasional hematuria. Urinalysis shows pyuria, but urine cultures are negative. A pelvic ultrasound reveals abnormalities in the fallopian tubes. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Urinary tract infection", "correct": false}, {"label": "B", "text": "Genitourinary tuberculosis", "correct": true}, {"label": "C", "text": "Pelvic inflammatory disease (PID)", "correct": false}, {"label": "D", "text": "Can be either B or C", "correct": false}], "correct_answer": "B. Genitourinary tuberculosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:692px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Genitourinary <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> (TB)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can affect any part of the <span class=\"customMeta\" data-dictid=\"2fd33fb2ac16927771889901daadeb\">genitourinary</span> tract. Symptoms often appear late, after destructive <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> lesions have developed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Urinary Symptoms</strong>: <strong>Frequency, dysuria, nocturia, hematuria</strong></li>\n<li><strong>Other Symptoms</strong>: <strong>Abdominal or <span class=\"customMeta\" data-dictid=\"316968b3e116927772021379938005\">flank</span> pain</strong></li>\n<li><strong>Asymptomatic: </strong>Some patients are asymptomatic, leading to delayed diagnosis and <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> organ damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genital TB (Women)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It affects <strong>fallopian tubes and endometrium</strong>, causing infertility, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain, and <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> abnormalities.</li>\n<li>Diagnosis via <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> or culture from <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> and curettage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genital TB (Men)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It affects <strong>epididymis </strong>(a tender mass that may drain via the fistula); <strong>orchitis </strong>and <strong>prostatitis </strong>may also occur.</li>\n<li>In 50% of cases, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement is also present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CXR</strong>: Up to 75% show abnormalities suggesting past or <span class=\"customMeta\" data-dictid=\"a45b36c1c716927771840ee63f1cba\">concurrent</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB.</li>\n<li><strong>Urinalysis</strong>: <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">Abnormal</span> in 90% of cases (pyuria, hematuria). Culture-negative <span class=\"customMeta\" data-dictid=\"53d0aa97fa1692777196817c1db471\">pyuria</span> in <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> is a key clue.</li>\n<li><strong>Imaging</strong>: IV pyelography, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> CT, or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> show deformities, obstructions, calcifications, and ureteral strictures.</li>\n<li><strong>Urine Culture</strong>: <strong>Three-morning <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> specimens confirm diagnosis in nearly 90% of cases</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ureteral Strictures</strong>: Can cause hydronephrosis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage, and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Responds well to chemotherapy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gastrointestinal Tuberculosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanisms of Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swallowing of <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> with direct seeding.</li>\n<li>Hematogenous spread.</li>\n<li>Ingestion of contaminated <span class=\"customMeta\" data-dictid=\"6c086f82651692777183dedda5f99a\">bovine</span> milk (common in developing areas).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common sites of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Terminal <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> and cecum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal: Pain (similar to appendicitis), swelling, obstruction, hematochezia, <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass.</li>\n<li>Systemic: Fever, weight loss, anorexia, night sweats.</li>\n<li>Complications: Ulcerations and <span class=\"customMeta\" data-dictid=\"cf1ebb699b16927772024941e0cdad\">fistulae</span> (mimicking Crohn’s disease); anal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> suggests rectal TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery is required to obtain <span class=\"customMeta\" data-dictid=\"a77eb309ca16927771897b99ead59f\">histologic</span> and culture specimens intraoperatively.</li>\n<li>Differential Diagnosis: Difficult to distinguish from Crohn’s disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tuberculous Peritonitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Results from the direct spread of <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> from ruptured <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes or <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> organs (e.g., <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> TB in women), or <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal: <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">Nonspecific</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, ascites.</li>\n<li>Systemic: Fever.</li>\n<li>Complication: Coexistence with <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> complicates diagnosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paracentesis: Reveals <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> fluid with high protein content and lymphocytic <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> (neutrophils may predominate at times).</li>\n<li>Direct Smear/Culture: Low yield; culturing large volumes of <span class=\"customMeta\" data-dictid=\"2a9ff5941c1692777182f4c00d6f69\">ascitic fluid</span> may improve results.</li>\n<li>Peritoneal Biopsy: Typically needed for diagnosis, best obtained via laparoscopy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical intervention may be required for diagnosis and management in many cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-year-old boy presents with fever and pleuritic chest pain. Chest X-ray shows a small calcified lesion in the lower right lung and enlarged hilar lymph nodes. He also has a rash on his legs resembling erythema nodosum. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute bacterial pneumonia", "correct": false}, {"label": "B", "text": "Primary pulmonary tuberculosis", "correct": true}, {"label": "C", "text": "Cystic fibrosis", "correct": false}, {"label": "D", "text": "Viral lower respiratory tract infection", "correct": false}], "correct_answer": "B. Primary pulmonary tuberculosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:712px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Primary TB - Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB occurs shortly after initial TB infection; common in children in high-transmission areas. May be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or mildly symptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Occasionally, pleuritic chest pain</li>\n<li>Skin manifestations: <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> nodosum (legs) or phlyctenular conjunctivitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">Lesion</span> (Ghon Focus)</strong>: The initial <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> typically forms in the middle or lower lung zones, often <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> with <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> hilar/paratracheal lymphadenopathy.</li>\n<li><strong>Ghon Complex:</strong> Combination of Ghon focus, pleural reaction, and regional lymphadenopathy; may heal and <strong>calcify </strong>over time. The calcified <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> is called Ranke complex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">Immunocompromised</span> Individuals (e.g., young children, HIV+ patients):</li>\n<li>Lesion <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> with potential <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"6e3d0adac31692777183113e8b2e05\">cavitation</span> (progressive primary TB).</li>\n<li>Pleural Effusion: <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">Bacilli</span> may penetrate pleural space from <span class=\"customMeta\" data-dictid=\"6136118183169277719961922f8790\">subpleural</span> focus; seen in up to two-thirds of severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lymphadenopathy</strong>: Enlarged hilar/paratracheal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes can <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> bronchi, causing:</li>\n<li>Bronchial <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and lung collapse</li>\n<li>Partial <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> with wheezing</li>\n<li>Segmental/lobar <span class=\"customMeta\" data-dictid=\"301f9a675d16927771892fb39029d3\">hyperinflation</span> <strong>(ball-valve effect)</strong>.</li>\n<li>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> may lead to necrotic <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> and <span class=\"customMeta\" data-dictid=\"6e3d0adac31692777183113e8b2e05\">cavitation</span> in <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> airways.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bronchiectasis</strong>: May develop in areas affected by progressive caseating pneumonia.</li>\n<li><strong>Dissemination</strong>: <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">Hematogenous</span> spread can lead to:</li>\n<li><strong>Miliary </strong>Disease: Multiple <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> lesions in organs.</li>\n<li><strong>TB Meningitis</strong>: Particularly in young children and <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> individuals.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which finding is not typically present in primary tuberculosis?", "options": [{"label": "A", "text": "Hilar lymphadenopathy", "correct": false}, {"label": "B", "text": "Perihilar infiltrate", "correct": false}, {"label": "C", "text": "Non-caseating granuloma", "correct": true}, {"label": "D", "text": "Pleural effusion", "correct": false}], "correct_answer": "C. Non-caseating granuloma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Jp37pWO5h3ksSiRaBG3l1746007981.png", "https://image.prepladder.com/notes/oGjeQH4gh7jws2pQ6FsX1745578424.png", "https://image.prepladder.com/notes/i3Zr1bMDkUOdWRQgbhTw1745578502.png", "https://image.prepladder.com/notes/JYW5IXqK9aIuTlDhwc2X1744375808.png", "https://image.prepladder.com/notes/EqB85UBgByAASLrvHaTz1746008173.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hilar lymphadenopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in primary TB, especially in children. Enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes near the lung <span class=\"customMeta\" data-dictid=\"4fe753e1a91692777189b7bdb3e2e1\">hilum</span> are often seen on imaging.</p>\n<figure class=\"caption_element\"><img alt=\"Hilar lymphadeonopathy\" data-author=\"Basem Abbas Al Ubaidi\" data-hash=\"11461\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Chest_x-ray_of_bilateral_hilar_adenopathy_of_primary_pulmonary_tuberculosis.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/Jp37pWO5h3ksSiRaBG3l1746007981.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perihilar infiltrate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequently observed; represents primary infection near the <span class=\"customMeta\" data-dictid=\"4fe753e1a91692777189b7bdb3e2e1\">hilum</span> and surrounding lung tissue.</p>\n<p style=\"text-align:center\"><img alt=\"Right &lt;span class=\" custommeta\"=\"\" data-dictid=\"b78b1bdf6c1692777195170be3d18f\"/>perihilar infiltrates.png\" data-author=\"\" data-hash=\"9398\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/a4uh1Bb6kZ9aca0PS2pv1744375310.png\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pleural effusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present in cases of primary TB, especially in adolescents and young adults, due to pleural inflammation.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"TB Left Pleural Effusion\" data-author=\"Basem Abbas Al Ubaidi\" data-hash=\"11294\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pleural_effusion_of_primary_pulmonary_tuberculosis.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/oGjeQH4gh7jws2pQ6FsX1745578424.png\">\n<figcaption>{{caption_text}}</figcaption>\n</img></figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cavity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cavitary lesions are more characteristic of <span class=\"customMeta\" data-dictid=\"eee52fe3cc16927771970c8dffdfd2\">reactivation</span> (post-primary) TB rather than primary TB.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"TB CAVITY\" data-author=\"US Federal Government\" data-hash=\"11295\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:TB_CXR.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/i3Zr1bMDkUOdWRQgbhTw1745578502.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Snowstorm appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This refers to <span class=\"customMeta\" data-dictid=\"de0ef5a95116927771922f41d2b8b5\">miliary</span> TB, which shows numerous tiny nodules scattered throughout the lungs. It’s seen in <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> TB rather than in <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> primary TB.</p>\n<p style=\"text-align:center\"><img alt=\"Miliary TB.png\" data-author=\"\" data-hash=\"9400\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/JYW5IXqK9aIuTlDhwc2X1744375808.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ghon Complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consists of a combination of a <span class=\"customMeta\" data-dictid=\"881b7758221692777188581e24b00a\">Ghon focus</span> (a primary <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in the lung) and involved regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes (usually hilar <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes).</li>\n<li>Located in the lower part of the upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> or the upper part of the lower <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the lung.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Ghon complex\" data-author=\"Basem Abbas Al Ubaidi\" data-hash=\"11462\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Chest_x-ray_of_Ghon%27s_complex_of_active_tuberculosis.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/EqB85UBgByAASLrvHaTz1746008173.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the pathophysiology of postprimary tuberculosis, which of the following immunological events is most critical for the development of cavitary lesions in the lung apices and how does it contribute to tissue destruction?", "options": [{"label": "A", "text": "Activation of B cells leads to antibody production, which facilitates phagocytosis of M. tuberculosis.", "correct": false}, {"label": "B", "text": "Release of IL-4 and IL-10 from T-helper cells, promoting a Th2 response that leads to fibrosis and walling off of the infection.", "correct": false}, {"label": "C", "text": "Secretion of TNF-α and IFN-γ by activated T cells, resulting in macrophage activation and the subsequent formation of caseous necrosis.", "correct": true}, {"label": "D", "text": "Induction of a robust innate immune response mediated by neutrophils, resulting in rapid clearance of bacteria and prevention of necrosis.", "correct": false}], "correct_answer": "C. Secretion of TNF-α and IFN-γ by activated T cells, resulting in macrophage activation and the subsequent formation of caseous necrosis.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reactivation of <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">Latent</span> Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>After the primary infection, TB <strong>bacilli can become <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> within granulomas</strong> formed in the lungs or <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes. These granulomas help contain the infection but <strong>do not eliminate it.</strong></li>\n<li>The bacteria can remain <span class=\"customMeta\" data-dictid=\"ea2c7a14ba1692777186a074b34ee8\">dormant</span> for years in this <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> state. <strong>Reactivation occurs when the host's <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> is weakened</strong>, which can be due to factors such as <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> conditions (HIV, diabetes, malnutrition)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immune Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Upon reactivation, a <strong>cell-mediated immune response</strong> is triggered, primarily involving <span class=\"customMeta\" data-dictid=\"9f1d97eb2b1692777200b3926afd54\">T lymphocytes</span> (CD4+ and CD8+ T cells).</li>\n<li>Activated T cells release cytokines like interferon-gamma (IFN-γ), which activates macrophages, enhancing their ability to kill <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> bacteria.</li>\n<li>Despite this response, the <strong>immune system may fail to contain the bacteria, leading to continued replication.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granuloma Formation and <span class=\"customMeta\" data-dictid=\"99368d5fef1692777183ea405bed67\">Caseous</span> Necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The reactivated <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> can cause <strong>caseous necrosis</strong> within the granulomas, characterised by the destruction of lung tissue and the formation of a necrotic centre.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> leads to the formation of <strong>cavitary lesions,</strong> especially in the <strong>lung apices,</strong> where oxygen levels are higher, favouring the growth of M. tuberculosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cavitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs in the <strong>apices of the lungs or <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> segments of the lower lobes.</strong></li>\n<li>As the necrotic tissue liquefies, cavities develop in the lung parenchyma. These cavities provide a nutrient-rich environment for the bacteria, allowing them to proliferate.</li>\n</ul>\n<ul>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"9d83c734af1692777183d57cd5ada7\">cavitary</span> lesions and ongoing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> can lead to the destruction of lung tissue and <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> of lung function.</li>\n<li>In some cases, the <strong>infection can spread hematogenously, leading to <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB, affecting other organs like the kidneys, bones, and central nervous system.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following matches the type of tuberculosis focus with its correct location? Type of TB Focus Location 1. Assman Focus a. Subpleural 2. Ghon Focus b. Infraclavicular 3. Puhl Lesion c. Supraclavicular 4. Rich Focus d. Brain", "options": [{"label": "A", "text": "1-b, 2-a, 3-c, 4-d", "correct": true}, {"label": "B", "text": "1-a, 2-c, 3-d, 4-b", "correct": false}, {"label": "C", "text": "1-c, 2-d ,3-a, 4-b", "correct": false}, {"label": "D", "text": "1-d, 2-b, 3-c, 4-a", "correct": false}], "correct_answer": "A. 1-b, 2-a, 3-c, 4-d", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:267px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of TB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Focus Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assman Focus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infraclavicular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ghon Focus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subpleural</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Puhl Lesion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supraclavicular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rich Focus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brain</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:596px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Focus/Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ghon Focus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location</strong>: Lower part of the upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> or upper part of the lower <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the lung, typically subpleural.</li>\n<li>The initial area of infection in primary TB appears as a <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> lesion. When combined with <strong>lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement,</strong> it forms the <strong>Ghon complex.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simon Focus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location</strong>: <span class=\"customMeta\" data-dictid=\"37e7c553a216927771814a90e4edcd\">Apices</span> of the lungs.</li>\n<li>A small <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">nodular</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> forms in the lung <span class=\"customMeta\" data-dictid=\"37e7c553a216927771814a90e4edcd\">apices</span> due to the <span class=\"customMeta\" data-dictid=\"eee52fe3cc16927771970c8dffdfd2\">reactivation</span> of <span class=\"customMeta\" data-dictid=\"ea2c7a14ba1692777186a074b34ee8\">dormant</span> TB bacteria.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Assmann Focus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location</strong>: Infraclavicular</li>\n<li>It is <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to cavitation, leading to potential bacterial spread and transmission.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weigert Focus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location</strong>: In the lung tissue near blood vessels.</li>\n<li>Occurs due to <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> (blood-borne) spread of TB, creating lesions along the <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> pathways. Weigart focus is often seen in <span class=\"customMeta\" data-dictid=\"de0ef5a95116927771922f41d2b8b5\">miliary</span> or <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rich Focus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location</strong>: Brain or meninges.</li>\n<li>A site of TB infection within the central nervous system, which can rupture, leading to <span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\">tuberculous</span> meningitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ranke Complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location</strong>: Typically in the lung <span class=\"customMeta\" data-dictid=\"37e7c553a216927771814a90e4edcd\">apices</span> with calcified <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the hilum.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"7174662b761692777197b45dfae193\">Ranke complex</span> consists of a calcified <span class=\"customMeta\" data-dictid=\"881b7758221692777188581e24b00a\">Ghon focus</span> and involved <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, indicating old, inactive TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Puhl <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location</strong>: Most commonly found in the <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> region, which is significant as this location can indicate the spread of TB from the lungs or other primary sites of infection.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary purpose of Interferon-gamma release assays (IGRAs) to tuberculosis?", "options": [{"label": "A", "text": "To confirm active TB disease", "correct": false}, {"label": "B", "text": "To diagnose latent TB infection", "correct": true}, {"label": "C", "text": "To monitor treatment response", "correct": false}, {"label": "D", "text": "To assess the severity of lung disease", "correct": false}], "correct_answer": "B. To diagnose latent TB infection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes the principle behind the LAMP test?", "options": [{"label": "A", "text": "Amplifying RNA to detect TB", "correct": false}, {"label": "B", "text": "Isothermal amplification of DNA at a constant temperature", "correct": true}, {"label": "C", "text": "PCR amplification with thermal cycling", "correct": false}, {"label": "D", "text": "Culture growth of Mycobacterium tuberculosis", "correct": false}], "correct_answer": "B. Isothermal amplification of DNA at a constant temperature", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sputum <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial screening for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB.</p>\n<p>Samples are stained using the Ziehl-Neelsen method or Auramine-O <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB) under a microscope.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quick and inexpensive. Can provide results within a few hours.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low sensitivity, especially in cases of <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB or in patients with HIV.</p>\n<p>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and non-tuberculous <span class=\"customMeta\" data-dictid=\"46f768d2e41692777193d69cbc7eec\">mycobacteria</span> (NTM).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirm the diagnosis of TB and assess drug susceptibility.</p>\n<p><strong>Solid Media:</strong> <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">Sputum</span> is inoculated onto solid culture media like <strong>Löwenstein-Jensen </strong>or Middlebrook agar.</p>\n<p><strong>Liquid Media: </strong>Automated systems like <strong>BACTEC or MGIT</strong> are used to detect growth faster.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The gold standard for TB diagnosis.</p>\n<p>Allows for drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Time-consuming; results can take weeks.</p>\n<p>Requires specialized laboratory facilities.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Xpert MTB/RIF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</p>\n<p><strong>Method</strong>:</p>\n<p>A cartridge-based system that performs <span class=\"customMeta\" data-dictid=\"6483f3ef3116927771935d328a8ab2\">nucleic acid</span> <span class=\"customMeta\" data-dictid=\"13e14b31b21692777181520d7c651c\">amplification</span> (NAAT).</p>\n<p>Sputum or other specimens are processed directly in the cartridge.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid results (within 2 hours).</p>\n<p>High sensitivity and specificity.</p>\n<p>Simultaneously detects <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More expensive than <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> microscopy.</p>\n<p>Does not provide full drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LAMP (Loop-Mediated Isothermal Amplification)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects DNA of <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> tuberculosis.</p>\n<p><strong>Method</strong>:</p>\n<p>Amplifies DNA at a constant temperature without the need for <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> cycling.</p>\n<p>Sputum or other specimens are used.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid results (within 1-2 hours).</p>\n<p>High <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> and sensitivity.</p>\n<p>Can be performed at the point of care.</p>\n<p>Used for patients with <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> with CD4+ counts of less than 100 cells/μL irrespective of signs and symptoms of TB.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less widely available than PCR-based tests.</p>\n<p>Cannot detect <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> directly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TrueNat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Point-of-care test for TB detection.</p>\n<p><strong>Method</strong>:</p>\n<p>Uses a micro-PCR technology to amplify DNA.</p>\n<p>Results are available within 60 minutes.</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Portable and easy to use in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> health facilities.</p>\n<p>Provides results quickly, facilitating immediate treatment decisions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Line <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">Probe</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">Assay</span> (LPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects TB and <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> (rifampicin and isoniazid).</p>\n<p><strong>Method</strong>:</p>\n<p>Sputum samples are processed, and DNA is extracted.</p>\n<p>Amplified DNA is hybridized to specific probes on a <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> strip.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid results (within 1-2 days).</p>\n<p>Can detect multiple mutations associated with drug resistance.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires a laboratory <span class=\"customMeta\" data-dictid=\"3a6d14db861692777198565f57828c\">setup</span> and trained personnel.</p>\n<p>Not suitable for all strains of TB.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RFLP</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IS6110 <span class=\"customMeta\" data-dictid=\"3668babc2b169277719777e6f04c66\">restriction fragment</span> length <span class=\"customMeta\" data-dictid=\"15d98152c61692777196a0f2fb42a0\">polymorphism</span> (RFLP)</strong> analysis is widely used for molecular epidemiological studies of tuberculosis. Restriction enzymes Nru I, EcoN I, Pst I, and Pvu II were used to analyze IS6110 fingerprints in <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> strains H37Rv (virulent) and H37Ra (avirulent).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old man with advanced HIV infection (CD4 count of 50 cells/mm³) is diagnosed with pulmonary tuberculosis (TB) and started on anti-tuberculosis treatment. Two weeks later, he initiated antiretroviral therapy (ART). After 3 weeks on ART, he returns to the clinic complaining of worsening cough, fever and night sweats. Physical examination reveals enlarged cervical lymph nodes and increased lung crackles on auscultation. His viral load has dropped significantly, but his CD4 count remains low. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Drug-resistant TB", "correct": false}, {"label": "B", "text": "Immune reconstitution inflammatory syndrome (IRIS)", "correct": true}, {"label": "C", "text": "ART toxicity", "correct": false}, {"label": "D", "text": "New opportunistic infection", "correct": false}], "correct_answer": "B. Immune reconstitution inflammatory syndrome (IRIS)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the drugs used in the initial treatment of tuberculosis with their dosage. Drugs Dosage (mg/kg) a.Isoniazid i.10 b.Rifampicin ii.15 c.Pyrazinamide iii.5 d.Ethambutol iv.25", "options": [{"label": "A", "text": "a-iii,b-i,c-iv,d-ii", "correct": true}, {"label": "B", "text": "a-i,b-ii,c-iii,d-iv", "correct": false}, {"label": "C", "text": "a-iv,b-iii,c-ii,d-i", "correct": false}, {"label": "D", "text": "a-ii,b-iii,c-iv,d-i", "correct": false}], "correct_answer": "A. a-iii,b-i,c-iv,d-ii", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dose </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of action </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isoniazid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 mg/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibiting the <span class=\"customMeta\" data-dictid=\"859a34e1061692777183872a5e4441\">biosynthesis</span> of mycolic acid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rifampicin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 mg/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibiting DNA-dependent <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> polymerase, which further inhibits bacterial protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> and transcription.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pyrazinamide</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>25 mg/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibiting trans-translation and possibly <span class=\"customMeta\" data-dictid=\"cf1469795816927771840da7c58a72\">coenzyme</span> A <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> is needed for the bacteria to survive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ethambutol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15 mg/kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> arabinosyltransferases and prevents the <span class=\"customMeta\" data-dictid=\"859a34e1061692777183872a5e4441\">biosynthesis</span> of the mycobacterial cell wall.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of the shorter MDR-TB regimen?", "options": [{"label": "A", "text": "6 months of levofloxacin", "correct": false}, {"label": "B", "text": "5 months of clofazimine", "correct": false}, {"label": "C", "text": "5 months of ethambutol", "correct": false}, {"label": "D", "text": "5 months of isoniazid", "correct": true}], "correct_answer": "D. 5 months of isoniazid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MDR-TB patients without extensive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> or severe <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> disease</p>\n<p>No history of second-line drug use</p>\n<p>No <span class=\"customMeta\" data-dictid=\"f4975edd0b1692777203b54cf45c2d\">fluoroquinolone</span> resistance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recommended Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months of bedaquiline, <span class=\"customMeta\" data-dictid=\"938a61d0181692777191d07720a9c2\">levofloxacin</span> (or moxifloxacin)<strong> (Option A ruled out)</strong>, ethionamide, ethambutol, pyrazinamide, high-dose <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">isoniazid</span> <strong>(Option D)</strong>, clofazimine</p>\n<p>Followed by 5 months of <span class=\"customMeta\" data-dictid=\"938a61d0181692777191d07720a9c2\">levofloxacin</span> (or moxifloxacin), clofazimine<strong>(Option B ruled out)</strong>, pyrazinamide, and ethambutol <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prioritize <span class=\"customMeta\" data-dictid=\"a9f32a257d1692777194caf3b4cf78\">outpatient</span> care with adequate support when stable</p>\n<p>Hospitalization if necessary</p>\n<p>Respiratory infection control is essential</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 41-year-old man with a history of night sweats, fever, and weight loss presents with anal fistulae. Physical examination and imaging suggest an abscess near the rectum. Which diagnostic step should be prioritized to investigate a possible cause?", "options": [{"label": "A", "text": "Evaluation for rectal tuberculosis", "correct": true}, {"label": "B", "text": "Screening for Crohn’s disease", "correct": false}, {"label": "C", "text": "Colonoscopy with biopsy for malignancy", "correct": false}, {"label": "D", "text": "Culture and sensitivity of fistula discharge", "correct": false}], "correct_answer": "A. Evaluation for rectal tuberculosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gastrointestinal Tuberculosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanisms of Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Swallowing</strong> of <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> with direct seeding.</li>\n<li><strong>Hematogenous spread.</strong></li>\n<li><strong>Ingestion </strong>of contaminated <span class=\"customMeta\" data-dictid=\"6c086f82651692777183dedda5f99a\">bovine</span> milk (common in developing areas).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common sites of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Terminal <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> and cecum.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Abdominal:</strong> Pain (similar to appendicitis), swelling, obstruction, hematochezia, <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass.</li>\n<li><strong>Systemic: </strong>Fever, weight loss, anorexia, night sweats.</li>\n<li><strong>Complications: </strong>Ulcerations and <span class=\"customMeta\" data-dictid=\"cf1ebb699b16927772024941e0cdad\">fistulae</span> (mimicking Crohn’s disease); anal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> suggests rectal TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery is required to obtain <span class=\"customMeta\" data-dictid=\"a77eb309ca16927771897b99ead59f\">histologic</span> and culture specimens intraoperatively.</li>\n<li>Differential Diagnosis: Difficult to distinguish from Crohn’s disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 34 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Respiratory distress syndrome is due to the deficiency of?", "options": [{"label": "A", "text": "Dipalmitoyl Phosphatidylcholine", "correct": true}, {"label": "B", "text": "Phosphatidylserine", "correct": false}, {"label": "C", "text": "Phosphatidylethanolamine", "correct": false}, {"label": "D", "text": "Phosphatidylinositol", "correct": false}], "correct_answer": "A. Dipalmitoyl Phosphatidylcholine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phospholipids </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Synthesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phosphatidylserine </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inner <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> of the <strong>plasma membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Involved in <strong>apoptosis</strong>.</p>\n</li>\n<li>\n<p>It flips to the outer <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> of the <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> membrane, serving as a <strong>signal for phagocytes</strong> to engulf the dying cell.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Synthesized in the <strong>endoplasmic <span class=\"customMeta\" data-dictid=\"1b6498ff211692777197ae0981e366\">reticulum</span> (ER)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plays a role in <strong>blood clotting</strong> by facilitating the binding of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors.</p>\n<p>Supports neuronal function.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phosphatidylethanolamine</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>All <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> membranes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Important for<strong> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> fusion</strong> and the structural integrity of <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> membranes.</p>\n</li>\n<li>\n<p>Serves as a <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> for the <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> of phosphatidylserine.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Synthesized in the <strong>ER</strong> via the <strong>cytidine diphosphate-ethanolamine (CDP-ethanolamine) pathway</strong> or by <span class=\"customMeta\" data-dictid=\"52adc3ebf01692777185395a8b1e8c\">decarboxylation</span> of <span class=\"customMeta\" data-dictid=\"ae93185bf016927771958c234af6d9\">phosphatidylserine</span> in the mitochondria.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Plays a role in <strong>lipid metabolism</strong> and <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> dynamics.</li>\n<li>Deficiencies can impact <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> functions and are associated with various neurological disorders.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phosphatidylinositol</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>plasma <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> membranes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Involved in <strong>cell <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> pathways</strong>, particularly through the production of <strong>secondary messengers</strong></p>\n</li>\n<li>\n<p>Plays a role in <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <span class=\"customMeta\" data-dictid=\"4c550b1d7a1692777200641b5f4e28\">trafficking</span> and cytoskeletal organization.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Produced in the <strong>ER and Golgi apparatus</strong> from CDP-DAG and inositol.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Crucial for the function of <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> and other receptor-mediated <span class=\"customMeta\" data-dictid=\"28f5a05c8b1692777198471034364a\">signal transduction</span> pathways.</li>\n<li>Defects in <span class=\"customMeta\" data-dictid=\"26d585d1e41692777195144f4452a8\">phosphatidylinositol</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> are <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to various diseases, including diabetes and cancer.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The diagram below shows the pressure–volume curves for 3 different lungs. Which of the following is the best representation of compliance between the three lungs?", "options": [{"label": "A", "text": "A&amp;lt;B&amp;lt;C", "correct": false}, {"label": "B", "text": "B&amp;gt;A&amp;gt;C", "correct": true}, {"label": "C", "text": "B&amp;gt;C&amp;gt;A", "correct": false}, {"label": "D", "text": "C&amp;gt;A&amp;gt;B", "correct": false}], "correct_answer": "B. B&gt;A&gt;C", "question_images": ["https://image.prepladder.com/content/DA4kqIukUpLX12myiw9q1691490659.png"], "explanation_images": [], "explanation": "<p>Correct Option B: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the subsequent situations does oxygen therapy prove to be ineffective?", "options": [{"label": "A", "text": "Asthma", "correct": false}, {"label": "B", "text": "Acute myocardial infarction", "correct": false}, {"label": "C", "text": "Pulmonary edema", "correct": false}, {"label": "D", "text": "Central respiratory depression", "correct": true}], "correct_answer": "D. Central respiratory depression", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: Central &lt;span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\"&gt;respiratory&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In peripheral oxygen sensing chemoreceptors, which ion is implicated?", "options": [{"label": "A", "text": "Potassium", "correct": true}, {"label": "B", "text": "Calcium", "correct": false}, {"label": "C", "text": "Sodium", "correct": false}, {"label": "D", "text": "Chlorine", "correct": false}], "correct_answer": "A. Potassium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the breathing pattern of a patient with prolonged inspiratory spasms that resemble breath holding?", "options": [{"label": "A", "text": "Cheyne stokes breathing", "correct": false}, {"label": "B", "text": "Kussmaul breathing", "correct": false}, {"label": "C", "text": "Apneustic breathing", "correct": true}, {"label": "D", "text": "Biot breathing", "correct": false}], "correct_answer": "C. Apneustic breathing", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Apneustic breathing\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hypoxic Hypoxia is seen in which of the following?", "options": [{"label": "A", "text": "CO poisoning", "correct": false}, {"label": "B", "text": "HCN poisoning", "correct": false}, {"label": "C", "text": "Ischemia", "correct": false}, {"label": "D", "text": "A-V shunt", "correct": true}], "correct_answer": "D. A-V shunt", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Type of Hypoxia</strong></p>\n</td>\n<td>\n<p><strong>Etiology</strong></p>\n</td>\n<td>\n<p><strong>Examples</strong></p>\n</td>\n<td>\n<p><strong>PaCO2</strong></p>\n</td>\n<td>\n<p><strong>PaO2</strong></p>\n</td>\n<td>\n<p><strong>Cyanosis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hypoxic Hypoxia</p>\n</td>\n<td>\n<p>Inadequate oxygen supply or impaired utilization</p>\n</td>\n<td>\n<p>High altitude, <span class=\"customMeta\" data-dictid=\"44758fcec31692777184e24fa84582\">CO</span> poisoning, HCN poisoning, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> diseases</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n<td>\n<p>Low</p>\n</td>\n<td>\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anemic Hypoxia</p>\n</td>\n<td>\n<p>Reduced oxygen-carrying capacity of blood</p>\n</td>\n<td>\n<p>Anemia, blood loss, hemoglobinopathies, <span class=\"customMeta\" data-dictid=\"bb021d26d3169277718336718849a5\">carbon monoxide</span> poisoning</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n<td>\n<p>Low</p>\n</td>\n<td>\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stagnant Hypoxia</p>\n</td>\n<td>\n<p>Impaired <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> or <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> circulation</p>\n</td>\n<td>\n<p>Heart failure, shock, <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> disorders, vasoconstriction</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n<td>\n<p>Low</p>\n</td>\n<td>\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Histotoxic Hypoxia</p>\n</td>\n<td>\n<p>Inability of cells to utilize oxygen effectively due to toxic substances or <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders</p>\n</td>\n<td>\n<p>Cyanide poisoning, certain <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders</p>\n</td>\n<td>\n<p>Variable</p>\n</td>\n<td>\n<p>Variable</p>\n</td>\n<td>\n<p>May be absent or mild</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>1.</strong></p>\n</td>\n<td>\n<p><strong>Hypoxic hypoxia</strong></p>\n</td>\n<td>\n<p><strong>Low SaO2 and low SvO2 </strong></p>\n</td>\n<td>\n<p><strong>Cyanosis ++</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>2.</strong></p>\n</td>\n<td>\n<p><strong>Anemic hypoxia</strong></p>\n</td>\n<td>\n<p><strong>1. Anaemia (Low Hb)</strong></p>\n<p><strong>2. CO- <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> </strong></p>\n<p><strong>3. Meth- Hb (brown colour)</strong></p>\n</td>\n<td>\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"f3b66d8ec4169277718566066add68\">Cyanosis</span> is rare</strong></p>\n<p><strong>2. No cyanosis</strong></p>\n<p><strong>3. <span class=\"customMeta\" data-dictid=\"f3b66d8ec4169277718566066add68\">cyanosis</span> like appearance can be seen as not true cyanosis.</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>3.</strong></p>\n</td>\n<td>\n<p><strong>Stagnant <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> </strong></p>\n</td>\n<td>\n<p><strong>Very low SvO2</strong></p>\n</td>\n<td>\n<p><strong>Cyanosis ++</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>4. </strong></p>\n</td>\n<td>\n<p><strong>Histotoxic hypoxia</strong></p>\n</td>\n<td>\n<p><strong>SaO2 is Normal and high SvO2</strong></p>\n</td>\n<td>\n<p><strong>Cyanosis never seen</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the resulting lung volume if the chest wall is excluded and the lung is allowed to undergo elastic recoil?", "options": [{"label": "A", "text": "Minimum volume", "correct": true}, {"label": "B", "text": "Zero", "correct": false}, {"label": "C", "text": "Functional residual capacity", "correct": false}, {"label": "D", "text": "Residual volume", "correct": false}], "correct_answer": "A. Minimum volume", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<thead>\n<tr>\n<td>\n<p><strong>Lung Volumes</strong></p>\n</td>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Tidal Volume</p>\n</td>\n<td>\n<p>Volume of air inspired or expired during normal breathing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory Reserve Volume (IRV)</p>\n</td>\n<td>\n<p>Maximum volume of air that can be inspired above <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expiratory Reserve Volume (ERV)</p>\n</td>\n<td>\n<p>Maximum volume of air that can be expired below <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Residual Volume (RV)</p>\n</td>\n<td>\n<p>Volume of air remaining in the lungs after <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> expiration</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory Capacity</p>\n</td>\n<td>\n<p>Total volume of air that can be inspired after <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> <span class=\"customMeta\" data-dictid=\"2cbabc42d21692777187c451566867\">expiration</span> (TV + IRV)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity (FRC)</p>\n</td>\n<td>\n<p>Volume of air remaining in the lungs after a normal <span class=\"customMeta\" data-dictid=\"2cbabc42d21692777187c451566867\">expiration</span> (ERV + RV)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vital Capacity</p>\n</td>\n<td>\n<p>Maximum volume of air that can be forcefully exhaled after <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> inspiration (TV + <span class=\"customMeta\" data-dictid=\"9cea17d64b16927771905278e8ea88\">IRV</span> + ERV)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Total Lung Capacity</p>\n</td>\n<td>\n<p>Maximum volume of air the lungs can hold (TV + <span class=\"customMeta\" data-dictid=\"9cea17d64b16927771905278e8ea88\">IRV</span> + <span class=\"customMeta\" data-dictid=\"5a6905fdca16927771879daba1b8d2\">ERV</span> + RV)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Surfactant is secreted by which of the following?", "options": [{"label": "A", "text": "Type I pneumocyte", "correct": false}, {"label": "B", "text": "Type Il pneumocyte", "correct": true}, {"label": "C", "text": "Sertoli cell", "correct": false}, {"label": "D", "text": "Leydig cell", "correct": false}], "correct_answer": "B. Type Il pneumocyte", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The O 2 saturation with respect to PO₂ is marked as A. What happens to the Oxygen Hb dissociation curve upon transfusion of stored RBC?", "options": [{"label": "A", "text": "B", "correct": true}, {"label": "B", "text": "C", "correct": false}, {"label": "C", "text": "D", "correct": false}, {"label": "D", "text": "E", "correct": false}], "correct_answer": "A. B", "question_images": ["https://image.prepladder.com/content/XBB771OTEJjaV8txFlKz1741774793.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effect on O₂ <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">Dissociation</span> Curve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Impact</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low 2,3-BPG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Leftward shift (B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased O₂ affinity, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> unloading</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rightward shift</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enhances oxygen unloading</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leftward shift</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases oxygen binding</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypercapnia (↑ CO₂)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rightward shift</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enhances oxygen release</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypothermia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leftward shift</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreases oxygen unloading</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following situations is the equation V/Q = infinity accurate?", "options": [{"label": "A", "text": "Foreign body obstruction in the bronchus", "correct": false}, {"label": "B", "text": "Equal to dead space", "correct": true}, {"label": "C", "text": "When O2 and CO2 ratio is equal", "correct": false}, {"label": "D", "text": "The PO2 of alveolar air is 159 mmHg and PCO2 is 40 mmHg", "correct": false}], "correct_answer": "B. Equal to dead space", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent factors experiences an elevation in chronic obstructive pulmonary disease (COPD)? 1. FRC 2. TLC 3. VC 4. FEV1/FVC", "options": [{"label": "A", "text": "1 only", "correct": false}, {"label": "B", "text": "1 and 4", "correct": false}, {"label": "C", "text": "1 and 3", "correct": false}, {"label": "D", "text": "1 and 2", "correct": true}], "correct_answer": "D. 1 and 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/MMmpiPJuFnbwr2hG0Ikf1746601233.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Flow-volume parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Obstructive lung disease(e.g.COPD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Restrictive lung disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>RV (Residual Volume)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>FRC (Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>TLC (Total Lung Capacity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>FEV₁</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↓↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>FVC (Forced Vital Capacity)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>FEV₁/FVC Ratio</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">Normal or ↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Key insight</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">FEV₁ decreased more than FVC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\">FEV₁ decreased proportionately to FVC</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Determine the respiratory quotient (RQ) of a patient weighing 50 kg who exhales 200 ml/min of CO 2 and consumed 250 ml/min 02 .", "options": [{"label": "A", "text": "0.8", "correct": true}, {"label": "B", "text": "1", "correct": false}, {"label": "C", "text": "1.25", "correct": false}, {"label": "D", "text": "1.5", "correct": false}], "correct_answer": "A. 0.8", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During exercise, once a state of balance is achieved, it was observed that the body's oxygen consumption rate was 1500 ml/min. To determine the MET score, consider a baseline oxygen consumption rate of 250 ml/min.", "options": [{"label": "A", "text": "5", "correct": false}, {"label": "B", "text": "6", "correct": true}, {"label": "C", "text": "1/5", "correct": false}, {"label": "D", "text": "1/6", "correct": false}], "correct_answer": "B. 6", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which ion is primarily involved in the function of O2-sensitive channels in peripheral chemoreceptors?", "options": [{"label": "A", "text": "Potassium (K+)", "correct": true}, {"label": "B", "text": "Sodium (Na+)", "correct": false}, {"label": "C", "text": "Bicarbonate (HCO3-)", "correct": false}, {"label": "D", "text": "Chloride (Cl-)", "correct": false}], "correct_answer": "A. Potassium (K+)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Peripheral chemoreceptors are most sensitive to?", "options": [{"label": "A", "text": "Hypercapnia", "correct": false}, {"label": "B", "text": "Hypoxia", "correct": true}, {"label": "C", "text": "Acidosis", "correct": false}, {"label": "D", "text": "Alkalosis", "correct": false}], "correct_answer": "B. Hypoxia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fw9trWN2MZkr7Tegewse1741774859.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stimulus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effect on <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">Peripheral</span> Chemoreceptors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypoxia (↓ PaO₂)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Strongest stimulus</strong>, leading to increased ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypercapnia (↑ PaCO₂)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weak response; <span class=\"customMeta\" data-dictid=\"579693a0121692777184c972741ee0\">central chemoreceptors</span> dominate.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acidosis (↓ pH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peripheral response occurs, but <span class=\"customMeta\" data-dictid=\"579693a0121692777184c972741ee0\">central chemoreceptors</span> are more significant.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkalosis (↑ pH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal effect; detected mainly by central chemoreceptors.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Physiological dead space?", "options": [{"label": "A", "text": "Can be measured by spirometry", "correct": false}, {"label": "B", "text": "Is lesser than anatomical dead space", "correct": false}, {"label": "C", "text": "Represents inadequately ventilated alveoli", "correct": false}, {"label": "D", "text": "Represents inadequately perfused alveoli", "correct": true}], "correct_answer": "D. Represents inadequately perfused alveoli", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Concept</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Dead Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conducting airways where no gas exchange occurs (e.g., trachea, bronchi).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alveolar Dead Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alveoli that are ventilated but <strong>not perfused</strong>, contributing to wasted ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physiological Dead Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sum of <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> and alveolar dead space; reflects ineffective ventilation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1%. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Chronic Obstructive Pulmonary Disease (COPD)", "correct": true}, {"label": "B", "text": "Pulmonary Fibrosis", "correct": false}, {"label": "C", "text": "Interstitial Lung Disease", "correct": false}, {"label": "D", "text": "Asthma", "correct": false}], "correct_answer": "A. Chronic Obstructive Pulmonary Disease (COPD)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following has the highest airway resistance?", "options": [{"label": "A", "text": "Alveolar duct", "correct": false}, {"label": "B", "text": "Bronchi", "correct": true}, {"label": "C", "text": "Respiratory bronchioles", "correct": false}, {"label": "D", "text": "Small bronchioles", "correct": false}], "correct_answer": "B. Bronchi", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Carbon monoxide causes which type of hypoxia?", "options": [{"label": "A", "text": "Anemic hypoxia", "correct": true}, {"label": "B", "text": "Hypoxic hypoxia", "correct": false}, {"label": "C", "text": "Stagnant hypoxia", "correct": false}, {"label": "D", "text": "Histotoxic hypoxia", "correct": false}], "correct_answer": "A. Anemic hypoxia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jxEJ0KNLfkxGSBGStBBK1745215180.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked region in the given spirometry.", "options": [{"label": "A", "text": "Functional residual capacity", "correct": true}, {"label": "B", "text": "Tidal volume", "correct": false}, {"label": "C", "text": "Expiratory reserve volume", "correct": false}, {"label": "D", "text": "Inspiratory reserve volume", "correct": false}], "correct_answer": "A. Functional residual capacity", "question_images": ["https://image.prepladder.com/notes/U3bYWwE9VlTdXxMdNwa31745906236.png"], "explanation_images": ["https://image.prepladder.com/content/NDZfOxHwnGn14hW0tsfT1747629365.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lung Volume/Capacity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Typical Volume (mL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Formula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tidal Volume (TV) </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amount of air inhaled or exhaled during normal breath</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>500</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inspiratory Reserve Volume (IRV) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Additional air that can be inhaled after a normal inhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3000</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Expiratory Reserve Volume (ERV) </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Additional air that can be exhaled after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1200</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Residual Volume (RV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Air remaining in the lungs after a <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1200</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Dead Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Volume of air in conducting airways where no gas exchange occurs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>150</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total Lung Capacity (TLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maximum amount of air the lungs can hold</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6000</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TLC = TV + IRV + <span class=\"customMeta\" data-dictid=\"5a6905fdca16927771879daba1b8d2\">ERV</span> + RV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vital Capacity (VC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maximum air exhaled after a <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> inhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4800</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>VC = TV + IRV + ERV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inspiratory Capacity (IC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maximum air inhaled after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3500</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IC = TV + IRV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity (FRC) </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Air remaining in the lungs after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2400</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FRC = <span class=\"customMeta\" data-dictid=\"5a6905fdca16927771879daba1b8d2\">ERV</span> + RV</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A preterm baby who was delivered at 28 weeks developed respiratory distress syndrome. Which of the following is true about surface tension and compliance in this baby?", "options": [{"label": "A", "text": "Surface tension - decreased; Compliance - increased", "correct": false}, {"label": "B", "text": "Surface tension - increased; Compliance decreased", "correct": true}, {"label": "C", "text": "Both surface tension and compliance decreased", "correct": false}, {"label": "D", "text": "Both surface tension and compliance increased", "correct": false}], "correct_answer": "B. Surface tension - increased; Compliance decreased", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions will shift the oxygen-Hb dissociation curve to the left?", "options": [{"label": "A", "text": "Hypoxia", "correct": false}, {"label": "B", "text": "Hypercarbia", "correct": false}, {"label": "C", "text": "Alkalosis", "correct": true}, {"label": "D", "text": "Increase in 2,3-DPG", "correct": false}], "correct_answer": "C. Alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the lungs, which type of cells are responsible for the secretion of surfactant?", "options": [{"label": "A", "text": "Type 1 pneumocyte", "correct": false}, {"label": "B", "text": "Alveolar macrophage", "correct": false}, {"label": "C", "text": "Dust cells", "correct": false}, {"label": "D", "text": "Type 2 pneumocyte", "correct": true}], "correct_answer": "D. Type 2 pneumocyte", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following methods is used for calculation of anatomical dead space ?", "options": [{"label": "A", "text": "Multiple breath nitrogen test", "correct": false}, {"label": "B", "text": "Bohr’s method", "correct": false}, {"label": "C", "text": "Spirometry", "correct": false}, {"label": "D", "text": "Single breath nitrogen test", "correct": true}], "correct_answer": "D. Single breath nitrogen test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Single breath &lt;span class=\"customMeta\" data-dictid=\"391d32291016927771932bab695579\"&gt;nitrogen&lt;/span&gt; test: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the least likely condition to happen if a group of colleagues took an excursion to a high altitude-mountain region?", "options": [{"label": "A", "text": "Increase PaO2", "correct": true}, {"label": "B", "text": "Increase in RBC &amp;amp; Hb", "correct": false}, {"label": "C", "text": "Increased mitochndria", "correct": false}, {"label": "D", "text": "Hyperventilation", "correct": false}], "correct_answer": "A. Increase PaO2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Increase PaO2: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Adequate oxygen delivery at cellular level is present in which type of hypoxia ?", "options": [{"label": "A", "text": "Anemic", "correct": false}, {"label": "B", "text": "Stagnant", "correct": false}, {"label": "C", "text": "Hypoxic", "correct": false}, {"label": "D", "text": "Histotoxic", "correct": true}], "correct_answer": "D. Histotoxic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - H\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Adequate O 2 oxygen delivery at cellular level occurs in which type of hypoxia?", "options": [{"label": "A", "text": "Hypoxic", "correct": false}, {"label": "B", "text": "Anaemic", "correct": false}, {"label": "C", "text": "Stagnant", "correct": false}, {"label": "D", "text": "Histotoxic", "correct": true}], "correct_answer": "D. Histotoxic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - H\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Hypoxia</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hypoxic Hypoxia</p>\n</td>\n<td>\n<p>Decreased inspired oxygen or impaired gas exchange in lungs</p>\n</td>\n<td>\n<p>Insufficient <span class=\"customMeta\" data-dictid=\"c07e2d09e9169277719405252db970\">oxygen tension</span> in arterial blood</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anaemic Hypoxia</p>\n</td>\n<td>\n<p>Decreased oxygen-carrying capacity of blood</p>\n</td>\n<td>\n<p>Reduced <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> levels or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> function</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stagnant Hypoxia</p>\n</td>\n<td>\n<p>Impaired blood circulation</p>\n</td>\n<td>\n<p>Reduced <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Histotoxic Hypoxia</p>\n</td>\n<td>\n<p>Cellular inability to utilize oxygen</p>\n</td>\n<td>\n<p>Disruption in the <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> process</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following breathing patterns have prolonged inspiratory spasms that resemble breath-holding ?", "options": [{"label": "A", "text": "Biot breathing", "correct": false}, {"label": "B", "text": "Apneustic breathing", "correct": true}, {"label": "C", "text": "Cheyne stokes breathing", "correct": false}, {"label": "D", "text": "Kussmaul breathing", "correct": false}], "correct_answer": "B. Apneustic breathing", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Apneustic breathing: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Functional residua l capacity is:", "options": [{"label": "A", "text": "Volume expired after normal inspiration", "correct": false}, {"label": "B", "text": "Volume that remains after forced expiration", "correct": false}, {"label": "C", "text": "Expiratory reserve volume + residual volume", "correct": true}, {"label": "D", "text": "Tidal volume + inspiratory reserve volume", "correct": false}], "correct_answer": "C. Expiratory reserve volume + residual volume", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Expiratory reserve volume + &lt;span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\"&gt;residual&lt;/span&gt; volume: \n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Lung Volume/Capacity</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Typical Value (in adults)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tidal Volume (TV)</p>\n</td>\n<td>\n<p>Volume of air inhaled or exhaled during normal breathing</p>\n</td>\n<td>\n<p>500 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory Reserve Volume (IRV)</p>\n</td>\n<td>\n<p>Additional volume of air that can be inhaled after a normal <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> inspiration</p>\n</td>\n<td>\n<p>2,500-3,000 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expiratory Reserve Volume (ERV)</p>\n</td>\n<td>\n<p>Additional volume of air that can be exhaled after a normal <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> expiration</p>\n</td>\n<td>\n<p>1,000-1,200 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Residual Volume (RV)</p>\n</td>\n<td>\n<p>Volume of air remaining in the lungs after <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> expiration</p>\n</td>\n<td>\n<p>1,200-1,300 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Total Lung Capacity (TLC)</p>\n</td>\n<td>\n<p>Maximum volume of air the lungs can hold, including inspiratory reserve volume, <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume, <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> reserve volume, and <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> volume</p>\n</td>\n<td>\n<p>5,000-6,000 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vital Capacity (VC)</p>\n</td>\n<td>\n<p>Maximum volume of air that can be exhaled after a <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> inspiration, including inspiratory reserve volume, <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume, and <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> reserve volume</p>\n</td>\n<td>\n<p>4,500-5,000 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity (FRC)</p>\n</td>\n<td>\n<p>Volume of air remaining in the lungs after a normal <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> expiration, including <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> reserve volume and <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> volume</p>\n</td>\n<td>\n<p>2,400-2,800 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory Capacity (IC)</p>\n</td>\n<td>\n<p>Maximum volume of air that can be inhaled after a normal <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> expiration, including <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume and inspiratory reserve volume</p>\n</td>\n<td>\n<p>3,500-3,800 mL</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During forceful expiration, which type of neurons primarily exhibit increased firing ?", "options": [{"label": "A", "text": "Dorsal group of neurons", "correct": false}, {"label": "B", "text": "Caudal Ventral group of neurons", "correct": true}, {"label": "C", "text": "Pneumotaxic center", "correct": false}, {"label": "D", "text": "Apneustic center", "correct": false}], "correct_answer": "B. Caudal Ventral group of neurons", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\"&gt;Caudal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\"&gt;Ventral&lt;/span&gt; group of neu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the affinity of carbon monoxide to hemoglobin in comparison to oxygen ?", "options": [{"label": "A", "text": "100", "correct": false}, {"label": "B", "text": "4", "correct": false}, {"label": "C", "text": "250", "correct": true}, {"label": "D", "text": "150", "correct": false}], "correct_answer": "C. 250", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 250: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "V/Q = infinity means ____________", "options": [{"label": "A", "text": "Partial pressure of O2 becomes zero", "correct": false}, {"label": "B", "text": "No exchange of O2 &amp;amp; CO2", "correct": true}, {"label": "C", "text": "CO2 alone equilibrates with the venous blood", "correct": false}, {"label": "D", "text": "Partial pressure of both CO2 and O2 remain normal", "correct": false}], "correct_answer": "B. No exchange of O2 &amp; CO2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - No exchange of O2 &amp;amp; CO2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pacemaker generating the rhythm for breathing is ______________", "options": [{"label": "A", "text": "Pneumotaxic centre", "correct": false}, {"label": "B", "text": "Dorsal group of neurons in the medulla", "correct": false}, {"label": "C", "text": "Pre-Botziger complex", "correct": true}, {"label": "D", "text": "Apneustic centre", "correct": false}], "correct_answer": "C. Pre-Botziger complex", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Pre-Botzig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Single breath nitrogen method is used for measuring _____________", "options": [{"label": "A", "text": "Physiological dead space volume", "correct": false}, {"label": "B", "text": "Residual volume", "correct": false}, {"label": "C", "text": "Tidal volume", "correct": false}, {"label": "D", "text": "Anatomical dead space volume", "correct": true}], "correct_answer": "D. Anatomical dead space volume", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\"&gt;Anatomical&lt;/span&gt; dead space volu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 44 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 30 y/o woman presents with a persistent cough, fatigue, and painful red nodules on her lower legs. Her ACE levels were found to be elevated and her chest x-ray findings are given below. She has a family history of autoimmune diseases and carries the HLA-DRB1*03 haplotype. What pathophysiological feature is most likely contributing to her condition?", "options": [{"label": "A", "text": "Accumulation of neutrophils and eosinophils in lung tissue.", "correct": false}, {"label": "B", "text": "Interaction between antigen-presenting cells and T-helper cells leading to granuloma formation.", "correct": true}, {"label": "C", "text": "Decreased production of cytokines such as IL-2 and IFN-γ.", "correct": false}, {"label": "D", "text": "High levels of cyclosporine in the serum affecting T-cell activity.", "correct": false}], "correct_answer": "B. Interaction between antigen-presenting cells and T-helper cells leading to granuloma formation.", "question_images": ["https://image.prepladder.com/notes/lvua7WnQvMTcbFeWqKKq1744368303.png"], "explanation_images": ["https://image.prepladder.com/notes/kXZ2YzBjAzfRMih8aTJY1744368432.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents to the ED with severe chest pain and palpitations. She has a history of recurrent cough and fatigue over the past year. O/E, she has slight oedema in her lower extremities and a heart murmur. The chest X-ray of the patient is given below. Which of the following features is least likely associated with this patient's condition?", "options": [{"label": "A", "text": "Anterior uveitis leading to vision changes.", "correct": false}, {"label": "B", "text": "Elevated alkaline phosphatase and portal hypertension.", "correct": false}, {"label": "C", "text": "Hypocalcemia and hypocalciuria with increased PTH.", "correct": true}, {"label": "D", "text": "Congestive heart failure", "correct": false}], "correct_answer": "C. Hypocalcemia and hypocalciuria with increased PTH.", "question_images": ["https://image.prepladder.com/notes/lvua7WnQvMTcbFeWqKKq1744368303.png"], "explanation_images": ["https://image.prepladder.com/notes/lvua7WnQvMTcbFeWqKKq1744368303.png", "https://image.prepladder.com/notes/1q3mZ7C2iWqkuYdK1Gf81744368635.png", "https://image.prepladder.com/notes/3iUqVeoZ5hBNTSlCKCn71744370711.png", "https://image.prepladder.com/notes/OHviiYWzTy247evbjDQn1744370431.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>System</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Respiratory (Lung)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>&gt;90% of cases;</li>\n<li>Cough, dyspnea; <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> hilar <span class=\"customMeta\" data-dictid=\"870b3521e21692777180ed5afdaf8b\">adenopathy</span> (CXR), non-caseating granulomas, <span class=\"customMeta\" data-dictid=\"d54aac1d5516927771958b92a04d85\">peribronchial</span> thickening (CT), <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> lung volumes, <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"bilateral hilar lymphadenopathy.png\" data-author=\"\" data-hash=\"9334\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/lvua7WnQvMTcbFeWqKKq1744368303.png\"/>\n<p style=\"text-align:center\"><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> showing <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> hilar lymphadenopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Non-caseating Granulomas.pn\" data-author=\"\" data-hash=\"9345\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1q3mZ7C2iWqkuYdK1Gf81744368635.png\"/>\n<p style=\"text-align:center\"><strong>Non-caseating Granulomas </strong>(Naked <span class=\"customMeta\" data-dictid=\"2334b7498b1692777188fa8b2eee36\">granuloma</span> - no <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> collar)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Skin</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Erythema nodosum, <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> lesions, <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> pernio, hyper-/hypopigmentation, <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> nodules.</li>\n</ul>\n<p><img alt=\"sarcoidosis skin manifestations\" data-author=\"\" data-hash=\"9363\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/3iUqVeoZ5hBNTSlCKCn71744370711.png\"/></p>\n<p style=\"text-align:center\"><strong>Lupus pernio</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Eye</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Anterior uveitis, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> eye involvement (retinitis, <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> planitis), sicca, <span class=\"customMeta\" data-dictid=\"46e2a1c298169277719583f46ff587\">photophobia</span> and blurred vision; can lead to blindness, more common in African Americans. <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Liver</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase, transaminases, and <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> in advanced cases</li>\n<li>Granulomatous involvement in &gt;50%, <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> in 5%, can lead to <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> &amp; Spleen</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lymphopenia, anaemia (20%), leukopenia; granulomas in 30% (bone marrow) and 60% (spleen); <span class=\"customMeta\" data-dictid=\"b3eb52fe3b1692777199de8465eea8\">splenomegaly</span> in 5-10%, rare <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> for massive splenomegaly.</li>\n<li>Can cause myelophthisis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Calcium Metabolism</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Hypercalcemia/hypercalciuria</strong> in ~10%; more common in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> and whites.</li>\n<li>Granulomas <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> <strong>1-alpha hydroxylase</strong>.</li>\n<li>Increased 1,25-dihydroxyvitamin D.</li>\n<li>Associated with suppressed <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> and nephrolithiasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Renal</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>&lt;5% with direct <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> involvement</li>\n<li>Nephritis, hypercalcemia-associated <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure in 1-2% due to hypercalcemia.</li>\n<li>Leads to increased <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> levels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nervous System</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>5-10% involvement;</li>\n<li>Cranial nerve <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (e.g., the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve), <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis, <span class=\"customMeta\" data-dictid=\"cf3585c06f1692777182cba3cb4c97\">basilar</span> meningitis, myelopathy, seizures, cognitive changes, central diabetes insipidus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cardiac</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>More common in Japan;</li>\n<li>Congestive heart failure, arrhythmias, AV block, <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> tachycardia, left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> dysfunction, heart block. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman has been suffering from a persistent cough, progressive shortness of breath, and fatigue for the past several months. A chest X-ray shows bilateral hilar lymphadenopathy. The patient also has a skin rash, as shown in the image below. Which of the following statements regarding this patient's diagnosis is false?", "options": [{"label": "A", "text": "HRCT scan shows reticulonodular opacities.", "correct": false}, {"label": "B", "text": "PET scan indicates increased metabolic activity.", "correct": false}, {"label": "C", "text": "CD4:CD8 T-cell ratio in BAL &amp;lt; 3.5.", "correct": true}, {"label": "D", "text": "Biopsy shows non-caseating granulomas.", "correct": false}], "correct_answer": "C. CD4:CD8 T-cell ratio in BAL &lt; 3.5.", "question_images": ["https://image.prepladder.com/notes/3iUqVeoZ5hBNTSlCKCn71744370711.png"], "explanation_images": ["https://image.prepladder.com/notes/lvua7WnQvMTcbFeWqKKq1744368303.png", "https://image.prepladder.com/content/a4ZvvLGG2hF9MgT2yvPX1740587430.png", "https://image.prepladder.com/notes/cz9FsQDJhEF6DjiZ9sOE1745573232.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stage I: <span class=\"customMeta\" data-dictid=\"28055cb4f61692777189ea3a82b1f2\">Hilar lymphadenopathy</span> + right paratracheal lymphadenopathy</li>\n<li>Stage II: <span class=\"customMeta\" data-dictid=\"870b3521e21692777180ed5afdaf8b\">Adenopathy</span> + infiltrates</li>\n<li>Stage III: Infiltrates</li>\n<li>Stage IV: Fibrosis</li>\n</ul>\n<img alt=\"bilateral hilar lymphadenopathy.png\" data-author=\"\" data-hash=\"9334\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/lvua7WnQvMTcbFeWqKKq1744368303.png\"/>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/a4ZvvLGG2hF9MgT2yvPX1740587430.png\" width=\"440\"/></p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> and Gross <span class=\"customMeta\" data-dictid=\"c02ad9ae0f1692777198d76afc93c4\">specimen</span> showing Hilar lymphadenopathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HRCT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Reticulonodular opacities</strong> <strong>(galaxy sign)</strong> in a <span class=\"customMeta\" data-dictid=\"d31a3d4bef16927771951b172302f9\">perilymphatic</span> distribution, often centred on broncho-vascular bundles and <span class=\"customMeta\" data-dictid=\"6136118183169277719961922f8790\">subpleural</span> areas <strong>(Option A)</strong></li>\n</ul>\n<p><strong></strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Reticulonodular opacities (galaxy sign)\" data-author=\"Gaillard F, Hanh L, Saber M, et al.\" data-hash=\"11271\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/galaxy-sign-lungs\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/cz9FsQDJhEF6DjiZ9sOE1745573232.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spirometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FEV / <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> &lt;0.7- <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> stenosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DLCO</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduced</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PET scan &gt; <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> &gt; Gallium-67 scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For diagnosis of extra <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> sarcoidosis</li>\n<li>PET scan reveals increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activities in areas of inflammation. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical findings</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lymphopenia </strong></li>\n<li><strong>Elevated ACE</strong> levels.</li>\n<li><strong>Hypercalcemia </strong>may reflect increased <span class=\"customMeta\" data-dictid=\"aac0d9195b1692777183ab34253a6b\">calcitriol</span> (1,25-dihydroxyvitamin D) production by alveolar macrophages.</li>\n<li><strong>Hypercalciuria </strong>can lead to nephrocalcinosis.</li>\n<li>Liver Function Tests are mildly deranged in <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> involvement of the liver.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Non-caseating granulomas</strong> seen in biopsies from <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> or <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> organs <strong>confirm the diagnosis</strong>. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bronchoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May demonstrate a \"<strong>cobblestone</strong>\" appearance of the mucosa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bronchoalveolar lavage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytosis,CD4:CD8 &gt;3.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Endobronchial <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> (EBUS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Assists in diagnosing <span class=\"customMeta\" data-dictid=\"1bea5cbf1d16927771988b19241f4c\">sarcoidosis</span> in patients with <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> adenopathy.</li>\n<li>Can be combined with <span class=\"customMeta\" data-dictid=\"bb02f642c816927772002a55b1f741\">transbronchial</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> to improve <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> yield.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o woman diagnosed with sarcoidosis presents with worsening pulmonary symptoms, including shortness of breath and a persistent dry cough. She has also developed erythema nodosum on her legs. After a thorough evaluation, her physician decides that treatment is necessary to improve her quality of life and prevent complications. Which of the following treatment options is considered first-line for this patient's condition?", "options": [{"label": "A", "text": "Methotrexate 10–20 mg/week.", "correct": false}, {"label": "B", "text": "Prednisolone 20–40 mg/day.", "correct": true}, {"label": "C", "text": "Infliximab at higher doses.", "correct": false}, {"label": "D", "text": "Hydroxychloroquine 200 mg/day.", "correct": false}], "correct_answer": "B. Prednisolone 20–40 mg/day.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organs is least commonly involved in sarcoidosis?", "options": [{"label": "A", "text": "Spleen", "correct": false}, {"label": "B", "text": "Heart", "correct": true}, {"label": "C", "text": "Skin", "correct": false}, {"label": "D", "text": "Brain", "correct": false}], "correct_answer": "B. Heart", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o woman presents with progressive muscle weakness and a distinctive rash on her eyelids and knuckles. She also exhibits a rash like in the given image. She reports difficulty swallowing and has experienced some joint pain. Which of the following statements about this patient's condition is FALSE?", "options": [{"label": "A", "text": "The rash may precede or accompany the muscle weakness.", "correct": false}, {"label": "B", "text": "Weakness is typically asymmetric, affecting distal muscles more than proximal.", "correct": true}, {"label": "C", "text": "Nail bed telangiectasias are a common finding.", "correct": false}, {"label": "D", "text": "Patients may present with only a rash and no muscle weakness.", "correct": false}], "correct_answer": "B. Weakness is typically asymmetric, affecting distal muscles more than proximal.", "question_images": ["https://image.prepladder.com/notes/jHf8f3RY7TSzcfh4xjmn1744371309.png"], "explanation_images": ["https://image.prepladder.com/notes/F0gpkux2u34hSDn4QV4a1744371441.png", "https://image.prepladder.com/notes/945dw6S7IEwyiagGQhZm1745573121.png", "https://image.prepladder.com/notes/8ZDt0U7VKinzShK0n4sw1744372020.jpg", "https://image.prepladder.com/notes/jHf8f3RY7TSzcfh4xjmn1744371309.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Heliotrope rash\" data-author=\"\" data-hash=\"9374\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/F0gpkux2u34hSDn4QV4a1744371441.png\"/>\n<p style=\"text-align:center\"><strong>Heliotrope rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Gottron’s Papules\" data-author=\"Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"11270\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dermatomyositis2.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/945dw6S7IEwyiagGQhZm1745573121.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><strong>Gottron’s Papules</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Shawl sign\" data-author=\"\" data-hash=\"9380\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/8ZDt0U7VKinzShK0n4sw1744372020.jpg\"/>\n<p style=\"text-align:center\"><strong>Shawl sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"V SIGN.png\" data-author=\"\" data-hash=\"9373\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/jHf8f3RY7TSzcfh4xjmn1744371309.png\"/>\n<p style=\"text-align:center\"><strong>V Sign</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50 y/o woman presents with muscle weakness that has progressively worsened over the last 2 months. She also reports a red rash on her knuckles and upper eyelids. The histopathology image of muscle biopsy is given below. MxA staining is positive. Which of the following statements regarding her condition is false?", "options": [{"label": "A", "text": "Serum CK is elevated", "correct": false}, {"label": "B", "text": "Anti-TIF1 antibodies are associated with a favourable prognosis.", "correct": true}, {"label": "C", "text": "Perifascicular atrophy is characteristic of dermatomyositis.", "correct": false}, {"label": "D", "text": "Anti-MDA5 antibodies are linked to a higher risk of rashes, ulcers and ILD.", "correct": false}], "correct_answer": "B. Anti-TIF1 antibodies are associated with a favourable prognosis.", "question_images": ["https://image.prepladder.com/notes/ZLwRxVlSw52cGjPywpCI1745573300.png"], "explanation_images": ["https://image.prepladder.com/notes/ZLwRxVlSw52cGjPywpCI1745573300.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman has 3 months of progressive proximal muscle weakness, difficulty climbing stairs, and elevated creatine kinase (CK) levels. EMG indicates inflammatory myopathy, and a muscle biopsy shows endomysial infiltration with CD8+ T cells. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Polymyositis", "correct": true}, {"label": "B", "text": "Antisynthetase syndrome", "correct": false}, {"label": "C", "text": "Dermatomyositis", "correct": false}, {"label": "D", "text": "Overlap syndrome", "correct": false}], "correct_answer": "A. Polymyositis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/NzJkPoSKU1lSazXN7g5L1745573402.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o male presents with painful, recurrent oral ulcers lasting around 20 days. He also reports a history of genital ulcers and occasional skin lesions resembling erythema nodosum. Recently, he has developed blurred vision and redness in both eyes. Examination reveals anterior uveitis and multiple deep oral ulcers. A pathergy test is positive. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Behçet's disease", "correct": true}, {"label": "B", "text": "Cogan syndrome", "correct": false}, {"label": "C", "text": "Overlap syndrome", "correct": false}, {"label": "D", "text": "Antisynthetase syndrome", "correct": false}], "correct_answer": "A. Behçet's disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34 y/o male presents with a 2-year history of lower back stiffness and pain that improves with activity. He also has occasional knee and hip pain. Examination reveals reduced lumbar spine mobility and tenderness over the sacroiliac joints. What additional clinical feature is most likely associated with this condition?", "options": [{"label": "A", "text": "High fever and night sweats", "correct": false}, {"label": "B", "text": "Symmetrical small joint swelling", "correct": false}, {"label": "C", "text": "Generalized muscle weakness", "correct": false}, {"label": "D", "text": "Recurrent anterior uveitis", "correct": true}], "correct_answer": "D. Recurrent anterior uveitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ankylosing <span class=\"customMeta\" data-dictid=\"42d4868c2e1692777199353a7ad077\">Spondylitis</span> - Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>General Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Spine and Joint involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extra-articular manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inflammatory back pain</strong>: <strong>Gradual onset, worse with inactivity, improves with movement</strong> and is often associated with early morning stiffness.</li>\n<li><strong>Fatigue</strong>: A common and significant symptom.</li>\n<li><strong>Postural changes</strong>: Loss of <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> lordosis, increased <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> kyphosis, and forward stooping of the neck.</li>\n<li><strong>Enthesitis</strong>: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> at <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> sites, often mistaken for fibromyalgia.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Peripheral joint involvement</strong>: Affects large joints like<strong> hips, knees</strong>, and shoulders and is usually asymmetrical.</li>\n<li><strong>Sacroiliac joint involvement</strong>: B/L and asymmetrical; pain may <span class=\"customMeta\" data-dictid=\"f4a826ea4916927771977e2f55c16f\">radiate</span> to the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> thighs.</li>\n<li><strong>Reduced <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility:</strong> Limited movement in the <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> region due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and pain, often accompanied by muscle spasms.</li>\n</ul>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anterior uveitis:</strong> <strong>Most common extra <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> manifestation.</strong> Presents with sudden <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> eye pain, redness, and light sensitivity, often preceding joint symptoms. <strong>(Option D) </strong></li>\n<li>Anaemia, prostatitis, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease, <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> disease, and very rare cases of <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">amyloidosis</span> or upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</li>\n<li><strong>Osteoporosis</strong>: This can lead to vertebral fractures, especially with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26 year old male is evaluated for long-standing back pain and stiffness. Modified Schober’s test shows restricted lumbar flexion. Physical examination reveals limited chest expansion. Which additional finding would most likely be present?", "options": [{"label": "A", "text": "Free lateral bending of the spine", "correct": false}, {"label": "B", "text": "Loss of lumbar lordosis", "correct": true}, {"label": "C", "text": "Hypermobile cervical spine", "correct": false}, {"label": "D", "text": "Absence of tenderness over the sacroiliac joints", "correct": false}], "correct_answer": "B. Loss of lumbar lordosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/duflSc2wf5vYc0vvuSrN1745573606.png", "https://image.prepladder.com/notes/oh37YXgQ8f2dUDM0SXqV1744373466.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Modified Schober’s Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postural change</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"Modified Schober’s Test\" data-author=\"\" data-hash=\"11274\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/duflSc2wf5vYc0vvuSrN1745573606.png\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Position change\" data-author=\"\" data-hash=\"9393\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/oh37YXgQ8f2dUDM0SXqV1744373466.png\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20 y/o male presents with persistent back pain that improves with physical activity. He has a family history of inflammatory arthritis and shows HLA-B27 positivity. Imaging reveals sacroiliitis. Which of the following combinations fulfils the diagnostic criteria for axial spondyloarthritis?", "options": [{"label": "A", "text": "History of joint pain plus normal X-ray findings", "correct": false}, {"label": "B", "text": "HLA-B27 positivity plus a history of allergic rhinitis", "correct": false}, {"label": "C", "text": "HLA-B27 positivity plus two other spondyloarthritis features", "correct": true}, {"label": "D", "text": "Elevated CRP levels plus a positive Schober's test", "correct": false}], "correct_answer": "C. HLA-B27 positivity plus two other spondyloarthritis features", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnostic Criteria for <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">Axial</span> Spondyloarthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on clinical features, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> findings, and HLA-B27 status. Developed by the <strong>Assessment of <span class=\"customMeta\" data-dictid=\"af75ede1e116927771996e51c08003\">Spondyloarthritis</span> International Society</strong> (ASAS). Includes <span class=\"customMeta\" data-dictid=\"aabbc63449169277718277060e8642\">Ankylosing Spondylitis</span> (radiographic <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> spondyloarthritis) and non-radiographic <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> spondyloarthritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Imaging Arm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Arm </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires evidence of <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> on imaging</p>\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> on MRI</li>\n</ul>\n<p>and/or</p>\n<ul>\n<li>Definite radiographic <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> according to Modified New York criteria</li>\n<li>(Bilateral <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> on <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> if changes are mild or <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">Unilateral</span> <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> on <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> if changes are definite)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>HLA-B27 positivity plus at least two other <span class=\"customMeta\" data-dictid=\"af75ede1e116927771996e51c08003\">spondyloarthritis</span> features.</strong></li>\n</ul>\n<ul>\n<li><strong>Spondyloarthritis features:</strong> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> back pain, arthritis, enthesitis, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> uveitis, dactylitis, psoriasis, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease ( Crohn's or <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> colitis), family history of spondyloarthritis, elevated <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> and good response to NSAIDs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> evidence of <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> is present in the patient's history or examination, one other feature is required for the diagnosis of ankylosing spondylitis.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations of Ankylosing Spondylitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>X-rays </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MRI </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>HLA-B27: </strong>The presence of the HLA-B27 gene is a strong indicator of AS. The <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of AS in the general population is less than 0.5%.</li>\n<li><strong>Inflammatory Markers</strong>: Elevated <span class=\"customMeta\" data-dictid=\"49069760291692777187e0e72db819\">ESR</span> and <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> levels may indicate active disease.</li>\n<li><strong>Faecal Calprotectin</strong>: Helps screen for associated <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Show characteristic changes in <strong>sacroiliac joints</strong>, such as:</p>\n<ul>\n<li>Blurred <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> margins</li>\n<li>Erosions and sclerosis</li>\n<li>\"Pseudowidening\" of joint space (early stages)</li>\n<li>Joint space narrowing and <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (later stages)</li>\n<li>Bamboo spine - Vertebral body <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> by syndesmophytes</li>\n<li>Dagger sign - <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">Calcification</span> appears as a single <span class=\"customMeta\" data-dictid=\"418c408a7716927771979034974902\">radiodense</span> line vertically running down the spine on <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> radiographs.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Investigation of choice – <strong>more sensitive</strong> than <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> for detecting early <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> changes.</li>\n<li>Can reveal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> oedema, enthesitis, synovitis, and erosions.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o female with ankylosing spondylitis is experiencing episodes of uveitis. Which would be the most appropriate drug to address both her uveitis and her underlying condition?", "options": [{"label": "A", "text": "Anakinra", "correct": false}, {"label": "B", "text": "Adalimumab", "correct": true}, {"label": "C", "text": "Sulfasalazine", "correct": false}, {"label": "D", "text": "Tofacitinib", "correct": false}], "correct_answer": "B. Adalimumab", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment of Ankylosing Spondylitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Pharmacological Measures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exercises for improving posture, flexibility, and muscle strength.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pharmacological Therapy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-steroidal anti-inflammatory Drugs (NSAIDs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First-line treatment to treat pain and inflammation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease-Modifying Anti-Rheumatic Drugs (DMARDs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sulfasalazine</strong> is used for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arthritis</p>\n<p>Methotrexate is less effective in ankylosing spondylitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TNF Inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It reduces <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and is effective for both <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> symptoms.</li>\n<li>Examples: <strong>Infliximab, Etanercept, Adalimumab, Golimumab, Certolizumab Pegol.</strong></li>\n<li><strong>Adalimumab </strong>has been <strong>FDA-approved for managing uveitis</strong>. It can control both <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> symptoms and <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> episodes in the patient.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IL-17A Inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secukinumab</strong></p>\n<p>Effective in patients who have not tolerated anti-TNF therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be used in attacks of uveitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Janus <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> (JAK) Inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tofacitinib, Upadacitinib, and Filgotinib show <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> in clinical trials.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organ is most commonly associated with inflammatory pseudotumour in children?", "options": [{"label": "A", "text": "Lungs", "correct": true}, {"label": "B", "text": "Liver", "correct": false}, {"label": "C", "text": "Brain", "correct": false}, {"label": "D", "text": "Kidneys", "correct": false}], "correct_answer": "A. Lungs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 y/o male presents with abdominal pain, jaundice, and weight loss. Imaging reveals a mass in the liver, and laboratory tests show elevated IgG4 levels. A biopsy is performed to confirm the diagnosis. What is most likely associated with IgG4-related inflammatory pseudotumor?", "options": [{"label": "A", "text": "Epithelioid cell granulomas", "correct": false}, {"label": "B", "text": "Caseating granulomas", "correct": false}, {"label": "C", "text": "Necrotising vasculitis", "correct": false}, {"label": "D", "text": "Storiform fibrosis", "correct": true}], "correct_answer": "D. Storiform fibrosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/wYvoT4PM23N2kuTLqlc81744373887.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 y/o patient presents with mild abdominal pain, weight loss, and obstructive jaundice. Imaging reveals a \"sausage-shaped\" pancreas and a subsequent CT scan shows diffuse pancreatic enlargement. The patient's condition is suspected to be related to an inflammatory process rather than malignancy. Which of the following is the most appropriate first-line treatment for this condition?", "options": [{"label": "A", "text": "Rituximab", "correct": false}, {"label": "B", "text": "Surgical resection", "correct": false}, {"label": "C", "text": "Glucocorticoids", "correct": true}, {"label": "D", "text": "Antibiotics", "correct": false}], "correct_answer": "C. Glucocorticoids", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/exvdq5itP74njzoEPfiF1744374046.png", "https://image.prepladder.com/notes/O56hcT2MAVIdG1NNqoAJ1744374133.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 10 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 62-year-old man presents with sudden, severe pain in his right big toe, waking him from sleep. The joint is swollen, red, and extremely tender. He has a history of high uric acid levels and recently consumed protein-rich meals. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pseudogout", "correct": false}, {"label": "B", "text": "Saturnine gout", "correct": false}, {"label": "C", "text": "Podagra", "correct": true}, {"label": "D", "text": "Psoriatic arthritis", "correct": false}], "correct_answer": "C. Podagra", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/uNJh3zea7eGuugkqAktG1744363815.png", "https://image.prepladder.com/content/cUhyLOzPPiH8nTlt9qry1740631520.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 43-year-old man presents with severe pain in his right big toe, redness, and swelling, as shown in the image. He has a history of hypertension and recently increased her consumption of red meat. Which of the following best explains the pathophysiological process leading to her condition?", "options": [{"label": "A", "text": "Increased renal tubular secretion of uric acid", "correct": false}, {"label": "B", "text": "Decreased production of purines", "correct": false}, {"label": "C", "text": "Impaired renal excretion of uric acid", "correct": true}, {"label": "D", "text": "Increased breakdown of uric acid", "correct": false}], "correct_answer": "C. Impaired renal excretion of uric acid", "question_images": ["https://image.prepladder.com/content/kGImXuFoLRCKFZwDKTMH1740631590.png"], "explanation_images": ["https://image.prepladder.com/notes/5DwacFXvYhstmMBUilVE1745572169.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman with a history of elevated uric acid levels reports that she experienced a painful episode in her right big toe two months ago. Since that time, she has had no symptoms and feels completely normal. She is concerned about the possibility of future attacks. What stage of the associated condition is this patient most likely experiencing now?", "options": [{"label": "A", "text": "Asymptomatic Hyperuricemia", "correct": false}, {"label": "B", "text": "Acute Gout Attack", "correct": false}, {"label": "C", "text": "Intercritical Gout", "correct": true}, {"label": "D", "text": "Chronic Gouty Arthritis", "correct": false}], "correct_answer": "C. Intercritical Gout", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/p0C63q3fISMSJQlKdDks1745572323.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 1: <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">Asymptomatic</span> Hyperuricemia</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid levels without any symptoms.</li>\n<li>It can last for years &amp; individuals may be unaware of their condition.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 2: <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">Gout</span> Attack</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A sudden onset of <strong>severe pain, redness, and <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in a joint</strong>, most commonly the <strong>MTP join</strong>t, typically lasts <strong>1–2 weeks</strong>.</li>\n<li>Intense pain, extreme tenderness, and marked <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> with shiny, red skin.</li>\n<li>Symptoms usually resolve spontaneously.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 3: <span class=\"customMeta\" data-dictid=\"e833131fda16927771902a160b0a78\">Intercritical</span> Gout</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Periods between <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks</strong> when the patient is symptom-free &amp; intervals vary from weeks to years.</li>\n<li>No symptoms, but the risk of future attacks remains.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 4: Chronic Gouty Arthritis</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Persistent joint inflammation</strong> and <strong>damage</strong> due to repeated attacks.</li>\n<li>Chronic pain and swelling, <strong>joint deformities</strong> &amp; formation of <strong>tophi </strong>(urate crystal deposits)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old man presents with a sudden onset of severe pain in his left knee, accompanied by swelling and redness. He has a history of elevated uric acid levels. The physician suspects gout and plans to perform a joint aspiration for diagnostic purposes. Which of the following findings would most likely confirm the diagnosis of gout?", "options": [{"label": "A", "text": "The presence of rhomboid-shaped crystals under polarised light", "correct": false}, {"label": "B", "text": "Elevated white blood cell count with neutrophilic predominance", "correct": false}, {"label": "C", "text": "Needle-shaped crystals exhibiting negative birefringence", "correct": true}, {"label": "D", "text": "Thickened synovial fluid with a high percentage of lymphocytes", "correct": false}], "correct_answer": "C. Needle-shaped crystals exhibiting negative birefringence", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/DmB1fqFoKgDxMraBmsQP1744364891.png", "https://image.prepladder.com/content/D58MCRctLb2uJkenFmPM1740632036.png", "https://image.prepladder.com/notes/sQxDcxs6j7zV4dQdIlvs1744365135.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joint Aspiration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation of Choice </strong>(To confirm a <span class=\"customMeta\" data-dictid=\"cced7d91ec169277719680ab298ccf\">presumptive</span> diagnosis of gout)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings:</strong> Cloudy <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> fluid; <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count 5,000 to 75,000/μL. Thick, pasty fluid if many crystals.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crystal Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type:</strong> Needle-shaped <strong>monosodium <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> (MSU) crystals</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polarised light:</strong> Bright, <strong>negative birefringence</strong> (yellow parallel, blue perpendicular).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synovial Fluid Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staining/Culture:</strong> Ruling out <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> arthritis, as bacterial infection can coexist with MSU crystals.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Uric Acid Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Gout:</strong> May be falsely normal or low.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Gout:</strong> Typically elevated.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum creatinine:</strong> Elevated, indicating <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver function tests:</strong> Assess <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> function, particularly in older patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> levels:</strong> Elevated in older patients, indicating possible atherosclerosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 46-year-old man presents to the OPD with severe pain, redness, and swelling in his right knee. Examination reveals tender swelling and redness at the base of the right 1st toe. Serum urate levels are normal, but arthrocentesis reveals negatively birefringent needle-shaped crystals under polarised light. Which of the following is the drug of choice for this acute attack?", "options": [{"label": "A", "text": "Canakinumab", "correct": false}, {"label": "B", "text": "Oral colchicine", "correct": true}, {"label": "C", "text": "Intra-articular glucocorticoid injection", "correct": false}, {"label": "D", "text": "Allopurinol", "correct": false}], "correct_answer": "B. Oral colchicine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> attack </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colchicine</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Microtubule inhibitor, which prevents <span class=\"customMeta\" data-dictid=\"ef00bb99bd1692777192dbc816b3d4\">microtubule</span> assembly in neutrophils, thus reducing inflammation.</li>\n<li>Colchicine disrupts the function of the <span class=\"customMeta\" data-dictid=\"5d6a3738a016927771853497ecb24b\">cytoskeleton</span> by<strong> inhibiting the <span class=\"customMeta\" data-dictid=\"1346ac97b61692777196b91eff8228\">polymerization</span> of beta-tubulin into microtubules.</strong></li>\n<li>This prevents the formation and function of microtubules, which are essential for various <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> processes.</li>\n<li>By disrupting <span class=\"customMeta\" data-dictid=\"ef00bb99bd1692777192dbc816b3d4\">microtubule</span> formation, <span class=\"customMeta\" data-dictid=\"e6c39cccfc1692777184f4ea5296e6\">colchicine</span> inhibits the activation, degranulation, and migration of neutrophils, which are key players in the <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response. This reduces the <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"6826aa04ef16927771833336e53730\">cascade</span> associated with conditions like gout.</li>\n<li>Colchicine does not prevent <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid crystals, but it inhibits the release of an <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"6c9fa3a73216927771888299c86e08\">glycoprotein</span> from phagocytes. This contributes to its anti-inflammatory action in conditions like gout.</li>\n<li>Colchicine blocks <span class=\"customMeta\" data-dictid=\"972e3c28581692777192034f4e95ce\">metaphase</span> in dividing cells by disrupting <span class=\"customMeta\" data-dictid=\"d1ca319ebd1692777192a60ed7c087\">mitotic spindle</span> formation.</li>\n<li><strong>DOC for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks of gout.</strong></li>\n<li><strong>Dose:</strong> 0.6 mg TID - introduced after 2-3 days when <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> reduces.</li>\n<li><strong>Side effects:</strong> Nausea, <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> and diarrhoea.</li>\n<li>Avoided in elderly patients and those with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NSAIDs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is effective when used early in an attack of gout.</li>\n<li>Indomethacin 25-50 mg TID / <span class=\"customMeta\" data-dictid=\"60a96c20711692777193b56b020b8d\">Naproxen</span> 500 mg BID / <span class=\"customMeta\" data-dictid=\"5778d7dc361692777189571125f0bd\">Ibuprofen</span> 800 mg TID</li>\n<li>Avoided in elderly patients and those with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucocorticoids</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It can be used as an <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> for multi-articular involvement or <span class=\"customMeta\" data-dictid=\"f953c828ea16927771909cb3a51e36\">intra-articular</span> <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> for mono-articular involvement, or orally.</li>\n<li>Safe to use in elderly patients and those with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other treatments </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ice therapy: </strong>Reduces <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and inflammation</li>\n<li><strong>Canakinumab</strong> (IL-1 β inhibitor)<strong> (Option A)</strong></li>\n<li><strong>Anakinra: </strong>Reserved for resistant cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urate <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> agents </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Drugs: </strong>Allopurinol, Febuoxostat, <span class=\"customMeta\" data-dictid=\"2ee374b25c16927771963eae834a26\">Probenecid</span> and Pegloticase</li>\n<li>Contraindicated in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks.</li>\n<li>Rapidly reduces <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> level, which causes the <span class=\"customMeta\" data-dictid=\"1924dd4c6e169277718654d32a636f\">dissolution</span> of organised monosodium <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> crystals.</li>\n<li>Causes an <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> reaction towards the shed crystals.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old male presents with a 4-day history of severe pain, swelling, and redness in his right big toe. A diagnosis of acute gout was made, and treatment with NSAIDs resolved his symptoms. Investigations revealed a highly elevated serum uric acid level and increased 24-hour urinary uric acid level. Which anti-gout agent should be used in this patient?", "options": [{"label": "A", "text": "Pegloticase", "correct": false}, {"label": "B", "text": "Allopurinol", "correct": true}, {"label": "C", "text": "Febuxostat", "correct": false}, {"label": "D", "text": "Anakinra", "correct": false}], "correct_answer": "B. Allopurinol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Target </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduce <strong>serum urate</strong> level to &lt; <strong>5-6 mg / dL </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute gouty attack</strong></p>\n<p><strong>(Anti <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> therapy)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ice pack over swelling</li>\n<li><strong>NSAIDs (Indomethacin or Naproxen)</strong></li>\n<li>Oral <strong>colchicine</strong> 0.6 mg TID - introduced after 2-3 days when <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> reduces</li>\n<li>Oral <strong>prednisolone</strong> 15-20 mg daily for 3 days or <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> <strong>methylprednisolone</strong> 80-120 mg daily for 3 days is preferred for elderly patients or <span class=\"customMeta\" data-dictid=\"45ea6905f61692777196a0a0d5eada\">polyarticular</span> gout</li>\n<li><strong>Anakinra</strong> - for resistant cases <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-acute attack</strong></p>\n<p><strong>(based on 24-hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> level) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For overproducers </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For under producers </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Allopurinol</strong> <strong>(Option B)</strong>: <strong>This is a first-line treatmen</strong>t for <span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\">xanthine</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> inhibitors. It is typically initiated at 100 mg once daily and can be titrated up to 800 mg as needed.</li>\n<li><strong>Febuxostat</strong><strong> (Option C)</strong> is a newer <span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\">xanthine</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> administered at a <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> of 80-120 mg daily for patients who cannot tolerate allopurinol.</li>\n<li><strong>Pegloticase</strong><strong> (Option A)</strong><strong>: </strong>Recombinant <span class=\"customMeta\" data-dictid=\"104137889816927772017557e6a7de\">uricase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> used in cases resistant to standard therapy.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uricosuric agents:</strong></p>\n<ul>\n<li><strong>Probenecid </strong></li>\n<li><strong>Benzbromarone (</strong>withdrawn as it is hepatotoxic)</li>\n<li><strong>Sulfinpyrazone </strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<p>These agents increase the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid, but they are contraindicated in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> or urolithiasis.</p>\n<p>Patients on these drugs need to maintain high <span class=\"customMeta\" data-dictid=\"3d7596c31c1692777203ecf2ce7a17\">fluid intake</span> to prevent <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> crystallisation.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle measures</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight control</li>\n<li>Avoid high protein diet</li>\n<li>Avoid alcohol</li>\n<li>Avoid stress</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:535px\">\n<thead>\n<tr>\n<th colspan=\"3\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> </strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Target </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduce <strong>serum urate</strong> level to &lt; <strong>5-6 mg / dL </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> attack</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ice pack over swelling</li>\n<li><strong>NSAIDs</strong></li>\n<li>Oral <strong>colchicine</strong></li>\n<li>Glucocorticoids</li>\n<li><strong>Anakinra</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-acute attack</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For overproduces </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For underproduces </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Allopurinol</strong> <strong>(1st line)</strong></li>\n<li><strong>Febuxostat</strong></li>\n<li><strong>Pegloticase</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uricosuric agents: </strong></p>\n<ul>\n<li><strong>Probenecid </strong></li>\n<li><strong>Benzbromarone </strong></li>\n<li><strong>Sulfinpyrazone </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male with stage 2 chronic kidney disease presents with painful swelling at the base of his left big toe. He was diagnosed with an acute gouty attack and treated with oral glucocorticoids. Which anti-gout medication can be used to reduce the risk of another attack without dose modification?", "options": [{"label": "A", "text": "Probenecid", "correct": false}, {"label": "B", "text": "Allopurinol", "correct": false}, {"label": "C", "text": "Febuxostat", "correct": true}, {"label": "D", "text": "Lesinurad", "correct": false}], "correct_answer": "C. Febuxostat", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:673px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antigout agents safe to use in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Febuxostat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mechanism of action</strong>: <span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\">Xanthine</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> (more effective than allopurinol)</li>\n<li><strong>Dose:</strong> 80 to 120 mg daily</li>\n<li><strong>Indications:</strong>\n<ul>\n<li>Patients with the HLA-B* 5801 gene (Southeast Asians, Pacific islanders and blacks)</li>\n<li>Inadequate response to allopurinol</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> (no dose adjustment required as it undergoes <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> - glucuronidation and oxidation)</li>\n<li>Adverse effects of allopurinol</li>\n</ul>\n</li>\n<li>It should be initiated during the resolution phase of an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> attack, and <span class=\"customMeta\" data-dictid=\"a45b36c1c716927771840ee63f1cba\">concurrent</span> anti-inflammatory medications should be provided to prevent flare-ups.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benzbromarone </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uricosuric agent (increases <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of urate)</li>\n<li>Safe to use in CKD</li>\n<li>Withdrawn due to hepatotoxicity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pegloticase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recombinant <span class=\"customMeta\" data-dictid=\"104137889816927772017557e6a7de\">uricase</span> enzyme, which is safe to use in CKD</li>\n<li>Used in cases resistant to standard therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low dose <span class=\"customMeta\" data-dictid=\"6337926de316927771812a6842721f\">allopurinol</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>After dose adjustment, <span class=\"customMeta\" data-dictid=\"6337926de316927771812a6842721f\">allopurinol</span> may be used in patients with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n<li>The standard dose of 100mg is <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> to 50 mg, which may be gradually increased.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:389px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antigout agents safe to use in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Febuxostat</strong></li>\n<li><strong>Benzbromarone </strong></li>\n<li><strong>Pegloticase</strong></li>\n<li><strong>Low dose <span class=\"customMeta\" data-dictid=\"6337926de316927771812a6842721f\">allopurinol</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presents to the emergency department with sudden swelling, redness, and severe pain in both knees. He has experienced intermittent joint pain for the past few months. Polarised light microscopy of joint aspiration reveals rhomboid-shaped crystals exhibiting positive birefringence. Which statement best explains the pathogenesis of his condition?", "options": [{"label": "A", "text": "Excessive mechanical wear and tear of the articular cartilage", "correct": false}, {"label": "B", "text": "Deposition of calcium pyrophosphate crystals in cartilage matrix vesicles", "correct": true}, {"label": "C", "text": "Excess purine production causes crystal deposition in the joints", "correct": false}, {"label": "D", "text": "Autoimmune reaction leading to pannus formation in the joint", "correct": false}], "correct_answer": "B. Deposition of calcium pyrophosphate crystals in cartilage matrix vesicles", "question_images": ["https://image.prepladder.com/notes/HLaXQ4X48QmaOVkH0bN01744365754.png"], "explanation_images": ["https://image.prepladder.com/notes/HLaXQ4X48QmaOVkH0bN01744365754.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Calcium <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">pyrophosphate</span> deposition disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ageing</li>\n<li>Osteoarthritis</li>\n<li>Post <span class=\"customMeta\" data-dictid=\"09280d6b301692777192611776a67b\">Meniscectomy</span> or joint trauma</li>\n<li>Familial-genetic</li>\n<li>Hemochromatosis</li>\n<li>Hypophosphatasia</li>\n<li>Hypomagnesemia</li>\n<li>Certain drugs: <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">Thiazide</span> and loop diuretics</li>\n<li>Malabsorption</li>\n<li>Gitelman’s syndrome</li>\n<li>Gout</li>\n<li>X-linked hypophosphatemic rickets</li>\n<li>Familial hypocalciuric hypercalcemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mutation in <strong>ANKH gene</strong> ➜ Increased <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> transportation of pyrophosphate.</li>\n<li>Decreased levels of glycosaminoglycans in the cartilage, which results in\n\t\t\t\t<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"fae9d02cdc1692777190a3151d6fef\">inorganic</span> <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">pyrophosphate</span> in the <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> matrix.</li>\n<li>Calcium combines with this <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">pyrophosphate</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> CCP.</li>\n<li>Phagocytosis of <span class=\"customMeta\" data-dictid=\"852485cb4016927771835901213a01\">CCP</span> crystals by neutrophils and <span class=\"customMeta\" data-dictid=\"2748357f451692777191377abbe2a6\">macrophage</span> inflammation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute attack </strong>may follow surgery (especially parathyroidectomy) and trauma\n\t\t\t\t<ul>\n<li>Systemic signs can occur during the attack, such as fever and chills.</li>\n<li><strong>Joint swelling, redness and pain.</strong>\n<ul>\n<li>Most commonly affected joint: <strong>Knees</strong>.</li>\n<li>Rarely affected: First <span class=\"customMeta\" data-dictid=\"c7eec8acc51692777192539a955090\">metatarsophalangeal</span> joint.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Chronic</strong>:\n\n\t\t\t\t<ul>\n<li><strong>Symmetrical</strong> <strong>Polyarticular</strong> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> with severe joint damage.</li>\n<li>Chondrocalcinosis can occur.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray: </strong>Punctate or <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"418c408a7716927771979034974902\">radiodense</span> deposits within <span class=\"customMeta\" data-dictid=\"d8a54a93ac16927772033e2e81958d\">fibrocartilaginous joint</span> <span class=\"customMeta\" data-dictid=\"526b3e942016927771928828b6c34f\">meniscus</span> or <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> cartilage.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"linear &lt;span class=\" custommeta\"=\"\" data-dictid=\"418c408a7716927771979034974902\"/>radiodense deposits\" data-author=\"Taokinesis (Pixabay profile)Annotated by Mikael Häggström\" data-hash=\"11267\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Chondrocalcinosis_-_annotated.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/TkFHX77k9zl7kXWo3r9t1745572493.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Arthrocentesis: </strong>Positively birefringent rhomboid-shaped crystals under polarised light</p>\n<img alt=\"needle-shaped crystals.jpg\" data-author=\"\" data-hash=\"9303\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/HLaXQ4X48QmaOVkH0bN01744365754.png\"/></td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CPPD (Pseudogout)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gout </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crystal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">pyrophosphate</span> dihydrate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monosodium <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polarised <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positively</strong> birefringent (rhomboid-shaped crystals)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negatively birefringent</p>\n<p>(needle-shaped crystals)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute onset of <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and pain in large joints (often <strong>knees</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute onset of severe joint pain, often at the big toe (1st <span class=\"customMeta\" data-dictid=\"c7eec8acc51692777192539a955090\">metatarsophalangeal</span> joint)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joint involvement </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monoarticular or polyarticular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically monoarticular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated conditions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteoarthritis and hypothyroidism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperuricemia and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May lead to <strong>chondrocalcinosis </strong>(calcification in cartilage)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent attacks can lead to <strong>tophi.</strong> (crystal deposits)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old woman presents to the clinic with chronic pain and swelling in her shoulder joint. Radiographs reveal calcific tendinitis in the rotator cuff. A joint aspiration is performed, and the synovial fluid is analysed. If this patient has calcium apatite deposition disease, what type of crystal is most likely to be seen in the patient's synovial fluid?", "options": [{"label": "A", "text": "Positively birefringent rhomboid-shaped crystals", "correct": false}, {"label": "B", "text": "Strong birefringent bipyramidal crystals", "correct": false}, {"label": "C", "text": "Negatively birefringent needle-shaped crystals", "correct": false}, {"label": "D", "text": "Microcrystals with no birefringence", "correct": true}], "correct_answer": "D. Microcrystals with no birefringence", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/khj5HT23ZyZWC4t9D4cl1745572587.png", "https://image.prepladder.com/notes/HLaXQ4X48QmaOVkH0bN01744365754.png", "https://image.prepladder.com/notes/RJpLsoDv1tm8dX27Vd5x1744366468.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Microscopy of <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> fluid </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gout </strong></p>\n<p><strong>(Monosodium urate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute onset of severe joint pain, often at the big toe (<strong>podagra</strong>)</li>\n<li>Usually <strong>monoarticular</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Negatively birefringent needle-shaped crystals (Option C ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Negatively birefringent needle-shaped crystals\" data-author=\"Bobjgalindo\" data-hash=\"11268\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Fluorescent_uric_acid.JPG\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/khj5HT23ZyZWC4t9D4cl1745572587.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudogout</strong></p>\n<p><strong>(Calcium pyrophosphate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever and chills</li>\n<li><strong>Symmetrical</strong> <strong>polyarticular</strong> arthritis</li>\n<li>Maybe monoarticular</li>\n<li>Chondrocalcinosis can occur in chronic cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positively birefringent rhomboid-shaped crystals (Option A ruled out)</strong></p>\n<img alt=\"needle-shaped crystals.jpg\" data-author=\"\" data-hash=\"9303\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/HLaXQ4X48QmaOVkH0bN01744365754.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium <span class=\"customMeta\" data-dictid=\"4cd2f5e61a1692777181e000c76341\">Apatite</span> deposition disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It usually affects the <span class=\"customMeta\" data-dictid=\"0598d9069e1692777183736926a09e\">bursae</span> and tendons around joints.</li>\n<li>May lead to Milwaukee shoulder in the elderly.</li>\n<li>Associated with osteoarthritis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microcrystals of <span class=\"customMeta\" data-dictid=\"4cd2f5e61a1692777181e000c76341\">apatite</span> in the <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> fluid show<strong> no birefringence</strong> under polarised light.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> deposition disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No specific feature</li>\n<li>Joint involvement ranges from small to large joints</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Variable shape and variable birefringence</li>\n<li>The most easily recognisable crystals are <strong>strong birefringent bipyramidal crystals. (Option B ruled out)</strong></li>\n</ul>\n<p><img alt=\" strong birefringent bipyramidal crystals.\" data-author=\"\" data-hash=\"9307\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/RJpLsoDv1tm8dX27Vd5x1744366468.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match each condition with its corresponding key synovial fluid characteristics: Conditions Key Characteristics 1. Normal a. Yellow, Cloudy, &amp;gt;50,000 WBC 2. Non-inflammatory b. Colorless, Clear, &amp;lt;200 WBC 3. Inflammatory c. Yellow, Opaque, Positive Gram Stain 4. Septic d. Xanthochromic or Red, Bloody 5. Hemarthrosis e. Straw-like, Clear, 200 - 2000 WBC", "options": [{"label": "A", "text": "1 - b, 2 - e, 3 - a, 4 - c, 5 - d", "correct": true}, {"label": "B", "text": "1 - a, 2 - b, 3 - e, 4 - d, 5 - c", "correct": false}, {"label": "C", "text": "1 - c, 2 - d, 3 - b, 4 - e, 5 - a", "correct": false}, {"label": "D", "text": "1 - b, 2 - c, 3 - a, 4 - d, 5 - e", "correct": false}], "correct_answer": "A. 1 - b, 2 - e, 3 - a, 4 - c, 5 - d", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:759px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colour </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clarity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viscosity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WBC(mm3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neutrophils </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gram <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crystals </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colorless</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;200</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;25%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non - inflammatory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straw like</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>200-2000</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;25%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammatory </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cloudy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2000-50000</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;50%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Septic </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Opaque</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;50,000</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;75%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemarthrosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Xanthochromic or red</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bloody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>200-2000</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50-75%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 47 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following is true about polyarteritis nodosa?", "options": [{"label": "A", "text": "Necrotising inflammation of large vessels", "correct": false}, {"label": "B", "text": "Patient has hypogammaglobulinemia", "correct": false}, {"label": "C", "text": "90% is associated with ANCA positivity", "correct": false}, {"label": "D", "text": "30% is associated with Hepatitis B", "correct": true}], "correct_answer": "D. 30% is associated with Hepatitis B", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the deformity depicted in the image:", "options": [{"label": "A", "text": "Swan neck deformity", "correct": false}, {"label": "B", "text": "Boutonniere deformity", "correct": true}, {"label": "C", "text": "Z line deformity", "correct": false}, {"label": "D", "text": "Mallet finger deformity", "correct": false}], "correct_answer": "B. Boutonniere deformity", "question_images": ["https://image.prepladder.com/content/zh10VG1RDKkjVP5MrMnV1747902629.png"], "explanation_images": ["https://image.prepladder.com/content/6XxOGLtm1EjCHrwz2v981747902685.png", "https://image.prepladder.com/content/vMlsCGqS8xY50ON9420U1747902638.png", "https://image.prepladder.com/content/04XcG5xEAgrhHLIOTNxL1747902678.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Articular <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> and changes in <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Articular changes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autoimmune <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> mediates <span class=\"customMeta\" data-dictid=\"388a4ccfbf1692777194a8f6a2d3b4\">pannus</span> formation, eroding the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and bone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metacarpophalangeal joint<strong> (MCP)</strong>, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> <strong>(PIP) </strong>joint and <strong>wrist</strong> joint are involved</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"9\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deformities</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Swan neck <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Option A)</strong></p>\n<ul>\n<li>Extension at <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (<strong>PIP</strong>)</li>\n<li>Flexion at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (<strong>DIP</strong>): The DIP joint is not involved; <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> occurs due to tension on the tendons attached to the base of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> phalanges</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Boutonniere deformity</strong></p>\n<ul>\n<li>Flexion<strong> </strong>at PIP and extension at DIP</li>\n<li>Both swan neck and boutonniere <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> can occur in different fingers of the same hand.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Z-line <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Option C)</strong></p>\n<ul>\n<li><strong>Subluxation </strong>of the first <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joint.</li>\n<li>Hyperextension of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Rollcloud,\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Z-shaped_deformity.jpg\" data-tags=\"\" height=\"2817\" src=\"https://image.prepladder.com/content/6XxOGLtm1EjCHrwz2v981747902685.png\" width=\"2550\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"3441\" src=\"https://image.prepladder.com/content/vMlsCGqS8xY50ON9420U1747902638.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with flaccid bullous lesions as shown in the image below involving the entire trunk and oral cavity. Acantholytic cells are seen on Tzank smear. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Pemphigus foliaceus", "correct": false}, {"label": "B", "text": "Pemphigus vulgaris", "correct": true}, {"label": "C", "text": "Dermatitis herpetiformis", "correct": false}, {"label": "D", "text": "Bullous pemphigoid", "correct": false}], "correct_answer": "B. Pemphigus vulgaris", "question_images": ["https://image.prepladder.com/content/jfXkgf42MivxktLgzgqc1747902808.png"], "explanation_images": ["https://image.prepladder.com/content/ZHJcfCx33LnxXqzAssTD1747902819.png", "https://image.prepladder.com/content/rMmG72lpCWUuRaZbAxBF1747902828.png", "https://image.prepladder.com/content/chZf4J2ScgRnRaLjiHWd1747902835.png", "https://image.prepladder.com/content/kS9NjW3DgE7F3KXBbg3m1747902890.png", "https://image.prepladder.com/content/NEC724BLFQ1Yso6GWwL51747902901.png", "https://image.prepladder.com/content/v5eLHhCWu62kcQYIJ8YW1747903024.png", "https://image.prepladder.com/content/NJmM5DcMrqbBuNIlgH4R1747970593.png", "https://image.prepladder.com/content/S3PuptMJg3ESe9oZSQf71747903066.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Antigen affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Immunobullous disease-associated</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmoglein 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus <span class=\"customMeta\" data-dictid=\"dfc66a833816927772038da4307e01\">foliaceous</span> (Subcorneal split)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmoglein 3 &gt; 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus <span class=\"customMeta\" data-dictid=\"a038b675ea169277720227edae8451\">Vulgaris</span> (Suprabasal split)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmocolin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgA pemphigus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmoplakin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paraneoplastic pemphigus</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pemphigus vulgaris</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pemphigus foliaceus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suprabasal split</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcorneal splits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DSG 3&gt; 1 is target antigen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DSG 1 is target antigen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mucosa involved</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mucosa not involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus vegetans is the variant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus Erythematosus ( Senear Usher Syndrome) is a <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> (a/w SLE)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinically present with <span class=\"customMeta\" data-dictid=\"d28003a82c1692777202475273e346\">flaccid</span> blisters and erosions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinically present with erosions and rarely blisters</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:768px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chronic Bullous Disorder of Childhood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dermatitis Herpetiformis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pemphigus Vulgaris</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pemphigus Foliaceus</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bullous Pemphigoid</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cutaneous Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">Tense</span> vesicles on normal/ urticarial patches</p>\n<p>• <strong>String of pearls </strong>appearance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Polymorphic (small vesicles, erythematous papules, and urticarial plaques) - erosions</p>\n<p>• Crusts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Flaccid blisters • Painful/ persistent erosions and crusts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Exfoliative dermatitis</p>\n<p>• Arcuate, circinate, or <span class=\"customMeta\" data-dictid=\"ce3cc4c1bd16927771967fba44f261\">polycyclic</span> lesions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Large, <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> blisters that may be hemorrhagic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Most Common Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Face, Extremities, Genital area, Trunk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extensor surfaces of limbs, Buttocks, Shoulders, Nape of neck, Scalp</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scalp, Face, Upper torso, <strong>Oral <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> only</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Head and neck</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acral (palms and soles),<strong> Flexural areas</strong> (inner thighs, axillae, and groin)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pruritus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>±</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>++++</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>± to +++</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mucosal Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent and severe</p>\n<p><strong>(oral <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> mostly)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LAD 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermal <span class=\"customMeta\" data-dictid=\"8da830779416927772004eec86224b\">trans</span> <span class=\"customMeta\" data-dictid=\"0f74dab81916927771887fc3d3c5aa\">glutaminase</span> 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dsg 1, 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dsg 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BPAG2/ BPAG1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HLA DQ2, DQ8.</strong></p>\n<p>Commonly associated with <strong>gluten sensitive enteropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ ve nikolsky sign,</p>\n<p>Bulla spread sign: <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> angulated margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>- ve nikolsky sign, Bulla spread sign: regular round margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• <strong>Subepidermal blisters </strong></p>\n<p>• Inflammatory <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> with eosinophils and neutrophils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Subepidermal blisters with <span class=\"customMeta\" data-dictid=\"041f0e547a1692777193350b3f7d39\">neutrophilic</span> microabscesses within <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n<p>• Fibrin deposition • Granular deposits of IgA within <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Acantholysis</p>\n<p>(Suprabasal split)</p>\n<p>• <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">Dermal</span> <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> (lymphocytes, eosinophils and neutrophils)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Subtle acantholysis</p>\n<p>• <strong>Subcorneal </strong>separation</p>\n<p>• <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">Dermal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> ± eosinophils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Subepidermal blisters with eosinophilia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Direct Immunofluorescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Linear <strong>IgA </strong>along <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> junction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Granular deposits of IgA within <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgG deposition around keratinocytes (fish net or <span class=\"customMeta\" data-dictid=\"b8938475cf1692777185ca43d57b41\">crazy paving</span> pattern)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deposition of IgG around keratinocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Linear deposits of IgG or C3 at basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> zone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Díaz, M.S. &amp; Morita, L. &amp; Ferrari, Bruno &amp; Sartori, S. &amp; Greco, M.F. &amp; Bonells, L. &amp; González-Enseñat, M.A. &amp; Villa, M.A. &amp; Larralde, Margarita. \" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Direct-immunofluorescence-findings-in-linear-IgA-bullous-dermatosis-Note-the-linear-IgA_fig3_335686136\" data-tags=\"\" height=\"607\" src=\"https://image.prepladder.com/content/kS9NjW3DgE7F3KXBbg3m1747902890.png\" width=\"846\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Michael Occidental, M.D., Randie H. Kim, M.D., Ph.D.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/imgau/skinnontumordermatitisherpetiformisKim02.jpg\" data-tags=\"\" height=\"3016\" src=\"https://image.prepladder.com/content/NEC724BLFQ1Yso6GWwL51747902901.png\" width=\"4015\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Reunala, Timo &amp; Salmi, Teea &amp; Hervonen, Kaisa &amp; Kaukinen, Katri &amp; Collin, Pekka. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/publication/325122702/figure/fig1/AS:11431281211273433@1702371758088/Dermatitis-herpetiformis-Typical-scratched-papules-and-macules-on-the-elbows-A-and-on.tif\" data-tags=\"\" height=\"2359\" src=\"https://image.prepladder.com/content/v5eLHhCWu62kcQYIJ8YW1747903024.png\" width=\"3928\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jeffrey N. Li ∙ Parth Patel ∙ Cristian Gonzalez ∙ Travis Vandergriff ∙ Heather Goff\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.jaadcasereports.org/article/S2352-5126(21)00141-7/fulltext\" data-tags=\"\" height=\"3778\" src=\"https://image.prepladder.com/content/NJmM5DcMrqbBuNIlgH4R1747970593.png\" width=\"3526\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Liza Mohapatra,Kallolinee Samal,Prasenjeet Mohanty,Siddhartha Dash\" data-hash=\"\" data-license=\"CC BY-NC-SA\" data-source=\"https://www.researchgate.net/figure/Bullous-pemphigoid-Direct-immunofluorescence-study-showing-linear-immunoglobulin-G-and_fig1_334253361\" data-tags=\"\" height=\"907\" src=\"https://image.prepladder.com/content/S3PuptMJg3ESe9oZSQf71747903066.png\" width=\"1198\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First-line Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dapsone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dapsone, Gluten-free diet (<strong>B</strong>arley, <strong>R</strong>ye, <strong>O</strong>ats, <strong>W</strong>heat)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High dose <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> corticosteroids,</p>\n<p><strong>Cyclophosphamide</strong> ( s/e hemorrhagic cystitis), <strong>Rituximab:</strong> <span class=\"customMeta\" data-dictid=\"4665fdd0a0169277718100f58eb0d5\">anti</span> CD 20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic or <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> corticosteroids</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low dose <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> corticosteroids</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with sinusitis, ulcerative lesions on the nasopharynx, nodular lesions with cavitations of the lung, and renal failure. Which of the following is the most useful investigation in this patient?", "options": [{"label": "A", "text": "Test for ANCA", "correct": true}, {"label": "B", "text": "Biopsy to show granuloma", "correct": false}, {"label": "C", "text": "AFB staining of sputum", "correct": false}, {"label": "D", "text": "BAL", "correct": false}], "correct_answer": "A. Test for ANCA", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with giant cell arteritis presented with headache, jaw claudication, polymyalgia rheumatica, and mononeuritis multiplex. What should be the first-line treatment for this patient?", "options": [{"label": "A", "text": "Abatacept", "correct": false}, {"label": "B", "text": "Tocilizumab", "correct": false}, {"label": "C", "text": "Steroids", "correct": true}, {"label": "D", "text": "Aspirin", "correct": false}], "correct_answer": "C. Steroids", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents with numbness of her fingertips. On examination, her face is tightened. The antinuclear antibody(ANA) is found to be positive and immunofluorescence shows the nucleolar pattern. What is the likely diagnosis?", "options": [{"label": "A", "text": "Systemic sclerosis", "correct": true}, {"label": "B", "text": "Sjogren’s syndrome", "correct": false}, {"label": "C", "text": "Systemic lupus erythematosus", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "A. Systemic sclerosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/77GucPj9qUqDqihvFilI1746442122.png", "https://image.prepladder.com/notes/74mADEIJKq1RYm7wIre51746442146.png", "https://image.prepladder.com/notes/Z06KwHpWl74LLDjsgvWx1746442171.png", "https://image.prepladder.com/notes/AQq5QLvSi1q7x2NkxScL1746442200.png", "https://image.prepladder.com/content/wRqpzGg4A28Vupt8mnYX1745410216.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 36-year-old woman presented with claudication in the forearm, transient loss of vision, and abdominal pain. Femoral pulses were weak. Fundus examination revealed retinal haemorrhages. What is the likely diagnosis?", "options": [{"label": "A", "text": "Polyarteritis nodosa", "correct": false}, {"label": "B", "text": "Thromboangitis obliterans", "correct": false}, {"label": "C", "text": "Takayasu arteritis", "correct": true}, {"label": "D", "text": "Microscopic polyangiitis", "correct": false}], "correct_answer": "C. Takayasu arteritis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is not associated with Iritis ?", "options": [{"label": "A", "text": "SLE", "correct": false}, {"label": "B", "text": "Behcet’s disease", "correct": false}, {"label": "C", "text": "Ulcerative colitis", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": true}], "correct_answer": "D. Rheumatoid arthritis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is more common in limited cutaneous systemic sclerosis when compared to diffuse cutaneous systemic sclerosis?", "options": [{"label": "A", "text": "Esophageal dysmotility", "correct": true}, {"label": "B", "text": "Myopathy", "correct": false}, {"label": "C", "text": "Interstitial lung disease", "correct": false}, {"label": "D", "text": "Scleroderma renal crisis", "correct": false}], "correct_answer": "A. Esophageal dysmotility", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Limited <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">Cutaneous</span> SSc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diffuse <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">Cutaneous</span> SSc</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Indolent onset</li>\n<li>Limited to fingers, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to elbows, face</li>\n<li>Slow progression</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid onset</li>\n<li>Diffuse: fingers, extremities, face, trunk</li>\n<li>Rapid progression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Raynaud's phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antedates skin involvement, sometimes by years</li>\n<li>May be associated with critical <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> in the digits</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Onset coincident with skin involvement</li>\n<li>Critical <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> less common</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Musculoskeletal (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild arthralgia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe arthralgia</li>\n<li>Carpal tunnel syndrome</li>\n<li>Tendon <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rubs</li>\n<li>Frequent, early onset and progression, can be severe</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal dysmotility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90% of cases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>80% of cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Interstitial lung disease (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Slowly progressive</li>\n<li>Generally mild</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent, early onset and progression, can be severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulmonary arterial hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent, late, may occur as an isolated complication</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often occurs in association with <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> lung disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scleroderma <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very rare</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs in 15%; generally early (&lt;4 years from disease onset)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcinosis cutis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent, prominent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common, mild</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic autoantibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anti-centromere</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anti-topoisomerase (Scl-70), anti-RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> III</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with uveitis, enthesitis, and sacroiliitis. Which of the following is most likely associated with this condition?", "options": [{"label": "A", "text": "HLA-B27", "correct": true}, {"label": "B", "text": "HLA-B57", "correct": false}, {"label": "C", "text": "HLA-B51", "correct": false}, {"label": "D", "text": "HLA-B5", "correct": false}], "correct_answer": "A. HLA-B27", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>General Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Spine and Joint involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extra-articular manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inflammatory back pain</strong>: <strong>Gradual onset, worse with inactivity, improves with movement</strong> and is often associated with early morning stiffness.</li>\n<li><strong>Fatigue</strong>: A common and significant symptom.</li>\n<li><strong>Postural changes</strong>: Loss of <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> lordosis, increased <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> kyphosis, and forward stooping of the neck.</li>\n<li><strong>Enthesitis</strong>: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> at <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> sites, often mistaken for fibromyalgia.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Peripheral joint involvement</strong>: Affects large joints like<strong> hips, knees</strong>, and shoulders and is usually asymmetrical.</li>\n<li><strong>Sacroiliac joint involvement</strong>: B/L and asymmetrical; pain may <span class=\"customMeta\" data-dictid=\"f4a826ea4916927771977e2f55c16f\">radiate</span> to the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> thighs.</li>\n<li><strong>Reduced <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility:</strong> Limited movement in the <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> region due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and pain, often accompanied by muscle spasms.</li>\n</ul>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anterior uveitis:</strong> <strong>Most common extra <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> manifestation.</strong> Presents with sudden <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> eye pain, redness, and light sensitivity, often preceding joint symptoms.</li>\n<li>Anaemia, prostatitis, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease, <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> disease, and very rare cases of <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">amyloidosis</span> or upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</li>\n<li><strong>Osteoporosis</strong>: This can lead to vertebral fractures, especially with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations of Ankylosing Spondylitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>X-rays </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MRI </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>HLA-B27:</strong><strong> </strong>The presence of the HLA-B27 gene is a strong indicator of AS. The <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of AS in the general population is less than 0.5%.</li>\n<li><strong>Inflammatory Markers</strong>: Elevated <span class=\"customMeta\" data-dictid=\"49069760291692777187e0e72db819\">ESR</span> and <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> levels may indicate active disease.</li>\n<li><strong>Faecal Calprotectin</strong>: Helps screen for associated <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Show characteristic changes in <strong>sacroiliac joints</strong>, such as:</p>\n<ul>\n<li>Blurred <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> margins</li>\n<li>Erosions and sclerosis</li>\n<li>\"Pseudowidening\" of joint space (early stages)</li>\n<li>Joint space narrowing and <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (later stages)</li>\n<li><strong>Bamboo spine </strong>- Vertebral body <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> by syndesmophytes</li>\n<li><strong>Dagger sign </strong>- <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">Calcification</span> appears as a single <span class=\"customMeta\" data-dictid=\"418c408a7716927771979034974902\">radiodense</span> line vertically running down the spine on <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> radiographs.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Investigation of choice – <strong>more sensitive</strong> than <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> for detecting early <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> changes.</li>\n<li>Can reveal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> oedema, enthesitis, synovitis, and erosions.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:515px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HLA Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-A1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reiter's syndrome</li>\n<li>Ankylosing spondylitis</li>\n<li>Juvenile <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> cholangitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE)</li>\n<li>Autoimmune hepatitis</li>\n<li>Multiple sclerosis</li>\n<li>Type 1 diabetes</li>\n<li>Melanoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-B8</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Celiac disease</li>\n<li>Autoimmune hepatitis</li>\n<li>Addison's disease</li>\n<li>Myasthenia gravis</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> cholangitis</li>\n<li>Dermatitis herpetiformis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-B27</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ankylosing spondylitis</li>\n<li>Reiter's syndrome (Reactive arthritis)</li>\n<li>Psoriatic arthritis</li>\n<li>Crohn's disease</li>\n<li>Ulcerative colitis</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> uveitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-B35</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ulcerative colitis</li>\n<li>Psoriasis</li>\n<li>Chronic active hepatitis</li>\n<li>Rheumatoid arthritis</li>\n<li>Subacute thyroiditis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-B51</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Behçet’s disease</li>\n<li>Uveitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-B5</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Behçet’s disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-B57</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slower <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-DR1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rheumatoid arthritis</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE)</li>\n<li>Vasculitis</li>\n<li>Pemphigus vulgaris</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-DR2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multiple sclerosis</li>\n<li>Allergic rhinitis</li>\n<li>Narcolepsy</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE)</li>\n<li>Goodpasture's syndrome</li>\n<li>Leprosy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-DR3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Type 1 diabetes</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE)</li>\n<li>Graves' disease</li>\n<li>Hashimoto’s thyroiditis</li>\n<li>Sjögren's syndrome</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"dd9fbecbed1692777184ab44e1624c\">cholangitis</span> (PBC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-DR4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rheumatoid arthritis</li>\n<li>Juvenile arthritis</li>\n<li>Insulin-dependent <span class=\"customMeta\" data-dictid=\"b6a934c67b16927771868fca92baf9\">diabetes mellitus</span> (Type 1 diabetes)</li>\n<li>Giant cell arteritis</li>\n<li>Pemphigus vulgaris</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-DR5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Graves' disease</li>\n<li>Hashimoto's thyroiditis</li>\n<li>Chronic active hepatitis</li>\n<li>Pernicious anemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-DQ2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Celiac disease</li>\n<li>Dermatitis herpetiformis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HLA-DQ8</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Celiac disease</li>\n<li>Type 1 diabetes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with pauci-immune glomerulonephritis?", "options": [{"label": "A", "text": "SLE nephritis", "correct": false}, {"label": "B", "text": "Anti-GBM glomerulonephritis", "correct": false}, {"label": "C", "text": "IgA nephropathy", "correct": false}, {"label": "D", "text": "Granulomatosis with polyangiitis (GPA)", "correct": true}], "correct_answer": "D. Granulomatosis with polyangiitis (GPA)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\"&gt;Granulomatosis&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\"&gt;polyangiitis&lt;/span&gt; (GPA):</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antibodies/Labs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Granulomatosis with <span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\">Polyangiitis</span> (GPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pauci-immune vasculitis</strong></li>\n<li>Upper/lower respiratory</li>\n<li><strong>Glomerulonephritis</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>PR3-ANCA</li>\n<li>c-ANCA pattern</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Granulomatous inflammation</li>\n<li>Small vessel vasculitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Microscopic Polyangiitis</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pulmonary-renal syndrome</li>\n<li>No granulomas</li>\n<li>Segmental <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> GN</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MPO-ANCA</li>\n<li>p-ANCA pattern</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Necrotizing vasculitis</li>\n<li>No granulomas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Churg-Strauss Syndrome/ <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">Eosinophilic</span> <span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\">Granulomatosis</span> with Polyangitis (EGPA) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asthma</li>\n<li>Peripheral eosinophilia</li>\n<li>Allergic rhinitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MPO-ANCA</li>\n<li>p-ANCA pattern</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eosinophilic granulomas</li>\n<li>Vasculitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mixed Cryoglobulinemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often HCV-associated</li>\n<li>Purpura</li>\n<li>Arthralgias</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cryoglobulins</li>\n<li>HCV antibodies</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immune complex deposits</li>\n<li>Small vessel vasculitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old female patient visits you with symptoms of finger swelling, heartburn, and occasional joint pain. During the examination, her hands appeared shiny, tight, and thickened with non-pitting oedema. Additionally, she has interstitial lung disease and tests positive for ANA antibodies, topoisomerase I antibodies, and anti-RNA polymerase III antibodies. What is the likely diagnosis?", "options": [{"label": "A", "text": "Limited cutaneous systemic sclerosis", "correct": false}, {"label": "B", "text": "Diffuse cutaneous systemic sclerosis", "correct": true}, {"label": "C", "text": "Raynaud's phenomenon", "correct": false}, {"label": "D", "text": "Peutz-jeghers syndrome", "correct": false}], "correct_answer": "B. Diffuse cutaneous systemic sclerosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6RoGO7hp91A5d3M1AAmJ1746784859.png", "https://image.prepladder.com/content/r2spFRZIBa3tuR7hkBds1746784876.png", "https://image.prepladder.com/content/IE973bltaGSa4Jh4f52y1746784891.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman complains of dryness in her mouth and eyes and has positive anti-Ro and anti-La antibodies. The image below shows a positive test result with a score of less than 5 mm in 5 minutes without anaesthesia. What is the probable diagnosis?", "options": [{"label": "A", "text": "Scleroderma", "correct": false}, {"label": "B", "text": "Dehydration", "correct": false}, {"label": "C", "text": "Lacrimal duct stones", "correct": false}, {"label": "D", "text": "Sjogren syndrome", "correct": true}], "correct_answer": "D. Sjogren syndrome", "question_images": ["https://image.prepladder.com/content/246FctK0etnEp3xkhrgz1746791714.png"], "explanation_images": ["https://image.prepladder.com/content/F80p7spBJ5eaAaoEvY8u1746791767.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 21-year-old woman with no comorbidities presented with numbness and paraesthesia of the fingers of both hands along with the characteristic finding as shown in the image below. She has no other illnesses and she says these episodes occur when she is under excess stress or during cold climates. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary Raynaud’s phenomenon", "correct": true}, {"label": "B", "text": "Secondary Raynaud’s phenomenon", "correct": false}, {"label": "C", "text": "Cold sores", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": false}], "correct_answer": "A. Primary Raynaud’s phenomenon", "question_images": ["https://image.prepladder.com/content/xeU7NIuzbvDJetxdXEcT1746792282.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man is experiencing chronic pain in his hands, knees, and hips, with increased pain in the hands during writing or typing. Additionally, he has morning stiffness in his joints that lasts for about 30 minutes. On examination, Heberden's and Bouchard's nodes are visible in the hands, and an X-ray of the knee shows narrowed joint space with osteophytes. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteoporosis", "correct": false}, {"label": "B", "text": "Osteoarthritis", "correct": true}, {"label": "C", "text": "Rheumatoid arthritis", "correct": false}, {"label": "D", "text": "Bone tumour", "correct": false}], "correct_answer": "B. Osteoarthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Osteoarthritis (OA)</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Psoriatic Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reactive Arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Joint Involvement Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symmetrical involvement of small joints (MCP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, especially DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, often DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically involves a single joint (e.g., big toe)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, often larger joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morning Stiffness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lasts over 1 hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resolves within 30 minutes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varies, often significant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely significant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable often follows infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling, tenderness, deformities (e.g., <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pain and <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> with use</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dactylitis, nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden, severe pain and swelling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Joint pain following an infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP, PIP, wrists, knees</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Knees, hips, hands (DIP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP, PIP, and can include spine and tendons</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically big toe (1st MTP joint)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Larger joints (e.g., knees, ankles)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiographic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft tissue swelling, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Osteophytes, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erosions, possible nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erosions and <span class=\"customMeta\" data-dictid=\"23ed22c5821692777200820f6150ac\">tophi</span> possible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar to RA but typically larger joints</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old woman presented with changes in the hand as shown below. There is decreased motion in the small joints and loss of wrinkle lines on the facial skin. Her chest radiograph showed prominent bilateral lower lobe infiltrates. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Rheumatoid arthritis", "correct": false}, {"label": "B", "text": "Scleroderma", "correct": true}, {"label": "C", "text": "Systemic lupus Erythematosus", "correct": false}, {"label": "D", "text": "Pneumonia", "correct": false}], "correct_answer": "B. Scleroderma", "question_images": ["https://image.prepladder.com/content/yKSizBHKlSkH2wL1qHAU1747047039.png"], "explanation_images": ["https://image.prepladder.com/content/jWv9nfXi6wxSBz5CQBhn1747047071.png", "https://image.prepladder.com/content/ozFZtrOMlR2iUSkCEXXz1747047071.png", "https://image.prepladder.com/content/dn3CPS8QUfIecdnztlSz1747047071.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which condition necessitates the use of anti-nuclear antibodies for accurate diagnosis?", "options": [{"label": "A", "text": "Scleroderma", "correct": false}, {"label": "B", "text": "Systemic lupus erythematosus", "correct": true}, {"label": "C", "text": "Drug induced lupus", "correct": false}, {"label": "D", "text": "Sjogren's syndrome", "correct": false}], "correct_answer": "B. Systemic lupus erythematosus", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Erythematosus (SLE)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Definition</p>\n</td>\n<td>\n<p>Chronic <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disease that can affect multiple organs and tissues.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Diagnostic Criteria</p>\n</td>\n<td>\n<p>Presence of at least four of the following criteria, with at least one clinical and one <span class=\"customMeta\" data-dictid=\"fced475d231692777189effb72c5c7\">immunologic</span> criterion:&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"b5e3350aab16927771912aa39c71f5\">Malar</span> rash: \"Butterfly\" <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> over the cheeks.&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"0af8272baf1692777186883cc728db\">Discoid</span> rash: Red, raised patches with scaling.&lt;br&gt; - Photosensitivity: Skin <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> after sun exposure.&lt;br&gt; - Oral ulcers: Painless ulcers in the mouth or nose.&lt;br&gt; - Arthritis: Non-erosive <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> affecting two or more <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> joints.&lt;br&gt; - Serositis: <span class=\"customMeta\" data-dictid=\"fa734f0ec81692777195c12e3e6a7c\">Pleuritis</span> or pericarditis.&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> disorder: <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">Proteinuria</span> or <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> casts in urine.&lt;br&gt; - Neurologic disorder: Seizures or psychosis.&lt;br&gt; - Hematologic disorder: <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> anemia, leukopenia, or lymphopenia.&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"fced475d231692777189effb72c5c7\">Immunologic</span> disorder: Positive anti-nuclear antibodies (ANA) or other specific autoantibodies.&lt;br&gt; - Positive anti-dsDNA or anti-Smith antibodies.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Laboratory Tests</p>\n</td>\n<td>\n<p>Complete <span class=\"customMeta\" data-dictid=\"57525e6f6416927771835d0fb0bee5\">blood count</span> (CBC): May show anemia, leukopenia, or thrombocytopenia.&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"64e0895e441692777187dad4949f29\">Erythrocyte</span> <span class=\"customMeta\" data-dictid=\"d53a6ee0c81692777198aeb94eb4ca\">sedimentation</span> rate (ESR) and C-reactive protein (CRP): Elevated markers of inflammation.&lt;br&gt; - Urinalysis: <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">Proteinuria</span> and <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> casts.&lt;br&gt; - Anti-nuclear antibodies (ANA): Positive in most <span class=\"customMeta\" data-dictid=\"d9bf27b09416927771984cdc6c0bc4\">SLE</span> cases.&lt;br&gt; - Anti-dsDNA and anti-Smith antibodies: Highly specific for SLE.&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">Complement</span> levels: May be decreased in active disease.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Additional Tests</p>\n</td>\n<td>\n<p>Anti-phospholipid antibodies: <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> anticoagulant, anticardiolipin, or anti-beta-2 <span class=\"customMeta\" data-dictid=\"6c9fa3a73216927771888299c86e08\">glycoprotein</span> antibodies.&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> biopsy: May be performed to evaluate <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> involvement.&lt;br&gt; - Other <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> and organ-specific tests as needed for specific organ involvement.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Differential Diagnosis</p>\n</td>\n<td>\n<p>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (RA)&lt;br&gt; - Sjögren's syndrome&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> sclerosis&lt;br&gt; - Dermatomyositis&lt;br&gt; - Drug-induced lupus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Clinical Management</p>\n</td>\n<td>\n<p>Individualized treatment based on disease severity and organ involvement.&lt;br&gt; - Nonsteroidal anti-inflammatory drugs (NSAIDs) for mild <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> and <span class=\"customMeta\" data-dictid=\"09b955b4f91692777193bd4080e7fc\">musculoskeletal</span> symptoms.&lt;br&gt; - Corticosteroids: <span class=\"customMeta\" data-dictid=\"5dff8e3fac1692777196f8c0c960f3\">Prednisone</span> is commonly used for moderate to severe disease.&lt;br&gt; - Immunosuppressants: Azathioprine, methotrexate, mycophenolate mofetil, or <span class=\"customMeta\" data-dictid=\"a6ed2a5f63169277718507c569e576\">cyclophosphamide</span> may be prescribed for <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> or organ-threatening disease.&lt;br&gt; - Hydroxychloroquine: Used for skin and joint manifestations.&lt;br&gt; - Patient education, counseling, and support.&lt;br&gt; - Regular monitoring and follow-up to assess disease activity and organ involvement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with severe pain and swelling in his knee joint for 10 days. He also complains of pain and discomfort during urination. He says that he had diarrhea one month ago and he has been unwell since then. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Reactive arthritis", "correct": true}, {"label": "B", "text": "Enteropathic arthritis", "correct": false}, {"label": "C", "text": "Rheumatoid arthritis", "correct": false}, {"label": "D", "text": "Psoriatic arthritis", "correct": false}], "correct_answer": "A. Reactive arthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Osteoarthritis (OA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Psoriatic Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reactive Arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Joint Involvement Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symmetrical involvement of small joints (MCP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, especially DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, often DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically involves a single joint (e.g., big toe)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, often larger joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morning Stiffness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lasts over 1 hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resolves within 30 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varies, often significant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely significant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable often <strong>follows infection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling, tenderness, deformities (e.g., <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pain and <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> with use</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dactylitis, nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden, severe pain and swelling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Joint pain following an infection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP, PIP, wrists, knees</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Knees, hips, hands (DIP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP, PIP, and can include spine and tendons</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically big toe (1st <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> joint)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Larger joints ( knees, ankles)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiographic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft tissue swelling, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Osteophytes, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erosions, possible nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erosions and <span class=\"customMeta\" data-dictid=\"23ed22c5821692777200820f6150ac\">tophi</span> possible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar to RA but typically larger joints</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady presents with recurrent bluing of her hands, stretching of her skin, difficulty swallowing, and lung lesions. What is the pattern of ANA and the diagnosis?", "options": [{"label": "A", "text": "Speckled pattern, SLE", "correct": false}, {"label": "B", "text": "Nuclear pattern, SLE", "correct": false}, {"label": "C", "text": "Anti-centromere pattern, CREST", "correct": true}, {"label": "D", "text": "Homogeneous pattern, systemic sclerosis", "correct": false}], "correct_answer": "C. Anti-centromere pattern, CREST", "question_images": ["https://image.prepladder.com/content/hsR019xh1y2Xjj6VLyFL1741866401.png"], "explanation_images": ["https://image.prepladder.com/content/9WULqkYsc5v7wupbKZjE1741866440.png", "https://image.prepladder.com/content/zuGVFR4eJMOlqlgrfQxg1741866475.png", "https://image.prepladder.com/content/68TJkO6ZDIbDNcMsssVN1741866503.png", "https://image.prepladder.com/content/eVFG4r6OYu5HqiUX5J3t1741866528.png", "https://image.prepladder.com/content/7Cri8Nj45g8r2FVUFXw41741866606.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:736px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Associations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Centromeric</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"908\" src=\"https://image.prepladder.com/content/9WULqkYsc5v7wupbKZjE1741866440.png\" width=\"1082\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fine, <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> speckling of the <span class=\"customMeta\" data-dictid=\"c0ca0c53601692777184a1f6e29e6c\">centromere</span> of chromosomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">Sclerosis</span> (especially limited form, <span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\">CREST</span> syndrome)</li>\n<li>Mixed <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">Connective</span> Tissue Disease (MCTD).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nucleolar</strong></p>\n<p><strong>(Option B)</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"908\" src=\"https://image.prepladder.com/content/zuGVFR4eJMOlqlgrfQxg1741866475.png\" width=\"932\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large, prominent <span class=\"customMeta\" data-dictid=\"2a251c31bc1692777193e31a6b738a\">nucleoli</span> within the cell nucleus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">Sclerosis</span> (particularly in patients with <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> lung disease)</li>\n<li>Polymyositis</li>\n<li>Sjögren's Syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Homogeneous</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"3122\" src=\"https://image.prepladder.com/content/68TJkO6ZDIbDNcMsssVN1741866503.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth, uniform <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> of the entire nucleus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Erythematosus (SLE)</li>\n<li>Drug-induced lupus</li>\n<li>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral/Rim</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/eVFG4r6OYu5HqiUX5J3t1741866528.png\" width=\"4168\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intense <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> of the nuclear <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> or periphery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Erythematosus (SLE), highly suggestive of SLE, especially with associated anti-dsDNA antibodies.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Speckled</strong></p>\n<p><strong>(Option A)</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"3302\" src=\"https://image.prepladder.com/content/7Cri8Nj45g8r2FVUFXw41741866606.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fine or <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> speckling throughout the nucleus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>SLE</li>\n<li>Sjogren’s Syndrome</li>\n<li>Scleroderma</li>\n<li>Polymyositis</li>\n<li>Rheumatoid Arthritis</li>\n<li>Mixed <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">Connective</span> Tissue</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>Speckled pattern can be nonspecific.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presents with oral ulcers and ulcers in the anal canal. He is diagnosed with Behçet's disease. Which of the following is not seen in this condition?", "options": [{"label": "A", "text": "Ulcer over the dorsum of the penis", "correct": true}, {"label": "B", "text": "It is more similar to Crohn's disease than ulcerative colitis", "correct": false}, {"label": "C", "text": "Bilateral panuveitis", "correct": false}, {"label": "D", "text": "Pathergy test positive is a criterion of ISG diagnostic criteria", "correct": false}], "correct_answer": "A. Ulcer over the dorsum of the penis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kO3hZ4R1vL5vyd6DrKOT1741867490.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>T-cell mediated immunity</li>\n<li>Th1 cell activation</li>\n<li>Elevated cytokines (IL-1, TNF-α)</li>\n<li>Neutrophilic vasculitis</li>\n<li>No specific autoantibodies</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Auto-inflammatory rather than autoimmune</li>\n<li>Affects vessels of all sizes</li>\n<li>Treatment targets inflammation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucocutaneous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral ulcers (97-99%)</li>\n<li>Genital ulcers (&gt;80%)</li>\n<li>Erythema nodosum</li>\n<li>Pathergy reaction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often initial presentation</li>\n<li>Oral ulcers heal without scarring</li>\n<li>Genital ulcers leave scars</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>B/L uveitis</strong> (&gt;50%) <strong>(Option C)</strong></li>\n<li>Vascular (25%)</li>\n<li>Neurologic (5-10%)</li>\n<li>Arthritis (non-erosive)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More severe in males</li>\n<li>Ocular disease can cause blindness</li>\n<li>Vascular involvement can be fatal</li>\n<li>Presents similar to <span class=\"customMeta\" data-dictid=\"5eddae989e1692777189a59921cc61\">IBD</span> (<strong>Crohn's disease</strong> &gt; <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">Ulcerative</span> colitis) <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria (ITR-ICBD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two Points Each:</p>\n<ul>\n<li>Genital aphthosis</li>\n<li>Ocular lesions</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>One Point Each:</p>\n<ul>\n<li>Oral aphthosis</li>\n<li>Skin lesions</li>\n<li>Vascular manifestations</li>\n<li><strong>Positive <span class=\"customMeta\" data-dictid=\"d29883e7151692777194b3427950d0\">pathergy</span> </strong><strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥3 points needed for diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-specific <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> markers</li>\n<li>No specific autoantibodies</li>\n<li>ESR, <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> elevation</li>\n<li>Leukocytosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps rule out other conditions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Required Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ophthalmologic examination</li>\n<li>Pathergy test</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> if needed</li>\n<li>Imaging, based on symptoms</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirms involvement and monitors complications</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucocutaneous Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Colchicine 1-2mg/day</li>\n<li>Topical steroids</li>\n<li>Topical sucralfate</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory: <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> steroids, azathioprine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anterior: <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">Topical</span> steroids</li>\n<li>Posterior: Steroids + azathioprine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory: <span class=\"customMeta\" data-dictid=\"6dfb2b0c981692777200eae81482e9\">TNF</span> inhibitors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vascular: High-dose steroids + cyclophosphamide</li>\n<li>Neurologic: High-dose steroids + immunosuppression</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires aggressive therapy and monitoring</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with joint swelling, a pan systolic murmur, negative rheumatoid factor (RF), and elevated ESR. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute rheumatic fever", "correct": true}, {"label": "B", "text": "Seronegative rheumatoid arthritis (RA)", "correct": false}, {"label": "C", "text": "Juvenile spondyloarthropathy", "correct": false}, {"label": "D", "text": "Ankylosing spondylitis", "correct": false}], "correct_answer": "A. Acute rheumatic fever", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; rheumatic fev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After confirming a diagnosis of gout, which of the following drugs is a purine analog that would be most appropriate for management?", "options": [{"label": "A", "text": "Allopurinol", "correct": true}, {"label": "B", "text": "Capecitabine", "correct": false}, {"label": "C", "text": "Cytarabine", "correct": false}, {"label": "D", "text": "Febuxostat", "correct": false}], "correct_answer": "A. Allopurinol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not true about ankylosing spondylitis?", "options": [{"label": "A", "text": "Affect males more than females", "correct": false}, {"label": "B", "text": "HLA B27 associated", "correct": false}, {"label": "C", "text": "Involvement of sacroiliac joints", "correct": false}, {"label": "D", "text": "Its non erosive and only joints are affected", "correct": true}], "correct_answer": "D. Its non erosive and only joints are affected", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Its &lt;span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\"&gt;non&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d6ccfc448916927771877d9bde179f\"&gt;erosive&lt;/span&gt; and only joints are affected: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman experiences skin thickening, muscle weakness, and pale peripheries upon cold exposure. Her creatine kinase is increased with positive ANA, and biopsy revealed scl-70 positivity and perifascicular infiltration. What is the antibody linked to this condition?", "options": [{"label": "A", "text": "Anti PM /Scl antibody", "correct": true}, {"label": "B", "text": "Anti Jo1 antibody", "correct": false}, {"label": "C", "text": "Anti centromere antibody", "correct": false}, {"label": "D", "text": "Antinuclear antibody", "correct": false}], "correct_answer": "A. Anti PM /Scl antibody", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3bOfvEeSYLP6Or1dQtwM1745932115.png", "https://image.prepladder.com/content/KZfgy4sHfvIFccJ5USEJ1745932198.png", "https://image.prepladder.com/content/oB3yab1DiQOI8X30FZya1745932206.png", "https://image.prepladder.com/content/Az8BFa932l9fP5fOWATq1745932215.png", "https://image.prepladder.com/content/powiTbdgA8CNSrvVi7hI1745932223.png", "https://image.prepladder.com/content/yYRMVMK1TQ458lpuLW1O1745932235.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"4665fdd0a0169277718100f58eb0d5\"&gt;Anti&lt;/span&gt; PM /Scl antibody</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diffuse </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Limited</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal &amp; Distal extremities, face, trunk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal to elbows, face</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Raynaud’s Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Onset &lt;1 year/at the time of skin changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Precede skin diseases by years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pulmonary (Interstitial fibrosis),</li>\n<li>Renal (Renovascular <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> crisis),</li>\n<li>GI &amp; Cardiac</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GI, Biliary cirrhosis, Pulmonary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nail fold capillaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilatation and dropout</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilatation without significant dropout</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antinuclear antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anti-topoisomerase 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anticentromere</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\"><strong>Auto-Antibody</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>SSc SUBSET</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Prominent characteristic</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Topoisomerase I (Scl-70)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>dcSSc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Speckled pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Michael Mahler, Marvin J. Fritzler\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2012/494356\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/KZfgy4sHfvIFccJ5USEJ1745932198.png\" width=\"464\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li>Tendon <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rubs, digital ischemic ulcers, scleroderma, extensive skin involvement, early ILD, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> involvement, <span class=\"customMeta\" data-dictid=\"85cd27a4521692777198d76c839cb2\">scleroderma</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Centromere proteins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>lcSSc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Discrete speckled (centromere) pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Simon Caulton \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Anti-centromere_antibodies#/media/File:CENTROMERE.jpg\" data-tags=\"\" height=\"404\" src=\"https://image.prepladder.com/content/oB3yab1DiQOI8X30FZya1745932206.png\" width=\"456\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Digital ischemic ulcers, <span class=\"customMeta\" data-dictid=\"a28b336ec21692777183ec0b5e47f9\">calcinosis</span> cutis, isolated PAH; <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis rare</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>dcSSc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Speckled pattern</li>\n<li>Rapidly progressive skin involvement, <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rubs, joint contractures, GAVE, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis, contemporaneous cancers; digital ulcers rare</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>U3-RNP (fibrillarin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Nucleolar pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Simon Caulton \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ANA_NUCLEOLAR_3.jpg\" data-tags=\"\" height=\"382\" src=\"https://image.prepladder.com/content/Az8BFa932l9fP5fOWATq1745932215.png\" width=\"461\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>PAH, ILD, <span class=\"customMeta\" data-dictid=\"85cd27a4521692777198d76c839cb2\">scleroderma</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis, GI <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement, myositis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Th/To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Nucleolar pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Simon Caulton \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ANA_NUCLEOLAR_3.jpg\" data-tags=\"\" height=\"382\" src=\"https://image.prepladder.com/content/powiTbdgA8CNSrvVi7hI1745932223.png\" width=\"461\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>ILD, PAH</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>PM/Scl</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Nucleolar pattern</li>\n<li>Calcinosis cutis, ILD, <strong>myositis overlap</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ku</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>overlap</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Speckled pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Michael Mahler, Marvin J. Fritzler\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2012/494356\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/yYRMVMK1TQ458lpuLW1O1745932235.png\" width=\"464\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>SLE, <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> overlap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>U1-RNP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Speckled pattern</li>\n<li>PAH, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> arthritis, <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> overlap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>U11/U12 RNP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Speckled pattern</li>\n<li>ILD</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "40 year lady presents with difficulty in eating due to persistent dry mouth. She also has grittiness in eyes due to dry eyes. On examination, dental caries is noted with enlarged cervical lymph nodes. Possible diagnosis is:", "options": [{"label": "A", "text": "MCTD", "correct": false}, {"label": "B", "text": "Sarcoidosis", "correct": false}, {"label": "C", "text": "Sjogren syndrome", "correct": true}, {"label": "D", "text": "Wegener’s granulomatosis", "correct": false}], "correct_answer": "C. Sjogren syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sjog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old male patient complains of paranasal sinus pain and bloody nasal discharge over the past few days. He has a history of previous hemoptysis and hematuria. Imaging studies reveal multiple bilateral nodular cavitary infiltrates. Which of the following antibodies is likely to be positive in this patient?", "options": [{"label": "A", "text": "c-ANCA", "correct": true}, {"label": "B", "text": "ANA", "correct": false}, {"label": "C", "text": "Anti-histone antibodies", "correct": false}, {"label": "D", "text": "Anti-Jo 1 antibodies", "correct": false}], "correct_answer": "A. c-ANCA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - c-ANCA\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man came to the medical OPD with complaints of early morning backache and stiffness, which improves on exercise, and persistent red eyes. On examination, lung expansion was less than 3 cm. X-ray is shown in the image given below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Ankylosing Spondylitis", "correct": true}, {"label": "B", "text": "Paget's Disease", "correct": false}, {"label": "C", "text": "Healed Tuberculosis", "correct": false}, {"label": "D", "text": "Osteopetrosis", "correct": false}], "correct_answer": "A. Ankylosing Spondylitis", "question_images": ["https://image.prepladder.com/notes/VEvNQU2i9SX7RqmKejsk1745917373.png"], "explanation_images": ["https://image.prepladder.com/notes/P1nRvJi4MIy2pHGUtjOd1745917374.png"], "explanation": "<p>Correct Answer A - Ankylosing Spondylitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ankylosing <span class=\"customMeta\" data-dictid=\"42d4868c2e1692777199353a7ad077\">Spondylitis</span> - Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>General Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Spine and Joint involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extra-articular manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inflammatory back pain</strong>: <strong>Gradual onset, worse with inactivity, improves with movement</strong> and is often associated with early morning stiffness.</li>\n<li><strong>Fatigue</strong>: A common and significant symptom.</li>\n<li><strong>Postural changes</strong>: Loss of <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> lordosis, increased <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> kyphosis, and forward stooping of the neck.</li>\n<li><strong>Enthesitis</strong>: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> at <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> sites, often mistaken for fibromyalgia.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Peripheral joint involvement</strong>: Affects large joints like<strong> hips, knees</strong>, and shoulders and is usually asymmetrical.</li>\n<li><strong>Sacroiliac joint involvement</strong>: B/L and asymmetrical; pain may <span class=\"customMeta\" data-dictid=\"f4a826ea4916927771977e2f55c16f\">radiate</span> to the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> thighs.</li>\n<li><strong>Reduced <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility:</strong> Limited movement in the <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> region due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and pain, often accompanied by muscle spasms.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Anterior uveitis:</strong> <strong>Most common extra <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> manifestation.</strong> Presents with sudden <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> eye pain, redness, and light sensitivity, often preceding joint symptoms.</li>\n<li>Anaemia, prostatitis, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease, <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> disease, and very rare cases of <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">amyloidosis</span> or upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</li>\n<li><strong>Osteoporosis</strong>: This can lead to vertebral fractures, especially with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations of Ankylosing Spondylitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>X-rays </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MRI </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>HLA-B27: </strong>The presence of the HLA-B27 gene is a strong indicator of AS. The <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of AS in the general population is less than 0.5%.</li>\n<li><strong>Inflammatory Markers</strong>: Elevated ESR and CRP levels may indicate active disease.</li>\n<li><strong>Faecal Calprotectin</strong>: Helps screen for associated <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Show characteristic changes in <strong>sacroiliac joints</strong>, such as:</p>\n<ul>\n<li>Blurred <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> margins</li>\n<li>Erosions and sclerosis</li>\n<li>\"Pseudowidening\" of joint space (early stages)</li>\n<li>Joint space narrowing and <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (later stages)</li>\n<li><strong>Bamboo spine </strong>- Vertebral body <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> by syndesmophytes</li>\n<li><strong>Dagger sign </strong>- Calcification appears as a single <span class=\"customMeta\" data-dictid=\"418c408a7716927771979034974902\">radiodense</span> line vertically running down the spine on <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> radiographs.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Investigation of choice – <strong>more sensitive</strong> than X-rays for detecting early <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> changes.</li>\n<li>Can reveal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> oedema, enthesitis, synovitis, and erosions.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Radiographic Abnormalities</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Periarticular osteoporosis, joint subluxation, marginal erosions, joint space narrowing, osteoporosis, osteopenia, and vertebral fractures.</li>\n<li>Ulnar Deviation, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of Synovial Tissue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Paget’s Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bone expansion, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> trabecular pattern.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Psoriatic <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (PsA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sacroiliitis, syndesmophytes, bone sclerosis.</li>\n<li>Pencil-in-cup deformity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Osteoarthritis (OA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Joint space narrowing, osteophytes, <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> sclerosis, fractures, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> thinning, osteosclerosis, lysis, pseudofractures, proliferative <span class=\"customMeta\" data-dictid=\"e1f58a43ce169277718758e6f0a08d\">enthesis</span> erosions, enthesophytes, joint deformity, <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> cysts.</li>\n<li>Heberden’s Nodes (involvement of DIP), Bouchard’s Nodes (involvement of PIP)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ankylosing Spondylitis (AS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Joint fusion, syndesmophytes, sacroiliitis, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> calcification.</li>\n<li>Bamboo Spine, Shiny Corner Sign, Squaring of Vertebrae</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Systemic Lupus Erythematosus (SLE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Joint space narrowing, <span class=\"customMeta\" data-dictid=\"b1db3c1e5d1692777195ff7cd3e282\">periarticular</span> osteoporosis, <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> cysts, <span class=\"customMeta\" data-dictid=\"a28b336ec21692777183ec0b5e47f9\">calcinosis</span> cutis.</li>\n<li>Destructive arthritis, erosions in later stages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute inflammation, joint space narrowing, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> erosions.</li>\n<li>Tophus (urate crystal deposits in soft tissue).</li>\n<li>Martel G sign: Also known as rat-bite erosions (lytic lesions with <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> margin &amp; overhanging edge)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Scleroderma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Calcinosis cutis, soft tissue calcifications, joint space narrowing.</li>\n<li>Ray Sign (involvement of small joints of hands).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presented with difficulty in activities like climbing stairs, getting up from a chair, and combing hair. Violaceous erythema of the upper eyelids was noted. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Inclusion body myositis", "correct": false}, {"label": "B", "text": "Dermatomyositis", "correct": true}, {"label": "C", "text": "Polymyositis", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": false}], "correct_answer": "B. Dermatomyositis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/myRvfydYXDYucnm5tS5p1746192065.png", "https://image.prepladder.com/content/YgFBnzwLRk10mKHQVaL61746192073.png", "https://image.prepladder.com/content/vTaqsJu3Lv9WuZEU96K41746192082.png", "https://image.prepladder.com/content/oU4GC8TqxvxzuV222uDM1746192089.png", "https://image.prepladder.com/content/NHN47PiG57fvpxo7ggeB1746192096.png", "https://image.prepladder.com/content/5YzKKlNV9roqcA4EkvWi1746192104.png"], "explanation": "<p>Correct Answer B- Dermatomyositis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Dermatomyositis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatomyositis </strong>is a chronic, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> seen in adults around 50-60 years of age.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<ul>\n<li>It presents as <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> muscle weakness (proximal &gt; distal)</li>\n<li><strong>Gottron’s papules</strong> (erythematous <span class=\"customMeta\" data-dictid=\"a37fd1603c1692777198f87a4a51dc\">scaly</span> papules over knuckles) are <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> of the disease.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dermatomyositis2.jpg\" data-tags=\"\" height=\"330\" src=\"https://image.prepladder.com/content/myRvfydYXDYucnm5tS5p1746192065.png\" width=\"608\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Gottron’s sign</strong>: Symmetric, confluent, <span class=\"customMeta\" data-dictid=\"57d8f3ea831692777202e8adc0cee9\">violaceous</span> <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> (CMVE) on the back of fingers, on the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> surfaces of joints of the elbows, knees, or ankles</li>\n<li>CMVE is seen over other sites too, and is named accordingly.</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Heliotrope rash: </strong>CMVE over the <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> skin</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Dermatomyositis\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/YgFBnzwLRk10mKHQVaL61746192073.png\" width=\"490\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>V-Sign:</strong> CMVE over the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> aspect of the neck</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Didona, Dario &amp; Fania, Luca &amp; Didona, Biagio &amp; Eming, Rüdiger &amp; Hertl, Michael &amp; Di Zenzo, Giovanni.\" data-hash=\"\" data-license=\" CC BY\" data-source=\"https://www.researchgate.net/figure/Paraneoplastic-dermatomyositis-V-sign-Erythematous-maculopapular-rash-of-the-V-area_fig5_340099670\" data-tags=\"\" height=\"308\" src=\"https://image.prepladder.com/content/vTaqsJu3Lv9WuZEU96K41746192082.png\" width=\"396\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Shawl sign: </strong>Involvement of upper back</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Krishna Adhikari Prashant Pant Sanjeev Bhandari Sandip Paudel Buddhi Prasad Paudyal Lucky Sharma Keshav Raj Sigdel Rojina Subedi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/A-Figures-showing-V-sign-B-Shawl-sign-and-C-Holster-sign-respectively_fig2_375774466\" data-tags=\"\" height=\"332\" src=\"https://image.prepladder.com/content/oU4GC8TqxvxzuV222uDM1746192089.png\" width=\"391\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Holster sign:</strong> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">Rash</span> over the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the thigh</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Porter, Emma &amp; Byrne, Berbie &amp; Sarfaraz, Sumreen &amp; Leonard, Niamh &amp; Field, Sinead\" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Symmetrical-ill-defined-erythema-of-the-lateral-thighs-consistent-with-Holster-sign_fig2_369461085\" data-tags=\"\" height=\"295\" src=\"https://image.prepladder.com/content/NHN47PiG57fvpxo7ggeB1746192096.png\" width=\"430\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Mechanic’s hand:</strong> Hyperkeratosis and fissuring on the edges of the fingers</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hanlin Yin Bei Liu Liangjing Lu\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/Clinical-manifestations-of-the-patients-A-C-mechanics-hands-D-aligned_fig1_357079256\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/5YzKKlNV9roqcA4EkvWi1746192104.png\" width=\"423\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presented with difficulty in activities like climbing stairs, getting up from a chair, and combing hair. Violaceous erythema of the upper eyelids was noted. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Inclusion body myositis", "correct": false}, {"label": "B", "text": "Dermatomyositis", "correct": true}, {"label": "C", "text": "Polymyositis", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": false}], "correct_answer": "B. Dermatomyositis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kBn2sGMSwr1ORdWuJL1x1746445159.png", "https://image.prepladder.com/content/AhHEOdBvSyGEN5KYGiQT1746445228.png", "https://image.prepladder.com/content/s4jW0wsVjZBzbjYOaGFW1746445236.png", "https://image.prepladder.com/content/TxunHiuGqTp8xIYNu7yR1746445248.png", "https://image.prepladder.com/content/QY7PenSS4FuFEVV6EyWi1746445256.png", "https://image.prepladder.com/content/US5N0kTbKBWHA7hTSPF61746445263.png"], "explanation": "<p>Correct Answer B - Dermatomyositis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dermatomyositis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatomyositis </strong>is a chronic, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> seen in adults around 50-60 years of age.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<ul>\n<li>It presents as <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> muscle weakness (proximal &gt; distal)</li>\n<li><strong>Gottron’s papules</strong> (erythematous <span class=\"customMeta\" data-dictid=\"a37fd1603c1692777198f87a4a51dc\">scaly</span> papules over knuckles) are <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> of the disease.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"330\" src=\"https://image.prepladder.com/content/kBn2sGMSwr1ORdWuJL1x1746445159.png\" width=\"608\"/></p>\n<ul>\n<li><strong>Gottron’s sign</strong>: Symmetric, confluent, <span class=\"customMeta\" data-dictid=\"57d8f3ea831692777202e8adc0cee9\">violaceous</span> <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> (CMVE) on the back of fingers, on the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> surfaces of joints of the elbows, knees, or ankles</li>\n</ul>\n<ul>\n<li>CMVE is seen over other sites too, and is named accordingly.\n\t\t\t\t<ul>\n<li><strong>Heliotrope rash: </strong>CMVE over the <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> skin</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/AhHEOdBvSyGEN5KYGiQT1746445228.png\" width=\"490\"/></p>\n<ul>\n<li>\n<ul>\n<li><strong>V-Sign:</strong> CMVE over the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> aspect of the neck</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"308\" src=\"https://image.prepladder.com/content/s4jW0wsVjZBzbjYOaGFW1746445236.png\" width=\"396\"/></p>\n<ul>\n<li>\n<ul>\n<li><strong>Shawl sign: </strong>Involvement of upper back</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"332\" src=\"https://image.prepladder.com/content/TxunHiuGqTp8xIYNu7yR1746445248.png\" width=\"391\"/></p>\n<ul>\n<li>\n<ul>\n<li><strong>Holster sign:</strong> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">Rash</span> over the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the thigh</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"295\" src=\"https://image.prepladder.com/content/QY7PenSS4FuFEVV6EyWi1746445256.png\" width=\"430\"/></p>\n<ul>\n<li>\n<ul>\n<li><strong>Mechanic’s hand:</strong> <span class=\"customMeta\" data-dictid=\"fc203fa4cb1692777189d4212b9366\">Hyperkeratosis</span> and fissuring on the edges of the fingers</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/US5N0kTbKBWHA7hTSPF61746445263.png\" width=\"423\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman presents with bilateral symmetrical tenderness in the joints of her hands and wrists. She also complains of early morning stiffness of &amp;gt; 1 hour. On examination, no erythema or redness was found. What could be the diagnosis?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": false}, {"label": "B", "text": "Psoriatic Arthritis", "correct": false}, {"label": "C", "text": "Gout", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": true}], "correct_answer": "D. Rheumatoid arthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Osteoarthritis (OA)</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Psoriatic Arthritis</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gout</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reactive Arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joint Involvement Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symmetrical </strong>involvement of small joints (MCP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymmetrical involvement, especially DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymmetrical involvement, often DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically involves a single joint (e.g., big toe)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymmetrical involvement, often larger joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morning Stiffness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lasts over 1 hour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resolves within 30 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varies, often significant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely significant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable often follows infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Swelling, tenderness, deformities (e.g., <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain and <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> with use</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dactylitis, nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden, severe pain and swelling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Joint pain following an infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCP, PIP, wrists</strong>, knees</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knees, hips, hands (DIP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MCP, PIP, and can include spine and tendons</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically big toe (1st <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> joint)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larger joints (e.g., knees, ankles)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiographic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Soft tissue swelling, joint space narrowing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteophytes, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erosions, possible nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erosions and <span class=\"customMeta\" data-dictid=\"23ed22c5821692777200820f6150ac\">tophi</span> possible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to RA but typically larger joints</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a first-line drug for the management of a patient with rheumatoid arthritis?", "options": [{"label": "A", "text": "Sulfasalazine", "correct": false}, {"label": "B", "text": "Hydroxychloroquine", "correct": false}, {"label": "C", "text": "Methotrexate", "correct": false}, {"label": "D", "text": "Azathioprine", "correct": true}], "correct_answer": "D. Azathioprine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/e7dh4oO2AkvM8bwNXCmx1745326600.png", "https://image.prepladder.com/notes/8u3OhSOtiZZRAs0V0NmL1745326663.png", "https://image.prepladder.com/notes/IGgM5KPqe1Twc7kF3tgx1745326632.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extra-articular manifestations of Rheumatoid arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-tender<strong> Rheumatoid nodules</strong> (most common),<strong> Livedo reticularis</strong>, Pyoderma gangrenosum<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"Temp Rheumatoid nodules\" data-author=\"\" data-hash=\"11003\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/e7dh4oO2AkvM8bwNXCmx1745326600.png\"/></p>\n<figure class=\"caption_element\"><img alt=\"Temp Livedo reticularis\" data-author=\"Nantsupawat T et al - Nantsupawat, Teerapat \" data-hash=\"11005\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Livedo_reticularis#/media/File:Livedo_reticularis_of_left_leg.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/8u3OhSOtiZZRAs0V0NmL1745326663.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Rheumatoid nodules and Livedo reticularis</strong></p>\n<figure class=\"caption_element\"><img alt=\"Temp Pyoderma gangrenosum\" data-author=\"Crohnie \" data-hash=\"11004\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Pyoderma_gangrenosum#/media/File:Crohnie_Pyoderma_gangrenosum.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/IGgM5KPqe1Twc7kF3tgx1745326632.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Pyoderma gangrenosum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keratoconjunctivitis sicca</strong>, episcleritis, scleritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CVS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pericarditis</strong>, myocarditis, Arrhythmias, ischemic heart disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pleuritis</strong>, Interstitial lung disease, <strong>Caplan syndrome </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salivary glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Xerostomia</strong>, periodontitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glomerulonephritis</strong>, Secondary amyloidosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperandrogenism, anaemia of chronic disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presents to the clinic with erythematous lesions over the exposed areas of the skin, like hands, arms, and chest. He also complains of arthralgia and breathlessness. Measuring which among the following antibodies will be useful in diagnosing the underlying conditions?", "options": [{"label": "A", "text": "Antihistone antibodies", "correct": false}, {"label": "B", "text": "Anti-dsDNA antibodies", "correct": true}, {"label": "C", "text": "Anticentromere antibodies", "correct": false}, {"label": "D", "text": "Antinuclear antibodies", "correct": false}], "correct_answer": "B. Anti-dsDNA antibodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoantibodies of SLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antigen recognised</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ANA </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple nuclear antigens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best screening test for diagnosis, it is <strong>highly sensitive but not very specific</strong> for SLE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-dsDNA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DNA (double-stranded)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High titers are specific for SLE</strong></p>\n<p>Used to correlate with disease severity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-C1q</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collagen-like determinants on C1q</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with active <strong>lupus nephritis</strong>, it is non-specific for <span class=\"customMeta\" data-dictid=\"d9bf27b09416927771984cdc6c0bc4\">SLE</span> and can be used to <strong>correlate with disease activity. <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> predisposes SLE.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-Sm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein complexes to 6 species of nuclear U1 RNA.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is <strong>highly specific for SLE.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-RNP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein complexed to U1 RNA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-specific to SLE</strong> and is associated with <strong>syndromes that <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> with rheumatic syndromes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-Ro (SS-A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein complexed to hY <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> 9 (primarily 60 <span class=\"customMeta\" data-dictid=\"027c8b222c16927771909172487af7\">kDa</span> and 52 kDa)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not very specific</strong>, it is associated with <strong>sicca syndrome and <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> lupus</strong> (congenital heart block)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-La (SS-B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>47-kDa protein complexed to hY RNA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly associated with <strong>Anti-Ro antibody</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antihistone</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histones associated with DNA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>drug-induced lupus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiphospholipid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phospholipids, β2-glycoprotein 1 cofactor, prothrombin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually predisposes to <strong>clotting, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> loss and thrombocytopenia.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti Erythrocyte</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythrocyte membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes <strong>autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiplatelet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surface and altered cytoplasmic antigens on platelets</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It contributes to <strong>thrombocytopenia,</strong> is<strong> not very specific or sensitive, </strong>and is not used in regular practice.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antineuronal antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neuronal and <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> surface antigens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occasionally, it shows a positive correlation with <strong>active <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> lupus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti Ribosomal P</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein in ribosomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>neuropsychiatric manifestations.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Takayasu arteritis most commonly involves:", "options": [{"label": "A", "text": "Pulmonary artery", "correct": false}, {"label": "B", "text": "Coronary arteries", "correct": false}, {"label": "C", "text": "Abdominal aorta", "correct": false}, {"label": "D", "text": "Arch of aorta", "correct": true}], "correct_answer": "D. Arch of aorta", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman presents with a chronic history of pain in the small joints of hands with stiffness of joints in the early hours of the day. The image of the patient's hands is given below. What is the most likely diagnosis ?", "options": [{"label": "A", "text": "Rheumatoid Arthritis", "correct": true}, {"label": "B", "text": "Osteoarthritis", "correct": false}, {"label": "C", "text": "Complex Regional Pain Syndrome", "correct": false}, {"label": "D", "text": "Villonodular synovitis", "correct": false}], "correct_answer": "A. Rheumatoid Arthritis", "question_images": ["https://image.prepladder.com/content/KTyl4yrw4dWZzcLQ5kXP1691475019.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Rheumatoid Arth\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n<td>\n<p>Chronic <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disease primarily affecting the joints, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and joint damage.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td>\n<p>Immune system attacks the <span class=\"customMeta\" data-dictid=\"4d5c42a8591692777199d8e337af3f\">synovium</span> (lining of joints), leading to inflammation, joint swelling, and destruction.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Clinical Features</strong></p>\n</td>\n<td>\n<p>Joint pain, stiffness, and swelling, typically <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> and involving small joints of hands and feet.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Extra-Articular Manifestations</strong></p>\n</td>\n<td>\n<p>Rheumatoid nodules, lung involvement (interstitial lung disease), vasculitis, eye <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (scleritis), pericarditis.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Imaging</strong></p>\n</td>\n<td>\n<p>X-rays and <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may show joint erosions, <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> hypertrophy, and soft tissue changes.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td>\n<p>Rheumatoid factor (RF) and anti-cyclic citrullinated <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> (anti-CCP) antibodies are commonly measured. Elevated acute-phase reactants (e.g., CRP, ESR).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following medications is not used in the treatment of rheumatoid arthritis?", "options": [{"label": "A", "text": "Febuxostat", "correct": true}, {"label": "B", "text": "Leflunomide", "correct": false}, {"label": "C", "text": "Etanercept", "correct": false}, {"label": "D", "text": "Methotrexate", "correct": false}], "correct_answer": "A. Febuxostat", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Febu\n<table>\n<tbody>\n<tr>\n<td>\n<p>Nonsteroidal Anti-inflammatory Drugs (NSAIDs)</p>\n</td>\n<td>\n<p>Ibuprofen, Naproxen, Celecoxib</p>\n</td>\n<td>\n<p>Inhibit the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"ebd6f6186316927771854d3b6d65be\">cyclooxygenase</span> (COX), reducing the production of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> prostaglandins. Provide pain relief and reduce inflammation.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Disease-Modifying Anti-rheumatic Drugs (DMARDs)</p>\n</td>\n<td>\n<p>Methotrexate, Sulfasalazine, Leflunomide</p>\n</td>\n<td>\n<p>Suppress the underlying <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> that drives <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> in RA. Decrease the production of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cytokines and prevent joint damage.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Biologic DMARDs</p>\n</td>\n<td>\n<p>Adalimumab, Etanercept, Infliximab</p>\n</td>\n<td>\n<p>Target specific molecules involved in the immune response, such as tumor <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> factor-alpha (TNF-alpha), <span class=\"customMeta\" data-dictid=\"cc29a6414e169277719052a6df813f\">interleukin-6</span> (IL-6), or B-lymphocyte <span class=\"customMeta\" data-dictid=\"209e26e2a61692777199d129f36248\">stimulator</span> (BLyS). <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">Inhibit</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> processes and slow down joint damage.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Janus <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> (JAK) Inhibitors</p>\n</td>\n<td>\n<p>Tofacitinib, Baricitinib, Upadacitinib</p>\n</td>\n<td>\n<p>Block the <span class=\"customMeta\" data-dictid=\"859f9b3ad916927771909475f4445b\">Janus kinase</span> enzymes, which are involved in the <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> pathways of various cytokines. Reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and joint damage by suppressing the immune response.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Corticosteroids</p>\n</td>\n<td>\n<p>Prednisone, Methylprednisolone</p>\n</td>\n<td>\n<p>Potent anti-inflammatory effects. Modulate immune responses, reduce inflammation, and provide rapid symptom relief.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Targeted <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">Synthetic</span> DMARDs</p>\n</td>\n<td>\n<p>Tofacitinib, Baricitinib, Upadacitinib</p>\n</td>\n<td>\n<p>Inhibit specific molecules within the immune system that contribute to RA, such as <span class=\"customMeta\" data-dictid=\"859f9b3ad916927771909475f4445b\">Janus kinase</span> (JAK) enzymes. Reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and joint damage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Anti-centromere antibodies are seen in which of the following conditions ?", "options": [{"label": "A", "text": "SLE", "correct": false}, {"label": "B", "text": "Drug induced lupus", "correct": false}, {"label": "C", "text": "Sjogren syndrome", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": true}], "correct_answer": "D. Scleroderma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A triad of asthma, systemic vasculitis and eosinophilia is seen in which of the following conditions ?", "options": [{"label": "A", "text": "Cryoglobulinemic vasculitis", "correct": false}, {"label": "B", "text": "Polyarteritis nodosa", "correct": false}, {"label": "C", "text": "Churg Strauss syndrome", "correct": true}, {"label": "D", "text": "Giant cell arteritis", "correct": false}], "correct_answer": "C. Churg Strauss syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Churg Strauss S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate statement regarding rheumatoid nodules?", "options": [{"label": "A", "text": "Tender, located on extensor surface and seen with arthritis", "correct": false}, {"label": "B", "text": "Non tender, located on extensor surface and seen with arthritis", "correct": true}, {"label": "C", "text": "Non tender, located on flexor surface and seen with arthritis", "correct": false}, {"label": "D", "text": "Tender, located on flexor surface and seen with arthritis", "correct": false}], "correct_answer": "B. Non tender, located on extensor surface and seen with arthritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Non tender, located on &lt;span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\"&gt;extensor&lt;/span&gt; surface and seen with arth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate description of marble Schonberg disease?", "options": [{"label": "A", "text": "Osteopetrosis", "correct": true}, {"label": "B", "text": "Osteomalacia", "correct": false}, {"label": "C", "text": "Osteosclerosis", "correct": false}, {"label": "D", "text": "Osteonecrosis", "correct": false}], "correct_answer": "A. Osteopetrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Common neurological tumour in NF-2?", "options": [{"label": "A", "text": "Vestibular Schwannoma", "correct": true}, {"label": "B", "text": "Optic glioma", "correct": false}, {"label": "C", "text": "Café-Au-Lait macules", "correct": false}, {"label": "D", "text": "Neurofibrosarcoma", "correct": false}], "correct_answer": "A. Vestibular Schwannoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Vestibular Sch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the next recommended investigation to aid in diagnosing the condition of a patient who has cutaneous vasculitis, glomerulonephritis, and peripheral neuropathy?", "options": [{"label": "A", "text": "ANCA", "correct": true}, {"label": "B", "text": "RA factor", "correct": false}, {"label": "C", "text": "HbsAg", "correct": false}, {"label": "D", "text": "MIF", "correct": false}], "correct_answer": "A. ANCA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - ANCA\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What extra-articular manifestation is commonly observed in patients with rheumatoid arthritis?", "options": [{"label": "A", "text": "Subcutaneous nodule", "correct": true}, {"label": "B", "text": "Sjogren’s syndrome", "correct": false}, {"label": "C", "text": "Felty’s syndrome", "correct": false}, {"label": "D", "text": "Vasculitis", "correct": false}], "correct_answer": "A. Subcutaneous nodule", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\"&gt;Subcutaneous&lt;/span&gt; nodu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A f emale patient presents with fever, oral ulcer, photosensitivity, and rashes on her face as shown below . What is the most likely diagnosis ?", "options": [{"label": "A", "text": "Dermatomyositis", "correct": false}, {"label": "B", "text": "Systemic lupus erythematosus", "correct": true}, {"label": "C", "text": "Rosacea", "correct": false}, {"label": "D", "text": "Melasma", "correct": false}], "correct_answer": "B. Systemic lupus erythematosus", "question_images": ["https://image.prepladder.com/content/WrvFZboupV3v84L6UNso1712315857.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Systemic &lt;span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\"&gt;lupus&lt;/span&gt; erythematosu\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Cutaneous Manifestations of SLE</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Butterfly <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">Rash</span> (Malar Rash)</p>\n</td>\n<td>\n<p>Red or erythematous <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> over the cheeks and <span class=\"customMeta\" data-dictid=\"a57b5419551692777183ef6e7bbb14\">bridge of the nose</span> in a butterfly pattern <span class=\"customMeta\" data-dictid=\"a57b5419551692777183ef6e7bbb14\">bridge of the nose</span> in a butterfly pattern</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Discoid Rash</p>\n</td>\n<td>\n<p>Round or oval-shaped red plaques with <span class=\"customMeta\" data-dictid=\"3eae9d3a481692777198158ddc37bc\">scaling</span> and scarring, commonly on the face, scalp, and ears</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Photosensitivity</p>\n</td>\n<td>\n<p>Increased sensitivity to sunlight, resulting in a <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> or worsening of existing skin lesions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oral Ulcers</p>\n</td>\n<td>\n<p>Painful, shallow ulcers in the mouth or nose typically without scarring</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subacute <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">Cutaneous</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Erythematosus (SCLE)</p>\n</td>\n<td>\n<p>Red, scaly, and <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> (ring-shaped) lesions that may develop a more defined border with central clearing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Raynaud's Phenomenon</p>\n</td>\n<td>\n<p>Intermittent color changes in the fingers or toes, often <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by cold or stress</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alopecia</p>\n</td>\n<td>\n<p>Hair loss, which can be patchy or diffuse(may not result in complete baldness)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vasculitis</p>\n</td>\n<td>\n<p>Inflammation of blood vessels resulting in skin rashes, ulcers, or necrosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with rheumatoid arthritis has been treated with methotrexate and low-dose corticosteroids for the past 4 months . However, the disease is still progressing. What would be your recommendation for the further management of this patient?", "options": [{"label": "A", "text": "Stop oral methotrexate and start parenteral methotrexate", "correct": false}, {"label": "B", "text": "Add sulfasalazine and hydroxychloroquine", "correct": true}, {"label": "C", "text": "Continue corticosteroids and methotrexate", "correct": false}, {"label": "D", "text": "Start only anti-TNF alpha agents", "correct": false}], "correct_answer": "B. Add sulfasalazine and hydroxychloroquine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Add &lt;span class=\"customMeta\" data-dictid=\"25673e79721692777199949b9db072\"&gt;sulfasalazine&lt;/span&gt; and hydroxychloroqu\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Conventional DMARDs</strong></p>\n</td>\n<td>\n<p>Methotrexate, Sulfasalazine, Hydroxychloroquine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Biological DMARDs</strong></p>\n</td>\n<td>\n<p>Tumor <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">Necrosis</span> Factor (TNF) Inhibitors (e.g., Adalimumab, Etanercept, Infliximab), <span class=\"customMeta\" data-dictid=\"cc29a6414e169277719052a6df813f\">Interleukin-6</span> (IL-6) Inhibitors (e.g., Tocilizumab), B-cell Modulators (e.g., Rituximab), T-cell Co-stimulation Blockers (e.g., Abatacept), <span class=\"customMeta\" data-dictid=\"859f9b3ad916927771909475f4445b\">Janus Kinase</span> (JAK) Inhibitors (e.g., Baricitinib, Tofacitinib)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Targeted <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">Synthetic</span> DMARDs</strong></p>\n</td>\n<td>\n<p>Janus <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> (JAK) Inhibitors (e.g., Baricitinib, Tofacitinib)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Other DMARDs</strong></p>\n</td>\n<td>\n<p>Leflunomide, Cyclosporine, Azathioprine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most specific antibody in systemic sclerosis?", "options": [{"label": "A", "text": "Anti-DNA", "correct": false}, {"label": "B", "text": "Anti-topoisomerase", "correct": true}, {"label": "C", "text": "ANA", "correct": false}, {"label": "D", "text": "Anti-Ro", "correct": false}], "correct_answer": "B. Anti-topoisomerase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - A\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Antibody</strong></td>\n<td style=\"text-align:center\"><strong>Description</strong></td>\n</tr>\n<tr>\n<td>Anti-centromere</td>\n<td>Found in approximately 20-25% of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients, mainly those with limited <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis</td>\n</tr>\n<tr>\n<td>Anti-topoisomerase I</td>\n<td>Also known as the anti-Scl-70 antibody, it is present in about 10-20% of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients and is often associated with <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis</td>\n</tr>\n<tr>\n<td>Anti-RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> III</td>\n<td>Detected in around 10-15% of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> cases, it is primarily seen in patients with <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> and is associated with a higher risk of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement</td>\n</tr>\n<tr>\n<td>Anti-U3 RNP</td>\n<td>Found in a small percentage of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients, particularly those with <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> syndromes such as <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis/polymyositis</td>\n</tr>\n<tr>\n<td>Anti-U1 RNP</td>\n<td>Seen in some cases of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis, but more commonly associated with mixed <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue disease</td>\n</tr>\n<tr>\n<td>Anti-fibrillarin</td>\n<td>Identified in a subset of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients, often those with overlapping features of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> and polymyositis</td>\n</tr>\n<tr>\n<td>Anti-PM/Scl</td>\n<td>It occurs in a minority of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> cases and is associated with <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> syndromes like <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis/polymyositis</td>\n</tr>\n<tr>\n<td>Anti-Th/To</td>\n<td>Detected in a small number of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients, often in conjunction with other antibodies</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following characteristics are found in the pleural effusion fluid of a rheumatoid arthritis patient except :", "options": [{"label": "A", "text": "RA factor", "correct": false}, {"label": "B", "text": "High glucose", "correct": true}, {"label": "C", "text": "Cholesterol crystals", "correct": false}, {"label": "D", "text": "High LDH", "correct": false}], "correct_answer": "B. High glucose", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - High glu\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Etiology or Type of effusion</strong></td>\n<td style=\"text-align:center\"><strong>Gross Appearance</strong></td>\n<td style=\"text-align:center\"><strong>White <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">Blood Cell Count</span> (Cells/mcL)</strong></td>\n<td style=\"text-align:center\"><strong>Red <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">blood Cell Count</span> (Cells/mcL)</strong></td>\n<td style=\"text-align:center\"><strong>Glucose</strong></td>\n<td style=\"text-align:center\"><strong>Comments</strong></td>\n</tr>\n<tr>\n<td><strong>Malignancy</strong></td>\n<td>Turbid to bloody: occasionally serous</td>\n<td>1000 to 100,000 M</td>\n<td>100 to several hundred thousand</td>\n<td>Equal to <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels: &lt;60 mg/dl. In 15% of cases</td>\n<td>Eosinophilia uncommon: positive result on <span class=\"customMeta\" data-dictid=\"5e1dc9e4e016927771853795d2b0be\">cytologic</span> examination</td>\n</tr>\n<tr>\n<td><strong>Uncomplicated parapneumonic</strong></td>\n<td>Clear to turbid</td>\n<td>5000-25000 P</td>\n<td>&lt; 5000</td>\n<td>Equal to <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels</td>\n<td>Tube <span class=\"customMeta\" data-dictid=\"0e733c2a0916927772001a6cd08d35\">thoracostomy</span> unnecessary</td>\n</tr>\n<tr>\n<td><strong>Empyema</strong></td>\n<td>Turbid to purulent</td>\n<td>25,000 - 100,000 P</td>\n<td>&lt;5000</td>\n<td>Less than <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels: Often very low</td>\n<td>Drainage necessary: <span class=\"customMeta\" data-dictid=\"d3b3bee1b916927771961c3b7b380a\">putrid</span> <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> suggests <span class=\"customMeta\" data-dictid=\"4880fc99551692777181e25a64560f\">anaerobic</span> infection</td>\n</tr>\n<tr>\n<td><strong>Tuberculosis</strong></td>\n<td>Serous to serosanguineous</td>\n<td>5000 – 10,000 M</td>\n<td>&lt;10,000</td>\n<td>Equal to <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels: occasionally 60mg/dL</td>\n<td>Protein &gt; 4.0g/dL (may exceed 5g/dL) eosinophils<br/>\n\t\t\tcells (&gt;5%) make diagnosis unlikely: see text for additional <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tests</td>\n</tr>\n<tr>\n<td><strong>Rheumatoid</strong></td>\n<td>Turbid: greenish yellow</td>\n<td>1000-20,000 M or P</td>\n<td>&lt;1000</td>\n<td>&lt; 40 mg/dL</td>\n<td>Secondary <span class=\"customMeta\" data-dictid=\"cfa3ed6a1b1692777187669bb2c495\">empyema</span> common: high LD, low compliment, high <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> factor, cholesterol crystal are characteristic</td>\n</tr>\n<tr>\n<td><strong>Pulmonary infarction</strong></td>\n<td>Serous to grossly bloody</td>\n<td>1000- 50,000 M or P</td>\n<td>100-100,000</td>\n<td>Equal to <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels</td>\n<td>Variable findings: no <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> features</td>\n</tr>\n<tr>\n<td><strong>Esophageal rupture</strong></td>\n<td>Turbid to <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> red-brown</td>\n<td>&lt;5000 to 50,000 P</td>\n<td>1000 – 10,000</td>\n<td>Usually, low</td>\n<td>High <span class=\"customMeta\" data-dictid=\"ee24d3aa0016927771810af81a9cf3\">amylase</span> level (salivary origin): pneumothorax in 25% cases: effusion usually on left side: pH &lt;6.0 strongly suggests Diagnosis</td>\n</tr>\n<tr>\n<td><strong>Pancreatitis</strong></td>\n<td>Turbid to serosanguineous</td>\n<td>1000 – 50,000 P</td>\n<td>1000 – 10,000</td>\n<td>Equals to serum</td>\n<td>Usually left-sided: high <span class=\"customMeta\" data-dictid=\"ee24d3aa0016927771810af81a9cf3\">amylase</span> level</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a young male patient who experiences drooping eyelids that worsens as the day progresses, along with increased fatigue towards the end of the day which improves with rest? Additionally, the patient notices a significant decrease in drooping when placing an ice pack over their eyes.", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "Huntington chorea", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "External ophthalmoplegia", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Myasthenia grav\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\">\n<p><strong>Myasthenia Gravis</strong></p>\n</td>\n<td style=\"text-align:center\">\n<p><strong>Lambert Eaton Myasthenic Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mainly Associated with <span class=\"customMeta\" data-dictid=\"fbd2788fff16927772009c0137de78\">Thymus</span> Abnormalities</p>\n</td>\n<td>\n<p>Associated with small cell lung cancer, especially with male patients</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acetylcholine release is completely normal.<br/>\n\t\t\tProblem is with the <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> known as Post Junctional Defect.</p>\n</td>\n<td>\n<p>Acetylcholine release is less. Receptors are however normal.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Multiple antibodies but main are:</p>\n<ul>\n<li>\n<p>AchR antibody</p>\n</li>\n<li>\n<p>Anti Musk</p>\n</li>\n<li>\n<p>Anti LRP4</p>\n</li>\n</ul>\n</td>\n<td>\n<p>Antibody:</p>\n<ul>\n<li>\n<p>Anti P /Q <span class=\"customMeta\" data-dictid=\"25ad895a231692777202f568bc6bfc\">voltage</span> gated <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Might be having Ptosis, extra <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> Muscle weakness, Diplopia, Chewing muscle weakness</p>\n</td>\n<td>\n<p>Might be having Ptosis, extra <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> Muscle weakness, Diplopia, Chewing muscle weakness</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ptosis &amp; <span class=\"customMeta\" data-dictid=\"1458c330411692777186cd49bb6a30\">diplopia</span> are main complaints</p>\n</td>\n<td>\n<p>Shoulder <span class=\"customMeta\" data-dictid=\"a1d37a92d41692777188e12a817797\">Girdle</span> weakness, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">Proximal</span> Muscle weakness are main complaints</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Reflexes are Normal or preserved.<br/>\n\t\t\tDecremental response on repetitive nerve stimulation</p>\n<p>Drug of choice should be Pyridostigmine<br/>\n\t\t\tSurgical Treatment should be Thymectomy.<br/>\n\t\t\tSteroids used in <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">Ocular</span> M.Gravis</p>\n</td>\n<td>\n<p>Reflexes are <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> impotence, dry mouth, <span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\">orthostatic</span> hypotension.<br/>\n\t\t\tIncremental response on repetitive nerve stimulation</p>\n<p>Steroids are not used, rather 3,4 diaminopyridine.<br/>\n\t\t\tPyridostigmine can also be used because all pyridostigmine does is <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> responsible for <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> so the muscles get stimulated for longer duration.</p>\n<p>Chemotherapy is used for underlying small cell cancer as it can <span class=\"customMeta\" data-dictid=\"c329085d1b1692777192eda410629f\">metastasize</span> very fast. Drugs include: <span class=\"customMeta\" data-dictid=\"ca71207b36169277718438d09cbda0\">cisplatin</span> &amp; irinotecan</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 57 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 11 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old female complains of morning stiffness lasting over an hour and pain in her hands and wrists. On examination, there is swelling and tenderness of multiple small joints in her hands. Laboratory results show a positive rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. X-ray reveals soft tissue swelling and early joint space narrowing. Which of the following joint involvement patterns is most characteristic of this condition?", "options": [{"label": "A", "text": "Symmetrical involvement of small joints, particularly the MCP and PIP joints", "correct": true}, {"label": "B", "text": "Asymmetrical involvement of small joints, particularly the MCP and PIP joints", "correct": false}, {"label": "C", "text": "Symmetrical involvement of the DIP joints", "correct": false}, {"label": "D", "text": "Asymmetrical involvement of the DIP joints", "correct": false}], "correct_answer": "A. Symmetrical involvement of small joints, particularly the MCP and PIP joints", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteoarthritis (OA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Psoriatic Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reactive Arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joint Involvement Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symmetrical </strong>involvement of small joints (MCP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymmetrical involvement, especially DIP joints <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymmetrical involvement, often DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically involves a single joint (e.g., big toe)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymmetrical involvement, often larger joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morning Stiffness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lasts over 1 hour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resolves within 30 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varies, often significant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely significant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable often follows infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Swelling, tenderness, deformities (e.g., <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain and <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> with use</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dactylitis, nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden, severe pain and swelling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Joint pain following an infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCP, PIP, wrists</strong>, knees</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knees, hips, hands (DIP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MCP, PIP, and can include spine and tendons</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically big toe (1st <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> joint)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larger joints (e.g., knees, ankles)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiographic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Soft tissue swelling, joint space narrowing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteophytes, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erosions, possible nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erosions and <span class=\"customMeta\" data-dictid=\"23ed22c5821692777200820f6150ac\">tophi</span> possible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to RA but typically larger joints</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old woman presents with joint pain and swelling, particularly in her hands and wrists, over the past 6 months. She has a family history of autoimmune diseases, and laboratory tests show positive rheumatoid factor (RF) and anti-citrullinated protein antibodies (anti-CCP). Which of the following statements is true regarding the etiopathogenesis of this patient's condition?", "options": [{"label": "A", "text": "Crystal disposition in the joint spaces leads to joint inflammation", "correct": false}, {"label": "B", "text": "Presence of HLA-DR β 1 is strongly associated with this condition", "correct": true}, {"label": "C", "text": "Joint destruction occurs due to mechanical damage to the articular cartilage", "correct": false}, {"label": "D", "text": "Pregnancy can aggravate the symptoms of this condition", "correct": false}], "correct_answer": "B. Presence of HLA-DR β 1 is strongly associated with this condition", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HGu1svaC4e9ctHkotfN11740587132.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Male to female ratio - 1:3</p>\n<p>Peaks between 25 and 55 years</p>\n<p>Remains constant between 55 and 75</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Strongly associated with the HLA-DRβ1 gene<strong> (Option B)</strong></li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"a5379e182d1692777184224652dcb1\">concordance</span> in <span class=\"customMeta\" data-dictid=\"e7afab7b981692777192aca13178fa\">monozygotic</span> twins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triggers and suppressors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cigarette smoking and infections can trigger RA in genetically predisposed individuals by <span class=\"customMeta\" data-dictid=\"4881d0c99216927771849df336b09a\">citrullination</span> of proteins.</li>\n<li>RA may remit during pregnancy and can first appear <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> due to <span class=\"customMeta\" data-dictid=\"55241e8b7916927771896c864d30ea\">immune suppression</span> and hormonal changes. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1290\" src=\"https://image.prepladder.com/content/HGu1svaC4e9ctHkotfN11740587132.png\" width=\"1360\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female patient with a long-standing history of rheumatoid arthritis presents with specific difficulties in her left hand. She reports difficulty extending the distal interphalangeal (DIP) joint of her middle finger and flexing at the proximal interphalangeal (PIP) joint. Based on the clinical presentation, which of the following deformities is most consistent with the patient’s symptoms?", "options": [{"label": "A", "text": "Boutonniere deformity", "correct": false}, {"label": "B", "text": "Swan neck deformity", "correct": true}, {"label": "C", "text": "Z-line deformity", "correct": false}, {"label": "D", "text": "Mallet finger deformity", "correct": false}], "correct_answer": "B. Swan neck deformity", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BmUIuiF2YMPD8W6iPCZn1744356992.png", "https://image.prepladder.com/notes/jZsIfRYALsPLyexBhry11744357215.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Articular <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> and changes in <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Articular changes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> mediates <span class=\"customMeta\" data-dictid=\"388a4ccfbf1692777194a8f6a2d3b4\">pannus</span> formation, eroding the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and bone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metacarpophalangeal joint (<strong>MCP</strong>), <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint and <strong>wrist</strong> joint are involved</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"9\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deformities</strong></p>\n\t\t\t \n\n\t\t\t<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swan neck <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> </strong><strong>(Option B)</strong></p>\n<ul>\n<li>Extension at <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (<strong>PIP</strong>)</li>\n<li>Flexion at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (<strong>DIP</strong>): The <span class=\"customMeta\" data-dictid=\"fed387a73a16927771862b51ee0f29\">DIP joint</span> is not involved; <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> occurs due to tension on the tendons attached to the base of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> phalanges</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boutonniere <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> </strong><strong>(Option A ruled out)</strong></p>\n<ul>\n<li>Flexion<strong> </strong>at <span class=\"customMeta\" data-dictid=\"bc2c34fe2216927771957ca73ba3d9\">PIP</span> and extension at DIP</li>\n<li>Both swan neck and boutonniere <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> can occur in different fingers of the same hand.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Z-line deformity</strong><strong> (Option C ruled out)</strong></p>\n<ul>\n<li><strong>Subluxation </strong>of the first <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joint.</li>\n<li>Hyperextension of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Z line deformity\" data-author=\"Rollcloud\" data-hash=\"9152\" data-license=\"\" data-source=\"CC BY 3.0\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/BmUIuiF2YMPD8W6iPCZn1744356992.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"boutonniere deformity\" data-author=\"\" data-hash=\"9153\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/jZsIfRYALsPLyexBhry11744357215.png\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the clinic with joint pain and morning stiffness lasting more than one hour. Based on the EULAR classification criteria for rheumatoid arthritis, which of the following combinations of clinical, serological, and laboratory findings is most likely to lead to a definitive diagnosis of rheumatoid arthritis?", "options": [{"label": "A", "text": "Swelling in 3 small joints, positive anti-citrullinated protein antibodies (ACPA) at high titers, and elevated C-reactive protein (CRP), symptoms for 8 weeks", "correct": true}, {"label": "B", "text": "Swelling in 1 large joint, positive rheumatoid factor at low titers, normal ESR, and symptoms for 4 weeks", "correct": false}, {"label": "C", "text": "Swelling in 6 small joints, negative ACPA, elevated ESR, and symptoms for 5 weeks", "correct": false}, {"label": "D", "text": "Swelling in 4 large joints, positive ACPA at low titers, normal CRP, and symptoms for 12 weeks", "correct": false}], "correct_answer": "A. Swelling in 3 small joints, positive anti-citrullinated protein antibodies (ACPA) at high titers, and elevated C-reactive protein (CRP), symptoms for 8 weeks", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>THE 2010 ACR-EULAR <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">CLASSIFICATION</span> CRITERIA FOR <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">RHEUMATOID</span> ARTHRITIS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A. Joint Involvement </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 large joint</p>\n<p>2-10 large joints</p>\n<p>1-3 small joints (with or without involvement of large joints)</p>\n<p>4-10 small joints (with or without involvement of large joints)</p>\n<p>&gt;10 joints (at least 1 small joint)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n<p>1</p>\n<p>2</p>\n<p>3</p>\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>B. Serology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative RF and negative ACPA</p>\n<p>Low-positive RF or low-positive ACPA</p>\n<p>High-positive RF or high-positive ACPA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n<p>2</p>\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C. Acute-phase reactants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> and normal ESR</p>\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> ESR</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D. Duration of symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;6 weeks</p>\n<p>≥6 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n<p>1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male with a history of working in coal mines presents with progressive shortness of breath and a chronic cough. He reports that years ago, he was diagnosed with a joint condition that caused swelling and stiffness, particularly in his hands and wrists. Laboratory testing reveals he is positive for HLA-DR4. A chest X-ray shows multiple rounded opacities in both lung fields. A lung biopsy showed the following picture. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Caplan syndrome", "correct": true}, {"label": "B", "text": "Secondary Sjögren's syndrome", "correct": false}, {"label": "C", "text": "Felty syndrome", "correct": false}, {"label": "D", "text": "Lofgren syndrome", "correct": false}], "correct_answer": "A. Caplan syndrome", "question_images": ["https://image.prepladder.com/notes/cdgDt5nAeYdZokPF6zXe1745565196.png"], "explanation_images": ["https://image.prepladder.com/notes/cdgDt5nAeYdZokPF6zXe1745565196.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old male presents with multiple subcutaneous nodules on his arms and back, along with joint pain and stiffness primarily affecting his hands and knees. He has erythema nodosum and a positive family history of similar conditions. Which of the following is a common ocular extra-articular manifestation associated with this condition?", "options": [{"label": "A", "text": "Keratoconjunctivitis sicca", "correct": true}, {"label": "B", "text": "Uveitis", "correct": false}, {"label": "C", "text": "Iritis", "correct": false}, {"label": "D", "text": "Iridocyclitis", "correct": false}], "correct_answer": "A. Keratoconjunctivitis sicca", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BnKwsd1CJX04X7T8GiAV1744358462.png", "https://image.prepladder.com/notes/1ytcgpctemxmP6u6pvKh1744358582.png", "https://image.prepladder.com/notes/G8fGZ9oa90VSEpGwLNa51745565355.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extra-articular manifestations of <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-tender<strong> <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> nodules</strong> (most common),<strong> <span class=\"customMeta\" data-dictid=\"53f2eb017116927771918255da4e8b\">Livedo</span> reticularis</strong>, <span class=\"customMeta\" data-dictid=\"089ef1b1bf169277719626559c2930\">Pyoderma</span> gangrenosum<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"rheumatoid nodules\" data-author=\"\" data-hash=\"9163\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/BnKwsd1CJX04X7T8GiAV1744358462.png\"/><img alt=\"Livedo reticularis\" data-author=\"\" data-hash=\"9164\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1ytcgpctemxmP6u6pvKh1744358582.png\"/>\n<p><strong>Rheumatoid nodules and <span class=\"customMeta\" data-dictid=\"53f2eb017116927771918255da4e8b\">Livedo</span> reticularis</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pyoderma gangrenosum\" data-author=\"Crohnie \" data-hash=\"11263\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Pyoderma_gangrenosum#/media/File:Crohnie_Pyoderma_gangrenosum.jpg\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/G8fGZ9oa90VSEpGwLNa51745565355.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p><strong>Pyoderma gangrenosum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keratoconjunctivitis sicca (Option A)</strong>, episcleritis, scleritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CVS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pericarditis</strong>, myocarditis, Arrhythmias, ischemic heart disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pleuritis</strong>, <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">Interstitial</span> lung disease, <strong>Caplan syndrome </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salivary glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Xerostomia</strong>, periodontitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glomerulonephritis</strong>, Secondary amyloidosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperandrogenism, anaemia of chronic disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old man presents with bilateral pain, swelling, and stiffness in his hands and wrists for the past 4 months. His symptoms are worse in the morning and improve throughout the day. The physical exam shows synovitis in the metacarpophalangeal joints. Considering the high specificity for rheumatoid arthritis, which initial investigation is most appropriate to confirm the diagnosis in this patient?", "options": [{"label": "A", "text": "Anti-nuclear antibody test", "correct": false}, {"label": "B", "text": "Anti-cyclic citrullinated peptide antibody", "correct": true}, {"label": "C", "text": "Synovial fluid analysis", "correct": false}, {"label": "D", "text": "MRI of the affected joints", "correct": false}], "correct_answer": "B. Anti-cyclic citrullinated peptide antibody", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>To establish diagnosis </strong></p>\n<ul>\n<li>Clinical criteria</li>\n<li>Erythrocyte <span class=\"customMeta\" data-dictid=\"d53a6ee0c81692777198aeb94eb4ca\">sedimentation</span> rate (ESR) and C-reactive protein (CRP)</li>\n<li>Ultrasound or magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <strong>(Option D ruled out)</strong></li>\n<li>ACPA and RF (both are positive in about 70% of the cases)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>To monitor disease damage</strong></p>\n<ul>\n<li>X-rays</li>\n<li>Functional assessment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>To monitor disease activity and drug <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> </strong></p>\n<ul>\n<li>Pain (visual <span class=\"customMeta\" data-dictid=\"22e0051a181692777181872183edb2\">analogue</span> scale)</li>\n<li>Early morning <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> (minutes)</li>\n<li>Joint tenderness</li>\n<li>Joint swelling</li>\n<li>DAS28 score (Disease activity score 28)</li>\n<li>Erythrocyte <span class=\"customMeta\" data-dictid=\"d53a6ee0c81692777198aeb94eb4ca\">sedimentation</span> rate and C-reactive protein</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>To monitor drug safety </strong></p>\n<ul>\n<li>Urinalysis</li>\n<li>Full blood count</li>\n<li>Chest X-ray</li>\n<li>Urea and creatinine</li>\n<li>Liver function test</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female patient presents with significant joint pain, stiffness, and swelling affecting multiple joints. Her Disease Activity Score (DAS28) is 5.4, indicating high disease activity. She has not responded adequately to lifestyle modifications and NSAIDs. Which medication is considered this patient's first-line disease-modifying antirheumatic drug (DMARD)?", "options": [{"label": "A", "text": "Sulfasalazine", "correct": false}, {"label": "B", "text": "Methotrexate", "correct": true}, {"label": "C", "text": "Leflunomide", "correct": false}, {"label": "D", "text": "Hydroxychloroquine", "correct": false}], "correct_answer": "B. Methotrexate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> score typically ranges from 0 to 10.\n\t\t\t\t<ul>\n<li>Low Disease Activity: <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> &lt; 3.2</li>\n<li>Moderate Disease Activity: <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> 3.2 - 5.1</li>\n<li>High Disease Activity: <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> &gt; 5.1</li>\n</ul>\n</li>\n<li>A decrease in the <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> score indicates improvement, while an increase suggests worsening disease activity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female patient with rheumatoid arthritis presents with persistent joint pain and swelling despite being on methotrexate and low-dose prednisolone for the past six months. Her Disease Activity Score (DAS28) is 5.4, indicating high disease activity. What is the most appropriate next step in her management?", "options": [{"label": "A", "text": "Increase the dose of methotrexate", "correct": false}, {"label": "B", "text": "Initiate oral triple therapy", "correct": true}, {"label": "C", "text": "Switch from methotrexate to leflunomide", "correct": false}, {"label": "D", "text": "Continue methotrexate for 3 more months", "correct": false}], "correct_answer": "B. Initiate oral triple therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> score typically ranges from 0 to 10.\n\t\t\t\t<ul>\n<li>Low Disease Activity: <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> &lt; 3.2</li>\n<li>Moderate Disease Activity: <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> 3.2 - 5.1</li>\n<li>High Disease Activity: <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> &gt; 5.1</li>\n</ul>\n</li>\n<li>A decrease in the <span class=\"customMeta\" data-dictid=\"7862e7ea6016927771850e9059150c\">DAS</span> score indicates improvement, while an increase suggests worsening disease activity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient with rheumatoid arthritis comes for evaluation of remission after six months of treatment. According to the ACR/EULAR remission criteria, which of the following is not true?", "options": [{"label": "A", "text": "Tender joint count ≤1", "correct": false}, {"label": "B", "text": "Simplified Disease Activity Index (SDAI) score of ≤ 3.2", "correct": false}, {"label": "C", "text": "CRP ≤3 mg/dL", "correct": false}, {"label": "D", "text": "Patient global assessment ≤ 2", "correct": true}], "correct_answer": "D. Patient global assessment ≤ 2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: 1. Swan neck deformity a) 2. Boutonniere deformity b) 3. Z-line deformity c) 4. Mallet finger deformity d)", "options": [{"label": "A", "text": "1-c, 2-b, 3-d, 4-a", "correct": false}, {"label": "B", "text": "1-b, 2-d, 3-a, 4-c", "correct": true}, {"label": "C", "text": "1-a, 2-c, 3-b, 4-d", "correct": false}, {"label": "D", "text": "1-d, 2-a, 3-c, 4-b", "correct": false}], "correct_answer": "B. 1-b, 2-d, 3-a, 4-c", "question_images": ["https://image.prepladder.com/notes/AltnNqd9rXim9rfcuQtw1745585435.png", "https://image.prepladder.com/notes/oh0LnljwKb3Ru4XOYlu51744361835.png", "https://image.prepladder.com/notes/4NwnK4Fn6CpzTmrk9RVv1744362165.png", "https://image.prepladder.com/notes/afB2KX0QfhqLAIPCMPA11745585451.png"], "explanation_images": ["https://image.prepladder.com/notes/oh0LnljwKb3Ru4XOYlu51744361835.png", "https://image.prepladder.com/notes/hZXo31XSHfhyul0uVJN11744361958.png", "https://image.prepladder.com/notes/aP7XqFYCgK51KeN2eEp01744362070.png", "https://image.prepladder.com/notes/4NwnK4Fn6CpzTmrk9RVv1744362165.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deformities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Images</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swan neck deformity</strong></p>\n<ul>\n<li>Extension at <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (<strong>PIP</strong>)</li>\n<li>Flexion at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (<strong>DIP</strong>): The <span class=\"customMeta\" data-dictid=\"fed387a73a16927771862b51ee0f29\">DIP joint</span> is not involved; <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> occurs due to tension on the tendons attached to the base of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> phalanges</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Swan neck deformity\" data-author=\"\" data-hash=\"9233\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/oh0LnljwKb3Ru4XOYlu51744361835.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boutonniere deformity</strong></p>\n<ul>\n<li>Flexion<strong> </strong>at <span class=\"customMeta\" data-dictid=\"bc2c34fe2216927771957ca73ba3d9\">PIP</span> and extension at DIP</li>\n<li>Both swan neck and boutonniere <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> can occur in different fingers of the same hand.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"boutonniere deformity\" data-author=\"\" data-hash=\"9234\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/hZXo31XSHfhyul0uVJN11744361958.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Z-line deformity</strong></p>\n<ul>\n<li><strong>Subluxation </strong>of the first <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joint.</li>\n<li>Hyperextension of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Z-line deformity\" data-author=\"\" data-hash=\"9235\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/aP7XqFYCgK51KeN2eEp01744362070.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mallet finger deformity</strong><strong> </strong></p>\n<ul>\n<li>Inability to extend the <span class=\"customMeta\" data-dictid=\"fed387a73a16927771862b51ee0f29\">DIP joint</span> due to a <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> injury without affecting the <span class=\"customMeta\" data-dictid=\"bc2c34fe2216927771957ca73ba3d9\">PIP</span> joint.</li>\n<li>It is usually a sports injury and is not seen in <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"Mallet finger deformity\" data-author=\"\" data-hash=\"9236\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/4NwnK4Fn6CpzTmrk9RVv1744362165.png\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 14 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 25-year-old woman presents with fatigue, joint pain, and a photosensitive rash. She reports mouth ulcers and hair loss. Laboratory tests show positive ANA and elevated anti-ds DNA antibodies. Further examination reveals elevated levels of IFN-α. Which of the following is a consequence of elevated IFN-α in this condition?", "options": [{"label": "A", "text": "Decreased B cell activation", "correct": false}, {"label": "B", "text": "Enhanced clearance of apoptotic cells", "correct": false}, {"label": "C", "text": "Suppression of T cell activity", "correct": false}, {"label": "D", "text": "Increased antibodies production", "correct": true}], "correct_answer": "D. Increased antibodies production", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predisposing/Risk factors of SLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complement deficiencies of <strong>C1q, C2, and C4</strong></li>\n<li><strong>TREX1</strong> gene mutations</li>\n<li>Affecting <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> presentation of <strong>HLA-DRB, DR3, DQA2</strong></li>\n<li><strong>Enhanced <span class=\"customMeta\" data-dictid=\"cc8345eacd1692777190c2e063a170\">innate</span> immunity</strong>, mainly increased production of IFNs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gender: <strong>Female</strong></li>\n<li>OCPs and HRT</li>\n<li>Ultraviolet light</li>\n<li>Smoking</li>\n<li>Silicosis</li>\n<li>Vitamin D deficiency</li>\n<li>EBV infection.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with a history of recurrent fever, myalgia, photosensitivity, and joint pain. On examination, multiple erythematous plaques with adherent scales are noted on her face and scalp. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Urticarial eruptions", "correct": false}, {"label": "B", "text": "Malar rash", "correct": false}, {"label": "C", "text": "Subacute cutaneous lupus erythematosus (SCLE)", "correct": false}, {"label": "D", "text": "Discoid lupus erythematosus", "correct": true}], "correct_answer": "D. Discoid lupus erythematosus", "question_images": ["https://image.prepladder.com/notes/476zdl7J5Rc56ap8dRcs1744447533.png"], "explanation_images": ["https://image.prepladder.com/notes/cGNKnkTtHAH5ffzNOvrT1744447670.png", "https://image.prepladder.com/notes/KD9cPXbIG6uWxZBQ2uov1744447789.png", "https://image.prepladder.com/notes/W2A8jjvUlE44Te6k2Yr31744447910.png", "https://image.prepladder.com/notes/CNcD7l9MPvoZJNSGloEo1744448017.png", "https://image.prepladder.com/notes/dPyszrz38BkyoyKNrQlz1744448123.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical manifestations of SLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Constitutional symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, fatigue, myalgia, weight loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucocutaneous symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Malar rash/ Butterfly rash</strong> is <span class=\"customMeta\" data-dictid=\"99af5986841692777195c8f611e7f0\">photosensitive</span> and involves the cheeks and nose, <strong>sparing the <span class=\"customMeta\" data-dictid=\"0d0dc81f3e1692777193490eadcacd\">nasolabial</span> folds.</strong> <strong>(Option B)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Malar rash\" data-author=\"Doktorinternet\" data-hash=\"9901\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Malar_rash\" data-tags=\"April2025\" height=\"342\" src=\"https://image.prepladder.com/notes/cGNKnkTtHAH5ffzNOvrT1744447670.png\" width=\"342\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Discoid <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Discoid lupus erythematosus\" data-author=\"Mohammad2018 \" data-hash=\"9902\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Discoid_lupus_erythematosus\" data-tags=\"April2025\" height=\"428\" src=\"https://image.prepladder.com/notes/KD9cPXbIG6uWxZBQ2uov1744447789.png\" width=\"355\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Subacute <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</strong> are scaly, red, <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> or flat, <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> lesions, similar to <span class=\"customMeta\" data-dictid=\"8b9f55244b1692777196b5ddb9a6bf\">psoriasis</span> <strong>(Option C)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Subacute cutaneous lupus erythematosus\" data-author=\"Uva, Luís &amp; Miguel, Diana &amp; Pinheiro, Catarina &amp; Freitas, Joao &amp; Gomes, Manuel &amp; Filipe, Paulo\" data-hash=\"9903\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/publication/230659291_Cutaneous_Manifestations_of_Systemic_Lupus_Erythematosus/citation/download\" data-tags=\"April2025\" height=\"284\" src=\"https://image.prepladder.com/notes/W2A8jjvUlE44Te6k2Yr31744447910.png\" width=\"399\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Ulcers</strong></li>\n<li><strong>Lichen planus</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Lichen planus\" data-author=\"James Heilman, MD \" data-hash=\"9904\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Lichen_planus\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/CNcD7l9MPvoZJNSGloEo1744448017.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Urticarial eruptions</strong> are red or skin-coloured, raised, and surrounded by a <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> of redness <strong>(Option A)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Urticarial eruptions\" data-author=\"James Heilman, MD \" data-hash=\"9905\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hives\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/dPyszrz38BkyoyKNrQlz1744448123.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Joint pain with <span class=\"customMeta\" data-dictid=\"7d66a14e2416927771993133552ae6\">synovitis</span> involving more than two joints, typically non-erosive but occasionally leading to deformities in severe cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anemia </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> reactions, it can happen without other organ involvement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thrombocytopenia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuropsychiatric involvement </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cognitive impairment, mood disorders, psychosis, stroke, seizures, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lung and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This can be seen in 50% of patients affected with SLE.</li>\n<li>Pulmonary manifestations may include <strong>pleuritis,</strong> <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> lung disease, or <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension.</li>\n<li>Renal involvement typically presents as <strong>lupus nephritis, </strong>characterised by proteinuria, hematuria, and, in severe cases, progressive <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> dysfunction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old woman presents with chest pain worsened by deep breathing, shortness of breath, fatigue, joint pain, and a photosensitive facial rash. Physical examination reveals tenderness over the chest wall and mild joint swelling. Laboratory tests show positive ANA and elevated anti-dsDNA antibodies. A chest X-ray shows mild pleural effusion. Which of the following pulmonary complications is most likely associated with her condition? (ARDS: Acute Respiratory Distress Syndrome)", "options": [{"label": "A", "text": "ARDS", "correct": false}, {"label": "B", "text": "Shrinking lung syndrome", "correct": false}, {"label": "C", "text": "Pulmonary hypertension", "correct": false}, {"label": "D", "text": "Pleuritis", "correct": true}], "correct_answer": "D. Pleuritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/HMwCOgDHhNk3VXZwZEiR1744448299.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Involvement in SLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pleuritis</strong><strong> (most common): </strong>Prevalence (30 - 50%)</li>\n<li>Pneumonitis</li>\n<li>Atelectasis</li>\n<li>Reduced lung volume and</li>\n<li>Pulmonary fibrosis</li>\n<li>Shrinking lung syndrome, (&lt; 5%) <strong>(Option B ruled out)</strong></li>\n<li>Intra-alveolar hemorrhage</li>\n<li>Pulmonary HTN (&lt; 5 %)<strong> (Option C ruled out)</strong></li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">Distress</span> Syndrome (ARDS) (&lt; 5%) <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is the most <strong>commonly involved system</strong></li>\n<li>Polyarthritis (<strong>symmetrical)</strong></li>\n<li>Polyarthralgia</li>\n<li><strong>Rheumatoid arthritis</strong></li>\n<li><strong>Myositis</strong></li>\n<li><strong>Jaccoud arthropathy</strong> is a <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> caused by <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> laxity, <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> fibrosis, and <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> imbalance.</li>\n<li>Axial skeletal involvement is uncommon.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Jaccoud arthropathy\" data-author=\"A. Najm, B. Le Goff, A. Achille, O. Espitia, C. Durant, F. Perrin, C. Agard\" data-hash=\"9906\" data-license=\"\" data-source=\"https://www.semanticscholar.org/paper/%5BThree-cases-of-Jaccoud%27s-arthropathy-during-Najm-Goff/f933e204973a6fe2477e6c41c5b29e3cac6436bd\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/HMwCOgDHhNk3VXZwZEiR1744448299.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lupus <span class=\"customMeta\" data-dictid=\"d4d4bbdd341692777193b705a75667\">nephritis</span> (most common)</strong></li>\n<li>Proteinuria</li>\n<li>Nephrotic syndrome</li>\n<li>Rarely End-stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Disease (ESRD)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nervous system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Headache, Seizures, Stroke, Polyneuropathy, TIA, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> confusional state, Movement disorder, <span class=\"customMeta\" data-dictid=\"50ca3536ab16927771820138ef02f8\">Aseptic</span> meningitis, Myelopathy, <span class=\"customMeta\" data-dictid=\"1cb2d1482916927771964c2890313e\">Psychosis</span> and Mood disorders.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease - common <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> </strong></li>\n<li>Pericarditis</li>\n<li>Coronary vasculitis</li>\n<li>Myocarditis</li>\n<li><strong>Libman sacks endocarditis</strong></li>\n<li>Accelerated atherosclerosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematological manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anemia of chronic disease</li>\n<li>Leucopenia</li>\n<li>Lymphopenia</li>\n<li>Thrombocytopenia</li>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> anemia-MCC of <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> in SLE</li>\n<li>Splenomegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GI involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal pain</li>\n<li>Nausea, diarrhoea</li>\n<li>Abnormal liver enzymes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular manifestation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sicca syndrome: <strong>Dry eyes (keratoconjunctivitis sicca) </strong>and<strong> <span class=\"customMeta\" data-dictid=\"e3afd7f63b1692777186b9a6e7824d\">dry mouth</span> (xerostomia).</strong></li>\n<li>Conjunctivitis</li>\n<li><strong>Episcleritis</strong></li>\n<li>Vasculitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents with joint pain and skin rashes after being treated with trimethoprim-sulfamethoxazole for a recent infection. She has a history of Systemic lupus erythematosus. Laboratory tests reveal positive anti-dsDNA antibodies. Which of the following antibodies would be more specific for diagnosing the cause of her symptoms?", "options": [{"label": "A", "text": "Anti-Ro", "correct": false}, {"label": "B", "text": "Anti-RNP", "correct": false}, {"label": "C", "text": "Anti-C1q", "correct": false}, {"label": "D", "text": "Antihistone", "correct": true}], "correct_answer": "D. Antihistone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autoantibodies of SLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antigen recognised</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ANA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple nuclear antigens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best screening test for diagnosis, it is <strong>highly sensitive but not very specific</strong> for SLE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-dsDNA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DNA (double-stranded)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High titers are specific for SLE</strong></p>\n<p>Used to correlate with disease severity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-C1q</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collagen-like determinants on C1q</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with active <strong>lupus nephritis</strong>, it is non-specific for <span class=\"customMeta\" data-dictid=\"d9bf27b09416927771984cdc6c0bc4\">SLE</span> and can be used to <strong>correlate with disease activity. <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> predisposes SLE.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-Sm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein complexed to 6 species of nuclear U1 RNA.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is <strong>highly specific for SLE.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-RNP (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein complexed to U1 RNA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-specific to SLE</strong> and is associated with <strong>syndromes that <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> with rheumatic syndromes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-Ro (SS-A) (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein complexed to hY <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> 9 (primarily 60 <span class=\"customMeta\" data-dictid=\"027c8b222c16927771909172487af7\">kDa</span> and 52 kDa)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not very specific</strong>, it is associated with <strong>sicca syndrome and <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> lupus</strong> (congenital heart block)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-La (SS-B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>47-kDa protein complexed to hY RNA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly associated with <strong>Anti-Ro antibody</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antihistone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histones associated with DNA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>drug-induced lupus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiphospholipid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phospholipids, β2-glycoprotein 1 cofactor, prothrombin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually predisposes to <strong>clotting, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> loss and thrombocytopenia.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti Erythrocyte</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythrocyte membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes <strong>autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiplatelet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surface and altered cytoplasmic antigens on platelets</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It contributes to <strong>thrombocytopenia,</strong> is<strong> not very specific or sensitive, </strong>and is not used in regular practice.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antineuronal antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neuronal and <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> surface antigens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occasionally, it shows a positive correlation with <strong>active <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> lupus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti Ribosomal P</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein in ribosomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>neuropsychiatric manifestations.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old woman presents with joint pain, fatigue, and a malar rash. Laboratory tests reveal positive ANA and anti-dsDNA antibodies. According to the EULAR/ACR classification criteria, which of the following criteria is not required for diagnosis?", "options": [{"label": "A", "text": "Antiphospholipid antibodies", "correct": false}, {"label": "B", "text": "Serositis", "correct": false}, {"label": "C", "text": "Neuropsychiatric symptoms", "correct": false}, {"label": "D", "text": "Ocular symptoms", "correct": true}], "correct_answer": "D. Ocular symptoms", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>EULAR/ACR <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> Criteria for SLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Domain and Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunological Domain and Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weight</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Constitutional</strong></p>\n<ul>\n<li>Fever</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiphospholipid antibodies (Option A ruled out)</strong></p>\n<ul>\n<li>Anti-cardiolipin antibodies or</li>\n<li>Anti-b2GP1 antibodies or</li>\n<li>Lupus anticoagulant</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematologic</strong></p>\n<ul>\n<li>Leukopenia</li>\n<li>Thrombocytopenia</li>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>3</p>\n<p>4</p>\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complement proteins</strong></p>\n<ul>\n<li>Low C3 or low C4</li>\n<li>Low C3 and C4</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>3</p>\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuropsychiatric (Option C ruled out)</strong></p>\n<ul>\n<li>Delirium</li>\n<li>Psychosis</li>\n<li>Seizure</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>2</p>\n<p>3</p>\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SLE – specific antibodies</strong></p>\n<ul>\n<li>Anti-ds DNA <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> or</li>\n<li>Anti-Smith antibody</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucocutaneous</strong></p>\n<ul>\n<li>Non-scarring alopecia</li>\n<li>Oral ulcers</li>\n<li>Subacute <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> OR <span class=\"customMeta\" data-dictid=\"0af8272baf1692777186883cc728db\">discoid</span> lupus</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> lupus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>2</p>\n<p>2</p>\n\t\t\t \n\n\t\t\t<p>4</p>\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serosal (Option B ruled out)</strong></p>\n<ul>\n<li>Pleural or <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion</li>\n<li>Acute pericarditis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>5</p>\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal</strong></p>\n<ul>\n<li>Joint Involvement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal</strong></p>\n<ul>\n<li>Proteinuria &gt;0.5 g/24 h</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> Class II or V <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> nephritis</li>\n<li><strong>Renal <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> Class III or IV <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> nephritis</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>4</p>\n\t\t\t \n\n\t\t\t<p>8</p>\n\t\t\t \n\n\t\t\t<p>10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A</strong><strong> positive <span class=\"customMeta\" data-dictid=\"a0db54ebbf1692777181d7ff70d047\">ANA</span> test </strong><strong>is required as an </strong><strong>entry criterion.</strong></li>\n<li><strong>A diagnosis is made if a total score of </strong><strong>≥10 points</strong><strong> is reached based on clinical and <span class=\"customMeta\" data-dictid=\"6eec2212b91692777189b54f3d9066\">immunological</span> features.</strong></li>\n<li><strong>All the criteria should be mainly explained by <span class=\"customMeta\" data-dictid=\"d9bf27b09416927771984cdc6c0bc4\">SLE</span> but not be attributed to other medical conditions or factors.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old woman presents with fatigue, a malar rash, and joint pain. Laboratory tests show positive anti-dsDNA, anti-Smith antibodies, and a positive ANA. She undergoes a renal biopsy that reveals features consistent with lupus nephritis. Based on the SLICC criteria, which of the following statements is true?", "options": [{"label": "A", "text": "Four clinical criteria must be met to confirm SLE", "correct": false}, {"label": "B", "text": "Renal biopsy indicating lupus with lupus autoantibodies is sufficient", "correct": true}, {"label": "C", "text": "At least 2 clinical criteria with one antibody confirms SLE", "correct": false}, {"label": "D", "text": "Presence of Anti-ds, Anti-Sm and ANA confirms SLE", "correct": false}], "correct_answer": "B. Renal biopsy indicating lupus with lupus autoantibodies is sufficient", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Systemic Lupus International Collaborating Clinic (SLICC) Criteria</li><li>↳ Systemic Lupus International Collaborating Clinic (SLICC) Criteria</li><li>↳ Systemic Lupus International Collaborating Clinic (SLICC) Criteria</li><li>↳ Systemic Lupus International Collaborating Clinic (SLICC) Criteria</li><li>↳ Clinical Manifestations Immunological Manifestations</li><li>↳ Clinical Manifestations</li><li>↳ Clinical Manifestations</li><li>↳ Clinical Manifestations</li><li>↳ Immunological Manifestations</li><li>↳ Immunological Manifestations</li><li>↳ Immunological Manifestations</li><li>↳ Skin: Acute cutaneous lupus erythematosus (photosensitive, malar, maculopapular, bullous) Chronic cutaneous lupus erythematosus (discoid lupus, panniculitis, lichen planus-like, hypertrophic verrucous, chill blains) ANA &gt; reference negative value Anti-dsDNA &gt; reference (if by ELISA, 2× reference) Anti-Sm Antiphospholipid antibodies Lupus anticoagulant Anticardiolipin Anti–β2-glycoprotein1 Low serum complement (C3, C4, or CH50) Positive direct Coombs test</li><li>↳ Skin: Acute cutaneous lupus erythematosus (photosensitive, malar, maculopapular, bullous) Chronic cutaneous lupus erythematosus (discoid lupus, panniculitis, lichen planus-like, hypertrophic verrucous, chill blains)</li><li>↳ Skin:</li><li>↳ Skin:</li><li>↳ Acute cutaneous lupus erythematosus (photosensitive, malar, maculopapular, bullous) Chronic cutaneous lupus erythematosus (discoid lupus, panniculitis, lichen planus-like, hypertrophic verrucous, chill blains)</li><li>↳ Acute cutaneous lupus erythematosus (photosensitive, malar, maculopapular, bullous)</li><li>↳ Acute cutaneous lupus erythematosus</li><li>↳ Chronic cutaneous lupus erythematosus (discoid lupus, panniculitis, lichen planus-like, hypertrophic verrucous, chill blains)</li><li>↳ Chronic cutaneous lupus erythematosus</li><li>↳ ANA &gt; reference negative value Anti-dsDNA &gt; reference (if by ELISA, 2× reference) Anti-Sm Antiphospholipid antibodies Lupus anticoagulant Anticardiolipin Anti–β2-glycoprotein1 Low serum complement (C3, C4, or CH50) Positive direct Coombs test</li><li>↳ ANA &gt; reference negative value Anti-dsDNA &gt; reference</li><li>↳ ANA &gt; reference negative value</li><li>↳ ANA</li><li>↳ Anti-dsDNA &gt; reference</li><li>↳ Anti-dsDNA</li><li>↳ (if by ELISA, 2× reference)</li><li>↳ Anti-Sm Antiphospholipid antibodies Lupus anticoagulant Anticardiolipin Anti–β2-glycoprotein1 Low serum complement (C3, C4, or CH50) Positive direct Coombs test</li><li>↳ Anti-Sm</li><li>↳ Anti-Sm</li><li>↳ Antiphospholipid antibodies</li><li>↳ Antiphospholipid antibodies</li><li>↳ Lupus anticoagulant</li><li>↳ Anticardiolipin</li><li>↳ Anti–β2-glycoprotein1</li><li>↳ Low serum complement (C3, C4, or CH50)</li><li>↳ Low serum complement</li><li>↳ Positive direct Coombs test</li><li>↳ Positive direct Coombs test</li><li>↳ Oral or nasal ulcers</li><li>↳ Oral or nasal ulcers</li><li>↳ Oral or nasal ulcers</li><li>↳ Oral or nasal ulcers</li><li>↳ Nonscarring alopecia</li><li>↳ Nonscarring alopecia</li><li>↳ Nonscarring alopecia</li><li>↳ Nonscarring alopecia</li><li>↳ Synovitis involving ≥2 joints</li><li>↳ Synovitis involving ≥2 joints</li><li>↳ Synovitis involving ≥2 joints</li><li>↳ Synovitis involving ≥2 joints</li><li>↳ Synovitis</li><li>↳ ≥2 joints</li><li>↳ Serositis (Pleurisy or pericarditis)</li><li>↳ Serositis (Pleurisy or pericarditis)</li><li>↳ Serositis (Pleurisy or pericarditis)</li><li>↳ Serositis (Pleurisy or pericarditis)</li><li>↳ Serositis</li><li>↳ Renal: Protein-to-creatinine ratio (Prot/Cr) ≥0.5 RBC casts Renal biopsy indicating lupus (Wire-loop lesions)</li><li>↳ Renal: Protein-to-creatinine ratio (Prot/Cr) ≥0.5 RBC casts Renal biopsy indicating lupus (Wire-loop lesions)</li><li>↳ Renal:</li><li>↳ Renal:</li><li>↳ Protein-to-creatinine ratio (Prot/Cr) ≥0.5 RBC casts Renal biopsy indicating lupus (Wire-loop lesions)</li><li>↳ Protein-to-creatinine ratio (Prot/Cr) ≥0.5</li><li>↳ RBC casts</li><li>↳ Renal biopsy indicating lupus (Wire-loop lesions)</li><li>↳ (Wire-loop lesions)</li><li>↳ Neurologic: Seizures Psychosis Mononeuritis &amp; myelitis Peripheral/Cranial neuropathies Acute confusional state</li><li>↳ Neurologic: Seizures Psychosis Mononeuritis &amp; myelitis Peripheral/Cranial neuropathies Acute confusional state</li><li>↳ Neurologic:</li><li>↳ Neurologic:</li><li>↳ Seizures Psychosis Mononeuritis &amp; myelitis Peripheral/Cranial neuropathies Acute confusional state</li><li>↳ Seizures</li><li>↳ Psychosis</li><li>↳ Mononeuritis &amp; myelitis</li><li>↳ Peripheral/Cranial neuropathies</li><li>↳ Acute confusional state</li><li>↳ Hematology: Hemolytic anemia Leukopenia (&lt;4000/μL) Lymphopenia (&lt;1000/μL) Thrombocytopenia (&lt;100,000/μL)</li><li>↳ Hematology: Hemolytic anemia Leukopenia (&lt;4000/μL) Lymphopenia (&lt;1000/μL) Thrombocytopenia (&lt;100,000/μL)</li><li>↳ Hematology:</li><li>↳ Hematology:</li><li>↳ Hemolytic anemia Leukopenia (&lt;4000/μL) Lymphopenia (&lt;1000/μL) Thrombocytopenia (&lt;100,000/μL)</li><li>↳ Hemolytic anemia</li><li>↳ Leukopenia (&lt;4000/μL)</li><li>↳ Lymphopenia (&lt;1000/μL)</li><li>↳ Thrombocytopenia (&lt;100,000/μL)</li><li>↳ Classification Criteria:</li><li>↳ Classification Criteria:</li><li>↳ At least 4 criteria must be present , with at least 1 from the clinical manifestations and 1 from the immunologic manifestations. (Option A, C and D ruled out) A renal biopsy indicating lupus nephritis qualifies as systemic lupus erythematosus (SLE) if any lupus autoantibodies are present, even if the total criteria are &lt; 4. (Option B)</li><li>↳ At least 4 criteria must be present , with at least 1 from the clinical manifestations and 1 from the immunologic manifestations. (Option A, C and D ruled out)</li><li>↳ At least 4 criteria must be present</li><li>↳ at least 1 from the clinical manifestations</li><li>↳ 1 from the immunologic manifestations. (Option A, C and D ruled out)</li><li>↳ A renal biopsy indicating lupus nephritis qualifies as systemic lupus erythematosus (SLE) if any lupus autoantibodies are present, even if the total criteria are &lt; 4. (Option B)</li><li>↳ A renal biopsy indicating lupus nephritis qualifies as systemic lupus erythematosus (SLE) if any lupus autoantibodies are present, even if the total criteria are &lt; 4. (Option B)</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> International Collaborating Clinic (SLICC) Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunological Manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin:</strong></p>\n<ul>\n<li><strong>Acute <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</strong> (photosensitive, malar, maculopapular, bullous)</li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</strong> (discoid lupus, panniculitis, <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> planus-like, hypertrophic verrucous, chill blains)</li>\n</ul>\n</td>\n<td rowspan=\"8\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>ANA</strong> &gt; reference negative value</li>\n<li><strong>Anti-dsDNA </strong>&gt; reference</li>\n</ul>\n<p>(if by ELISA, 2× reference)</p>\n<ul>\n<li><strong>Anti-Sm</strong></li>\n<li><strong>Antiphospholipid antibodies</strong></li>\n<li>Lupus anticoagulant</li>\n<li>Anticardiolipin</li>\n<li>Anti–β2-glycoprotein1</li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> </strong>(C3, C4, or CH50)</li>\n<li><strong>Positive direct Coombs test</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> ulcers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nonscarring alopecia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Synovitis </strong>involving<strong> ≥2 joints</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Serositis </strong>(Pleurisy or pericarditis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal:</strong></p>\n<ul>\n<li>Protein-to-creatinine ratio (Prot/Cr) ≥0.5</li>\n<li>RBC casts</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> indicating <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> <strong>(Wire-loop lesions)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurologic:</strong></p>\n<ul>\n<li>Seizures</li>\n<li>Psychosis</li>\n<li>Mononeuritis &amp; myelitis</li>\n<li>Peripheral/Cranial neuropathies</li>\n<li>Acute confusional state</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematology:</strong></p>\n<ul>\n<li>Hemolytic anemia</li>\n<li>Leukopenia (&lt;4000/μL)</li>\n<li>Lymphopenia (&lt;1000/μL)</li>\n<li>Thrombocytopenia (&lt;100,000/μL)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman with a known history of systemic lupus erythematosus presents with hypertension and elevated creatinine levels. A renal biopsy reveals glomerular inflammation affecting over 50% of her glomeruli. Based on these findings, which class of lupus nephritis does she fall under?", "options": [{"label": "A", "text": "Class V", "correct": false}, {"label": "B", "text": "Class II", "correct": false}, {"label": "C", "text": "Class III", "correct": false}, {"label": "D", "text": "Class IV", "correct": true}], "correct_answer": "D. Class IV", "question_images": ["https://image.prepladder.com/notes/0fLsf7FioQg4AWVByB7L1744448515.png"], "explanation_images": ["https://image.prepladder.com/content/CJ8MYYmIfrhtU6jhderu1740583904.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:676px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification of <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> nephritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class I: Minimal Mesangial <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normal <span class=\"customMeta\" data-dictid=\"c9bd75ce5f1692777188f7fe800061\">glomeruli</span> by light microscopy.</li>\n<li>Mesangial immune deposits detected by immunofluorescence.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class I: Minimal Mesangial &lt;span class=\" custommeta\"=\"\" data-dictid=\"ccd536a9071692777191f53538ca30\"/>Lupus Nephritis\" data-author=\"Anders, Hans-Joachim &amp; Fogo, Agnes.\" data-hash=\"11287\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Minimal-mesangial-lupus-nephritis-ISN-RPS-class-I-a-Glomerulus-without-mesangial-or_fig1_259630750\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/EWO9whgITZL4XuMdXwau1745577694.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class I: Minimal Mesangial &lt;span class=\" custommeta\"=\"\" data-dictid=\"ccd536a9071692777191f53538ca30\"/>Lupus Nephritis\" data-author=\"Anders, Hans-Joachim &amp; Fogo, Agnes.\" data-hash=\"11288\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Minimal-mesangial-lupus-nephritis-ISN-RPS-class-I-a-Glomerulus-without-mesangial-or_fig1_259630750\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/7rkoLa8SHNfouymAJhfM1745577708.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class II: Mesangial Proliferative <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Light microscopy</strong>: Mesangial <span class=\"customMeta\" data-dictid=\"38226ff6e41692777189b7d1c80f9d\">hypercellularity</span> (or) <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> expansion</li>\n<li><strong>Mesangial immune deposits</strong></li>\n<li>Subepithelial or <span class=\"customMeta\" data-dictid=\"debc628674169277719936b6424a58\">subendothelial</span> deposits may be present.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class II: Mesangial Proliferative &lt;span class=\" custommeta\"=\"\" data-dictid=\"ccd536a9071692777191f53538ca30\"/>Lupus <span class=\"customMeta\" data-dictid=\"d4d4bbdd341692777193b705a75667\">Nephritis</span> \" data-author=\"Elshweikh, Samah &amp; Elkhouly, Radwa &amp; Shaalan, Mohamed &amp; Shorbagy, Safinaz\" data-hash=\"9918\" data-license=\"\" data-source=\"https://www.researchgate.net/figure/Class-II-lupus-nephritis-showing-proliferation-of-mesangial-cells-arrow-H-E-X400_fig1_274257010\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/nlMnET1tF0fHvgdu62MP1744449341.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class II: Mesangial Proliferative &lt;span class=\" custommeta\"=\"\" data-dictid=\"ccd536a9071692777191f53538ca30\"/>Lupus Nephritis\" data-author=\"Habib, Rumana &amp; Islam, Reezwan &amp; Miah, Md &amp; Islam, Md Rashedul &amp; Rahman, Aminur &amp; Bhowmik, Nirmalendu.\" data-hash=\"9923\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Fig-6-Mesangial-proliferative-lupus-nephritis-Class-II-lupus-nephritis_fig5_320308764\" data-tags=\"April2025\" height=\"307\" src=\"https://image.prepladder.com/notes/kMspn6TvRyJeAGbU77uC1744449436.png\" width=\"364\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class III: <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis</strong></p>\n<ul>\n<li><strong>Class III (A):</strong> Active lesions—focal proliferative <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> nephritis.</li>\n<li><strong>Class III (C):</strong> Chronic inactive lesions—focal <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> nephritis.</li>\n<li><strong>Class III (A/C):</strong> Active and chronic lesions</li>\n</ul>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Active or inactive <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> involving <strong>≤50%</strong> of all glomeruli.</li>\n<li>Focal <span class=\"customMeta\" data-dictid=\"debc628674169277719936b6424a58\">subendothelial</span> immune deposits and possible mesangial alterations</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class III: &lt;span class=\" custommeta\"=\"\" data-dictid=\"da6db7b0e21692777203c4075458d3\"/>Focal <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis\" data-author=\"Anders, Hans-Joachim &amp; Fogo, Agnes.\" data-hash=\"9928\" data-license=\"\" data-source=\"https://www.researchgate.net/figure/Focal-lupus-nephritis-ISN-RPS-class-III-a-There-is-endocapillary-proliferation-and-a_fig2_259630750\" data-tags=\"April2025\" height=\"273\" src=\"https://image.prepladder.com/notes/UEEpLvA5NHpNGsLjOStp1744449627.png\" width=\"346\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class IV: <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">Diffuse</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis</strong></p>\n<ul>\n<li><strong>Class IV-S:</strong> <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">Diffuse</span> <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> <span class=\"customMeta\" data-dictid=\"d4d4bbdd341692777193b705a75667\">nephritis</span> (≥50% of involved <span class=\"customMeta\" data-dictid=\"c9bd75ce5f1692777188f7fe800061\">glomeruli</span> have <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> lesions).</li>\n<li><strong>Class IV-G:</strong> <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">Diffuse</span> global <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> <span class=\"customMeta\" data-dictid=\"d4d4bbdd341692777193b705a75667\">nephritis</span> (≥50% of involved <span class=\"customMeta\" data-dictid=\"c9bd75ce5f1692777188f7fe800061\">glomeruli</span> have global lesions).</li>\n<li><strong>Class IV (A):</strong> Active lesion</li>\n<li><strong>Class IV (A/C):</strong> Active and chronic lesion</li>\n<li><strong>Class IV (C):</strong> Chronic inactive lesions with scars</li>\n</ul>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Active or inactive <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> involving <strong>≥50%</strong> of all glomeruli.</li>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"debc628674169277719936b6424a58\">subendothelial</span> immune deposits and possible mesangial alterations.</li>\n<li><strong>Wire-loop lesions </strong>in <strong>IF</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class IV: &lt;span class=\" custommeta\"=\"\" data-dictid=\"89275101301692777186567d1912a0\"/>Diffuse <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis\" data-author=\"Nephron\" data-hash=\"9932\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Lupus_nephritis\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/FfjGDUmHHTPFKGQm2YDp1744449733.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"258\" src=\"https://image.prepladder.com/content/CJ8MYYmIfrhtU6jhderu1740583904.png\" width=\"331\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class V: Membranous <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Global or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"94aff4fd141692777199a78b5ed2eb\">subepithelial</span> immune deposits.</li>\n<li>Morphologic sequelae are observable by light microscopy, immunofluorescence, or <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> microscopy, with or without mesangial alterations.</li>\n<li>It may coexist with class III or IV LN.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class V: Membranous &lt;span class=\" custommeta\"=\"\" data-dictid=\"ccd536a9071692777191f53538ca30\"/>Lupus Nephritis\" data-author=\"Giannico, Giovanna &amp; Fogo, Agnes.\" data-hash=\"9940\" data-license=\"\" data-source=\"https://www.researchgate.net/figure/Membranous-lupus-nephropathy-with-segmental-sclerosis-The-area-of-segmental-sclerosis_fig3_230850562\" data-tags=\"April2025\" height=\"264\" src=\"https://image.prepladder.com/notes/SlyQlXjWBLSL6rzkcWCw1744450109.png\" width=\"348\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class V: Membranous &lt;span class=\" custommeta\"=\"\" data-dictid=\"ccd536a9071692777191f53538ca30\"/>Lupus Nephritis\" data-author=\"Mark A. Lusco, MD1 ∙ Agnes B. Fogo, MD1 agnes.fogo@vanderbilt.edu ∙ Behzad Najafian, MD2 ∙ Charles E. Alpers, MD\" data-hash=\"11289\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Membranous-lupus-nephropathy-with-segmental-sclerosis-The-area-of-segmental-sclerosis_fig3_230850562\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/vS2K8cCxTgw4CZ3MpXxe1745577733.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class VI: Advanced <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">Sclerotic</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>≥90% </strong>of <span class=\"customMeta\" data-dictid=\"c9bd75ce5f1692777188f7fe800061\">glomeruli</span> globally sclerosed.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> activity.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Class VI: Advanced &lt;span class=\" custommeta\"=\"\" data-dictid=\"934e9f88af169277719847f1a0728f\"/>Sclerotic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Nephritis\" data-author=\"Giannico, Giovanna &amp; Fogo, Agnes.\" data-hash=\"9945\" data-license=\"\" data-source=\"https://www.researchgate.net/figure/Global-sclerosis-in-lupus-nephritis-Despite-the-extensive-degree-of-sclerosis-the_fig2_230850562\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/uCmY10nv6PvfQY5Lshrh1744450426.png\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman with a history of SLE presents with increased fatigue, severe joint pain and pleuritis with features suggestive of coronary artery disease. Laboratory tests indicate elevated serum creatinine. Which of the following management strategies is most appropriate for this patient?", "options": [{"label": "A", "text": "High-dose glucocorticoids and Cyclophosphamide", "correct": true}, {"label": "B", "text": "Hydroxychloroquine and NSAIDs for symptom relief", "correct": false}, {"label": "C", "text": "Low-dose glucocorticoids, along with azathioprine", "correct": false}, {"label": "D", "text": "Conservative management with close monitoring and supportive care", "correct": false}], "correct_answer": "A. High-dose glucocorticoids and Cyclophosphamide", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/LG1pPiYA7HcwrSNgNo391745577916.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman with a history of hypertension presents with fever, rash, and joint pain. Laboratory tests show positive ANA and anti-histone antibodies. She has no signs of renal or neurological involvement. Which of the following medications is most likely responsible for her symptoms?", "options": [{"label": "A", "text": "Metoprolol", "correct": false}, {"label": "B", "text": "Hydrochlorothiazide", "correct": false}, {"label": "C", "text": "Hydralazine", "correct": true}, {"label": "D", "text": "Amlodipine", "correct": false}], "correct_answer": "C. Hydralazine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with TB on ATT isoniazid therapy presents with fatigue, fever, joint pain, and a rash. Laboratory tests reveal a positive antinuclear antibody (ANA) test, and anti-histone antibodies are detected. Which of the following ANA staining patterns is most likely found in this patient?", "options": [{"label": "A", "text": "Diffuse", "correct": true}, {"label": "B", "text": "Speckled", "correct": false}, {"label": "C", "text": "Nucleolar", "correct": false}, {"label": "D", "text": "Centromere", "correct": false}], "correct_answer": "A. Diffuse", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ClevrhavcjhtbxhMiihC1744450955.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>ANA patterns of SLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ANA pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibody identifies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histones</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant for<strong> drug-induced lupus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral (rim) pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-ds-DNA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly specific for <span class=\"customMeta\" data-dictid=\"d9bf27b09416927771984cdc6c0bc4\">SLE</span> but not very sensitive</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Speckled pattern </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti U1-RNP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with mixed <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue disease (MCTD)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti Sm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Is <strong>specific for Lupus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti Ro (SS-A)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>Sjögren’s, SCLE &amp; <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> lupus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti La (SS-B)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>Anti-Ro</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti Scl-70</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>diffuse scleroderma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti Jo-1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>polymyositis with <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> and arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nucleolar pattern</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RNA polymerase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>progressive <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Centromere</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kinetochore</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>CREST, Sjogren’s &amp; thyroiditis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ANA patterns of SLE\" data-author=\"Al-Mughales JA\" data-hash=\"9959\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Antinuclear_antibody\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ClevrhavcjhtbxhMiihC1744450955.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman with a history of recurrent miscarriages and recent episodes of deep vein thrombosis is found to have elevated anti-β2-glycoprotein I antibodies. Which of the following pathophysiological mechanisms is primarily responsible for her condition?", "options": [{"label": "A", "text": "Deactivation of the complement pathway", "correct": false}, {"label": "B", "text": "Increased apoptosis of endothelial cells", "correct": true}, {"label": "C", "text": "Decreased platelet activation", "correct": false}, {"label": "D", "text": "Impaired fibrinolysis", "correct": false}], "correct_answer": "B. Increased apoptosis of endothelial cells", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/RbDKDDtdowpCXyQrOqcu1745577963.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with a history of recurrent miscarriages, having experienced three miscarriages before 10 weeks of gestation and an unprovoked deep vein thrombosis (DVT) in her left leg six months ago, which required anticoagulation therapy. She is diagnosed with antiphospholipid syndrome. Which of the following is not a diagnostic criterion of antiphospholipid syndrome?", "options": [{"label": "A", "text": "Vascular thrombosis of artery, vein or any small vessel", "correct": false}, {"label": "B", "text": "3 or more unexplained consecutive miscarriages before 10 weeks of gestation", "correct": false}, {"label": "C", "text": "Positive titer for APLA antibodies on a single occasion", "correct": true}, {"label": "D", "text": "One or more unexplained deaths of a normal fetus at or after 10 weeks", "correct": false}], "correct_answer": "C. Positive titer for APLA antibodies on a single occasion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis of antiphospholipid syndrome </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical criteria </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vascular <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> - one or more clinical episodes of arterial, <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> or small vessel thrombosis<strong> (Option A ruled out)</strong></li>\n<li>Pregnancy <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> (anyone)\n\t\t\t\t<ul>\n<li>One or more unexplained deaths of a normal <span class=\"customMeta\" data-dictid=\"421fecf0e21692777202704942ac48\">fetus</span> at or after 10 weeks of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> <strong> (Option D ruled out)</strong></li>\n<li>One or more <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> births of a normal <span class=\"customMeta\" data-dictid=\"d7bb0026fe169277719321db7b41a2\">neonate</span> before 34 weeks of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> due to <strong>eclampsia</strong>, <strong>severe pre-eclampsia or <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> </strong></li>\n<li>Three or more unexplained consecutive miscarriages before 10 weeks of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> <strong> (Option B ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lab criteria </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate or high <span class=\"customMeta\" data-dictid=\"07e6f3a1921692777200051f692a60\">titer</span> of any one of the following antibodies on <strong>two occasions 12 weeks apart. </strong><strong>(Option C)</strong></p>\n<ul>\n<li><strong>Lupus <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> </strong></li>\n<li><strong>Anticardiolipin </strong></li>\n<li><strong>Anti-beta-2-glycoprotein-I</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis of APLA: One clinical</strong> + <strong>one laboratory criterion</strong> in the <strong>absence of other thrombophilia</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman with a known history of antiphospholipid syndrome (APS) was admitted to the hospital due to arterial thrombosis. She had a history of deep vein thrombosis (DVT) one year ago, for which she was treated with warfarin. She has been adherent to her warfarin therapy, with a target INR of 2.5. Investigations show the following reports. INR: 2.1 Lupus antibody: Positive Anticardiolipin antibody: Positive Anti-β2 glycoprotein I antibodies: Positive What would be the most appropriate adjustment to her treatment after this arterial thrombosis episode?", "options": [{"label": "A", "text": "Administration of oral hydroxychloroquine", "correct": false}, {"label": "B", "text": "Increase the dose of warfarin with a target INR of 3.0 to 4.0", "correct": true}, {"label": "C", "text": "Switch to direct oral thrombin inhibitor", "correct": false}, {"label": "D", "text": "Switch to low-dose aspirin with prophylactic dose low molecular weight heparin.", "correct": false}], "correct_answer": "B. Increase the dose of warfarin with a target INR of 3.0 to 4.0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:677px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of antiphospholipid syndrome </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>After the first <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Warfarin - </strong>Lifelong with a target INR 2.0-3.0</li>\n<li>Consider <strong>Direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitors</strong> if there is a <span class=\"customMeta\" data-dictid=\"c9f33964851692777185b94f619862\">contraindication</span> to <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">warfarin</span> or failure to achieve target INR *</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Increase <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">warfarin</span> dose</strong> with target INR 3.0-4.0 or <strong>(Option B)</strong></li>\n<li>Maintain INR 2.0-3.0 and <strong>low-dose <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> (LDA) </strong>70-100 mg/day</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnant woman with APLA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>LDA</strong> + <strong>Prophylactic</strong> dose of LMWH <strong>(Option D ruled out)</strong></li>\n<li>If <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> occurs - <strong>LDA</strong> + <strong>therapeutic</strong> dose of LMWH</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recurrent obstetric complications, even after standard treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>LDA</strong> + <strong>therapeutic</strong> dose of LMWH</li>\n<li><strong>Oral hydroxychloroquine </strong>400 mg / day <strong>(Option A ruled out)</strong></li>\n<li><strong>IV <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> </strong>400 mg/kg for 5 days</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asymptomatic patients with high-risk antiphospholipid profile </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Prophylactic low-dose <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Catastrophic antiphospholipid syndrome (CAPS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Combination therapy </strong>\n<ul>\n<li>Glucocorticoid</li>\n<li>Heparin</li>\n<li>Plasmapheresis or IV immunoglobulin</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Refractory CAPS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>B-cell <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> therapy with <span class=\"customMeta\" data-dictid=\"e3802f488416927771979c6d76c756\">rituximab</span> </strong></li>\n<li><strong>Complement <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> with <span class=\"customMeta\" data-dictid=\"6a9b33e69916927771861bd0e99af4\">Eculizumab</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>* Avoid direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitors</strong> in cases of prior arterial <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> or triple positive APLA <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following assay tests cannot detect lupus anticoagulant antibodies?", "options": [{"label": "A", "text": "Enzyme-linked immunosorbent assay", "correct": true}, {"label": "B", "text": "Activated thromboplastin time", "correct": false}, {"label": "C", "text": "Kaolin clotting time", "correct": false}, {"label": "D", "text": "Dilute Russell viper venom test", "correct": false}], "correct_answer": "A. Enzyme-linked immunosorbent assay", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Principle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dilute <span class=\"customMeta\" data-dictid=\"da8b539b8c1692777197325b19717c\">Russell <span class=\"customMeta\" data-dictid=\"efbb05601b1692777202641ca3e610\">Viper</span> <span class=\"customMeta\" data-dictid=\"ce053080da169277720142dbefddb2\">Venom</span> Time</span> (DRVVT) Test</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Utilises <span class=\"customMeta\" data-dictid=\"e63a499e5716927771860681cef17d\">dilute</span> Russell <span class=\"customMeta\" data-dictid=\"efbb05601b1692777202641ca3e610\">viper</span> <span class=\"customMeta\" data-dictid=\"ce053080da169277720142dbefddb2\">venom</span> to <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> <span class=\"customMeta\" data-dictid=\"69e0db00bd169277720233cd39735b\">factor X</span> in the <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> cascade.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> <strong>inhibits <span class=\"customMeta\" data-dictid=\"69e0db00bd169277720233cd39735b\">factor X</span> activation</strong>, leading to prolonged <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> time (no <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> formation).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kaolin <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">Clotting</span> Time</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the time taken for a <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> in the presence of kaolin, an <span class=\"customMeta\" data-dictid=\"a095f733351692777180a29940c98a\">activator</span> of the <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> pathway.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"9a504443b51692777190b7d2b2de65\">kaolin</span> <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> time</strong> indicates the presence of <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> anticoagulant, impairing normal coagulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Activated <span class=\"customMeta\" data-dictid=\"40141499f716927771945a13f86369\">Partial <span class=\"customMeta\" data-dictid=\"9b51982d06169277720063c9420fbb\">Thromboplastin</span> Time</span> (aPTT)</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses the <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> and common pathways of <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> by measuring the <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> time after adding an <span class=\"customMeta\" data-dictid=\"a095f733351692777180a29940c98a\">activator</span> to plasma.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prolonged aPTT</strong> suggests the presence of <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> anticoagulant, as it binds to β2-glycoprotein I or <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> and interferes with clotting.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 12 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old man presents with skin changes, reporting that his fingers have become thick and tight. He has developed painful ulcers on his fingertips that heal slowly. The physician notes shiny, taut skin on his face and limited neck extension. The given image shows the patient's facial features. Which of the following findings is NOT typically associated with the skin changes observed in this patient?", "options": [{"label": "A", "text": "Bilateral symmetrical skin thickening", "correct": false}, {"label": "B", "text": "Hyperpigmentation in sun-exposed areas", "correct": true}, {"label": "C", "text": "Fixed flexion contractures of the fingers", "correct": false}, {"label": "D", "text": "Telangiectasia on the face and hands", "correct": false}], "correct_answer": "B. Hyperpigmentation in sun-exposed areas", "question_images": ["https://image.prepladder.com/notes/3cz5wdJN0CaBKpUIscyt1744302116.png"], "explanation_images": ["https://image.prepladder.com/notes/3cz5wdJN0CaBKpUIscyt1744302116.png", "https://image.prepladder.com/notes/3mjSTaFhfV216AyNWBvR1744302256.png", "https://image.prepladder.com/notes/19CLEuq6svk1CW99er3k1744302379.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about the histopathological examination (HPE) of the images is correct? A) B) Image A shows a thickened dermis with collagen accumulation and loss of adipose tissue. Image B demonstrates normal glomerular architecture with no signs of injury. Image B shows vascular lesions and ischemic glomerular changes. Image A is characterized by alveolar septal fibrosis leading to gas exchange impairment.", "options": [{"label": "A", "text": "3 and 4", "correct": false}, {"label": "B", "text": "2 and 4", "correct": false}, {"label": "C", "text": "Only 2", "correct": false}, {"label": "D", "text": "1 and 3", "correct": true}], "correct_answer": "D. 1 and 3", "question_images": ["https://image.prepladder.com/notes/JROOXsvo9KaAqeMuG9d01744302481.png", "https://image.prepladder.com/notes/DCIY0GUfwXx9MQ8SEdWr1744302704.png"], "explanation_images": ["https://image.prepladder.com/notes/JROOXsvo9KaAqeMuG9d01744302481.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Organ/System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Pathologic Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>General Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Widespread microangiopathy, <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> loss, and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> across organs.</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (T and B lymphocytes, macrophages) around blood vessels, progressing to non-inflammatory obliterative <span class=\"customMeta\" data-dictid=\"4c8fd695b216927771920fd1af0c75\">microangiopathy</span> in late disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Thickened <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> due to <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> accumulation and atrophic adnexal glands.</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue replaced by collagen.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"2nd question Thickened dermis-systemic sclerosis\" data-author=\"Joel Pinczewski, M.D., Ph.D.\" data-hash=\"8762\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/skinnontumorscleroderma.html\" data-tags=\"\" height=\"317\" src=\"https://image.prepladder.com/notes/JROOXsvo9KaAqeMuG9d01744302481.png\" width=\"457\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lungs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>NSIP pattern with <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and mild inflammation; less commonly UIP pattern.</li>\n<li>Alveolar septal <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> leads to gas exchange <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (PAH).</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"0c950b29361692777190aa5f42e76b\">intimal</span> thickening, often with fibrosis, and sometimes associated with veno-occlusive disease and lymphocytic bronchiolitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gastrointestinal Tract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Muscularis propria <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> and fibrosis, especially in the lower esophagus, cause dysmotility.</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> with <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> ulceration, stricture, and potential Barrett’s metaplasia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Kidneys</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Vascular lesions in <span class=\"customMeta\" data-dictid=\"acc571bff61692777190b2fc43f406\">interlobular</span> and <span class=\"customMeta\" data-dictid=\"734bdc6ddd1692777182e15cb76ca5\">arcuate</span> arteries; ischemic <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> changes.</li>\n<li>Scleroderma <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis shows <span class=\"customMeta\" data-dictid=\"43b1f01822169277720222a3b354dd\">fibrinoid</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of arterioles, <span class=\"customMeta\" data-dictid=\"0c950b29361692777190aa5f42e76b\">intimal</span> proliferation, and thrombotic microangiopathy-like changes.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"2nd question - option (B) &lt;span class=\" custommeta\"=\"\" data-dictid=\"8f2e7fd96116927771995b451b5c90\"/>systemic sclerosis kidney histopathology\" data-author=\"by Francesco Reggiani 1,2,*ORCID,Gabriella Moroni 1 andClaudio Ponticelli 3\" data-hash=\"8767\" data-license=\"Open access\" data-source=\"https://www.mdpi.com/2075-4426/12/7/1123\" data-tags=\"\" height=\"276\" src=\"https://image.prepladder.com/notes/DCIY0GUfwXx9MQ8SEdWr1744302704.png\" width=\"406\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Heart</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Arteriolar <span class=\"customMeta\" data-dictid=\"0c950b29361692777190aa5f42e76b\">intimal</span> hypertrophy, myocardial fibrosis, and <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> band necrosis.</li>\n<li>Conduction system <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (especially SA node) and potential epicardial atherosclerosis.</li>\n<li>Common <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> inflammation, sometimes with effusions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Synovitis of hands, progressing to <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> in <span class=\"customMeta\" data-dictid=\"4d5c42a8591692777199d8e337af3f\">synovium</span> and tendons with <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rubs.</li>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and atrophy, similar to polymyositis.</li>\n<li>Fibrosis in <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> and minor salivary glands, leading to <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> and sicca syndrome.</li>\n<li>Decidual <span class=\"customMeta\" data-dictid=\"929584f4881692777201f5248a021d\">vasculopathy</span> in placentas, associated with adverse <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> outcomes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old woman presents with skin changes, including thickened and tight skin on her fingers, as well as pain and ulcerations at the fingertips. On examination, she has a shiny appearance to her skin and visible telangiectasia on her face. Which of the following options includes one pulmonary and one cardiac manifestation correctly associated with her clinical features?", "options": [{"label": "A", "text": "Tuberculosis; Congestive cardiac failure", "correct": false}, {"label": "B", "text": "Cavitation; Pericarditis", "correct": false}, {"label": "C", "text": "Pulmonary arterial hypertension; Constrictive pericarditis", "correct": true}, {"label": "D", "text": "Non-caseating granuloma; Atrial myxoma", "correct": false}], "correct_answer": "C. Pulmonary arterial hypertension; Constrictive pericarditis", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diffuse </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Limited</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal &amp; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> extremities, face, trunk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal to elbows, face</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Raynaud’s Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Onset &lt;1 year/at the time of skin changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Precede skin diseases by years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary (Interstitial fibrosis),</p>\n<p>Renal (Renovascular <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> crisis),</p>\n<p>GI &amp; Cardiac</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GI, <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">Biliary</span> cirrhosis, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nail fold capillaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilatation and dropout</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilatation without significant dropout</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antinuclear antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-topoisomerase 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anticentromere</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman with systemic sclerosis presents with new-onset hypertension and episodes of cold-induced finger discoloration. Which statement about her renal and vascular manifestations is false?", "options": [{"label": "A", "text": "Scleroderma renal crisis presents with accelerated hypertension and can cause renal failure.", "correct": false}, {"label": "B", "text": "Raynaud's phenomenon is the most common extracutaneous feature and can lead to ulcers.", "correct": false}, {"label": "C", "text": "Anti-centromere antibodies increase the risk of scleroderma renal crisis.", "correct": true}, {"label": "D", "text": "Nailfold capillaroscopy distinguishes between primary and secondary Raynaud’s.", "correct": false}], "correct_answer": "C. Anti-centromere antibodies increase the risk of scleroderma renal crisis.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4Ix5gVcJ9IEqeBdZ2xo81744303094.png", "https://image.prepladder.com/notes/dZNqdwHCSLFruVEPWpB11744303193.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with symptoms including skin thickening on her fingers, fatigue, and shortness of breath with episodes of painful swelling in her fingertips and difficulty swallowing. During her examination, a specific immunofluorescence test is performed, revealing the presence of several autoantibodies. Which of the following auto-antibodies is most likely associated with severe skin involvement and interstitial lung disease in this patient?", "options": [{"label": "A", "text": "Centromere Proteins", "correct": false}, {"label": "B", "text": "Topoisomerase I (Scl-70)", "correct": true}, {"label": "C", "text": "RNA Polymerase III", "correct": false}, {"label": "D", "text": "U1-RNP", "correct": false}], "correct_answer": "B. Topoisomerase I (Scl-70)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4NWhZf51FDm3B6kQFXlZ1744303409.png", "https://image.prepladder.com/notes/YYFoAsx4SKftuaYWUagq1744303515.png", "https://image.prepladder.com/notes/wmfBPi5FOIOjedlRg4yx1744303648.png", "https://image.prepladder.com/notes/wmfBPi5FOIOjedlRg4yx1744303648.png", "https://image.prepladder.com/notes/4NWhZf51FDm3B6kQFXlZ1744303409.png", "https://image.prepladder.com/notes/X1NaycBCISYk1UpOywMg1744303985.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Auto-Antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>SSc Subset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Prominent Characteristic</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Topoisomerase I (Scl-70)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>dcSSc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Speckled pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Speckled pattern immunofluorescence\" data-author=\"Michael Mahler, Marvin J. Fritzler\" data-hash=\"8779\" data-license=\"Open access\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2012/494356\" data-tags=\"\" height=\"274\" src=\"https://image.prepladder.com/notes/4NWhZf51FDm3B6kQFXlZ1744303409.png\" width=\"345\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Tendon <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rubs, digital ischemic ulcers, scleroderma, extensive skin involvement, early ILD, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> involvement, <span class=\"customMeta\" data-dictid=\"85cd27a4521692777198d76c839cb2\">scleroderma</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Centromere proteins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>lcSSc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Discrete speckled (centromere) pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Discrete speckled (centromere) pattern\" data-author=\"Simon Caulton \" data-hash=\"8780\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Anti-centromere_antibodies#/media/File:CENTROMERE.jpg\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/notes/YYFoAsx4SKftuaYWUagq1744303515.png\" width=\"392\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Digital ischemic ulcers, <span class=\"customMeta\" data-dictid=\"a28b336ec21692777183ec0b5e47f9\">calcinosis</span> cutis, isolated PAH; <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis rare <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>dcSSc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Speckled pattern</li>\n<li>Rapidly progressive skin involvement, <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rubs, joint contractures, GAVE, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis, contemporaneous cancers; digital ulcers rare <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>U3-RNP (fibrillarin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Nucleolar pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Nucleolar pattern immunofluorescence pattern\" data-author=\"Simon Caulton \" data-hash=\"8784\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ANA_NUCLEOLAR_3.jpg\" data-tags=\"\" height=\"343\" src=\"https://image.prepladder.com/notes/wmfBPi5FOIOjedlRg4yx1744303648.png\" width=\"352\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>PAH, ILD, <span class=\"customMeta\" data-dictid=\"85cd27a4521692777198d76c839cb2\">scleroderma</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis, GI <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement, myositis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Th/To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Nucleolar pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Nucleolar pattern immunofluorescence pattern\" data-author=\"Simon Caulton \" data-hash=\"8784\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ANA_NUCLEOLAR_3.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/notes/wmfBPi5FOIOjedlRg4yx1744303648.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>ILD, PAH</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>PM/Scl</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Nucleolar pattern</li>\n<li>Calcinosis cutis, ILD, <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> overlap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ku</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>overlap</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Speckled pattern</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Speckled pattern immunofluorescence\" data-author=\"Michael Mahler, Marvin J. Fritzler\" data-hash=\"8779\" data-license=\"Open access\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2012/494356\" data-tags=\"\" height=\"309\" src=\"https://image.prepladder.com/notes/4NWhZf51FDm3B6kQFXlZ1744303409.png\" width=\"389\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>SLE, <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> overlap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>U1-RNP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Speckled pattern</li>\n<li>PAH, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> arthritis, <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>U11/U12 RNP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>dc/lc SSc</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Speckled pattern</li>\n<li>ILD</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman presents with severe fatigue, dry mouth, difficulty swallowing, and episodes of coldness and color changes in her fingers. She reports dyspnea on exertion and has a history of gastrointestinal reflux. There is no visible skin thickening. Laboratory tests show positive anti-nuclear antibodies and anti-Scl-70 antibodies. Which condition is she most likely experiencing?", "options": [{"label": "A", "text": "Limited Scleroderma", "correct": false}, {"label": "B", "text": "Diffuse Scleroderma", "correct": false}, {"label": "C", "text": "Sine Sclerosis", "correct": true}, {"label": "D", "text": "Sjögren's Syndrome", "correct": false}], "correct_answer": "C. Sine Sclerosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:754px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Limited Scleroderma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diffuse Scleroderma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sine Sclerosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common type of scleroderma.</li>\n<li>Skin thickening is usually limited to fingers, hands, forearms, or face. <strong>(Option A ruled out)</strong></li>\n<li>Internal organ damage is less likely, and life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> is typically normal.</li>\n<li>Symptoms may include <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> (GI) issues (especially heartburn), severe Raynaud’s phenomenon, and <span class=\"customMeta\" data-dictid=\"09b955b4f91692777193bd4080e7fc\">musculoskeletal</span> pain.</li>\n<li>A small subset of patients can develop life-threatening <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension.</li>\n<li>Subtype - <strong>CREST Syndrome</strong>: Defined by five main features:\n\t\t\t\t<ul>\n<li><strong>Calcinosis</strong>: <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> deposits under the skin or in tissues.</li>\n<li><strong>Raynaud’s Phenomenon</strong>: Color changes, cold, numbness, or <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> in fingers/toes.</li>\n<li><strong>Esophageal Dysmotility</strong>: Causes heartburn.</li>\n<li><strong>Sclerodactyly</strong>: Thickened skin on fingers.</li>\n<li><strong>Telangiectasias</strong>: Red spots from enlarged blood vessels on fingers, face, or other areas.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Skin thickening over large body areas (fingers, hands, arms, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> trunk, legs, and face). <strong>(Option B ruled out)</strong></li>\n<li>Significant risk of organ damage (GI tract, kidneys, lungs, heart).</li>\n<li>Associated with skin dryness, itching, and <span class=\"customMeta\" data-dictid=\"09b955b4f91692777193bd4080e7fc\">musculoskeletal</span> pain.</li>\n<li>Life-threatening when lungs or heart are severely involved.</li>\n<li>Acute, severe high <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> can lead to <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presentation may include <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> or issues related to the kidneys, heart, or <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> system, <strong>without any skin involvement.</strong></li>\n<li>Raynaud's phenomenon might also be observed.</li>\n<li>Antinuclear antibodies may be detected, such as <strong>anti-Scl-70, ACA, or anti-RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> I, II, or III.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female presents with episodes of sequential color changes in her fingers (white, blue, and red) triggered by cold exposure. She has no underlying conditions, normal nail fold capillaroscopy, and symmetric involvement. Which of the following is the most likely diagnosis", "options": [{"label": "A", "text": "Secondary Raynaud's Due To Scleroderma", "correct": false}, {"label": "B", "text": "Primary Raynaud's Phenomenon", "correct": true}, {"label": "C", "text": "Acrocyanosis", "correct": false}, {"label": "D", "text": "Secondary Raynaud's Due To SLE", "correct": false}], "correct_answer": "B. Primary Raynaud's Phenomenon", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Secondary</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Younger (&lt;30 years)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Older (&gt;30 years)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nail fold capillaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large tortuous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoantibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative to low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endothelial damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Digital gangrene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Occlusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old female with diffuse cutaneous systemic sclerosis presents with severe headache, blurred vision, and blood pressure of 180/100 mmHg. Laboratory findings show creatinine of 2.8 mg/l, without thrombocytopenia or fragmented RBCs in peripheral smear. She has recently started on prednisolone 20mg daily for severe skin involvement. Which of the following is the most appropriate immediate management?", "options": [{"label": "A", "text": "Start calcium channel blockers and taper steroids", "correct": false}, {"label": "B", "text": "Immediate initiation of short-acting ACE inhibitors", "correct": true}, {"label": "C", "text": "Start plasmapheresis for suspected TTP", "correct": false}, {"label": "D", "text": "Increase steroid dose to control inflammation", "correct": false}], "correct_answer": "B. Immediate initiation of short-acting ACE inhibitors", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early disease stage (&lt;4 years)</li>\n<li>Diffuse/progressive skin involvement</li>\n<li>Anti-RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> III antibodies</li>\n<li>African-American race</li>\n<li>Male sex</li>\n<li>Glucocorticoid use</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Accelerated <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (&gt;150/90 mmHg)</strong></li>\n<li><strong>Progressive oliguric <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> insufficiency</strong></li>\n<li>Can be <span class=\"customMeta\" data-dictid=\"dcf83226dd1692777193d04dce5f19\">normotensive</span> in 10% cases (worse prognosis)</li>\n<li><strong>Microangiopathic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia</strong></li>\n<li>Thrombocytopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Warning signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Palpable <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rubs</li>\n<li>Pericardial effusion</li>\n<li>New unexplained anemia</li>\n<li>Thrombocytopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First-line: short-acting <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors</strong></li>\n<li>If needed:\n\t\t\t\t<ul>\n<li>Angiotensin II <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockers</li>\n<li>Calcium channel blockers</li>\n<li>Endothelin-1 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockers</li>\n<li>Up to 2/3 require dialysis</li>\n<li>30-50% can discontinue <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">dialysis</span> eventually</li>\n<li>Consider a <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplant after 2 years of dialysis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Daily BP monitoring in high-risk patients</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"0834e545c9169277719383768d0ff2\">nephrotoxic</span> drugs</li>\n<li>Limit glucocorticoids to &lt;10 mg/day</li>\n<li>Immediate reporting of BP changes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old female with diffuse cutaneous systemic sclerosis presents with worsening dyspnea and reduced lung function tests showing a restrictive pattern. Which of the following is the most appropriate treatment choice?", "options": [{"label": "A", "text": "High-dose oral glucocorticoids", "correct": false}, {"label": "B", "text": "Cyclophosphamide", "correct": true}, {"label": "C", "text": "Hydroxychloroquine", "correct": false}, {"label": "D", "text": "Thalidomide", "correct": false}], "correct_answer": "B. Cyclophosphamide", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease-modifying agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cyclophosphamide</strong> - for ILD</li>\n<li><strong>Mycophenolate mofetil</strong> - for skin and lung involvement</li>\n<li><strong>Tocilizumab </strong>- for skin and lung involvement</li>\n<li><strong>Nintedanib </strong>- for SSC-ILD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Calcium channel blockers - for Raynaud's</li>\n<li>Angiotensin II <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockers</li>\n<li>Phosphodiesterase-5 inhibitors</li>\n<li>Bosentan - for digital ulcers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Novel therapies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hematopoietic <span class=\"customMeta\" data-dictid=\"467c0b4fc016927771997e1043aeda\">stem cell transplantation</span> (HSCT) for severe cases</li>\n<li><strong>Rituximab</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with dry eyes and a dry mouth that has been persistent for the past 8 months. She also reports joint stiffness, fatigue, and recent dental caries. Histology reveals lymphocytic infiltration in the salivary glands. Which of the following factors is most directly implicated in the pathogenesis of her condition?", "options": [{"label": "A", "text": "CD8+ T cell infiltration in exocrine glands", "correct": false}, {"label": "B", "text": "Hypergammaglobulinemia with elevated B-cell activation", "correct": true}, {"label": "C", "text": "Mutations in the CFTR gene", "correct": false}, {"label": "D", "text": "Eosinophilic infiltration in minor salivary glands", "correct": false}], "correct_answer": "B. Hypergammaglobulinemia with elevated B-cell activation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/vqCavGvrWCYXBQv616GV1744304126.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old female presents with a history of persistent dry mouth and a gritty sensation in her eyes. Her clinical evaluation is significant for dry mucous membranes and parotid gland swelling. A labial salivary gland biopsy is performed, and the histopathological examination reveals inflammatory infiltration. Based on the histopathological findings in the provided image, which of the following features would most specifically support a diagnosis?", "options": [{"label": "A", "text": "Presence of multiple non-caseating granulomas", "correct": false}, {"label": "B", "text": "Lymphocytic foci surrounding ducts with a focus score ≥ 1 per 4 mm² area", "correct": true}, {"label": "C", "text": "Diffuse infiltration predominantly by neutrophils", "correct": false}, {"label": "D", "text": "Eosinophilic infiltration with periductal fibrosis", "correct": false}], "correct_answer": "B. Lymphocytic foci surrounding ducts with a focus score ≥ 1 per 4 mm² area", "question_images": ["https://image.prepladder.com/notes/izPwuoVSRuKNNWUXS3m01746006831.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient diagnosed with Sjogren Syndrome reports persistent dry eyes, despite using artificial tears. Which of the following treatments would be considered next to alleviate the ocular symptoms?", "options": [{"label": "A", "text": "Oral corticosteroids", "correct": false}, {"label": "B", "text": "Antihistamines", "correct": false}, {"label": "C", "text": "Topical cyclosporine eye drops", "correct": true}, {"label": "D", "text": "NSAIDs", "correct": false}], "correct_answer": "C. Topical cyclosporine eye drops", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 22 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Laboratory investigations reveal ESR 85 mm/hr, CRP 45 mg/L, and mild normochromic anemia. A biopsy of the temporal artery shows panarteritis with inflammatory mononuclear cell infiltrates and giant cell formation. In the analysis of T cells from the arterial lesion, which cytokines are primarily produced and play a crucial role in disease progression?", "options": [{"label": "A", "text": "IL-4 and IL-5", "correct": false}, {"label": "B", "text": "IL-2 and IFN-γ", "correct": true}, {"label": "C", "text": "IL-10 and TGF-β", "correct": false}, {"label": "D", "text": "IL-6 and TNF-α", "correct": false}], "correct_answer": "B. IL-2 and IFN-γ", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Z8468F81PCsargXPheCY1744301386.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old female presents with a new-onset headache, jaw claudication, and visual symptoms. Her ESR is 92 mm/hr and CRP is elevated. Temporal artery biopsy is planned, but immediate treatment is necessary. Which of the following is the most appropriate initial management strategy?", "options": [{"label": "A", "text": "Wait for biopsy results before starting any treatment", "correct": false}, {"label": "B", "text": "Start prednisone 40-60 mg/day immediately", "correct": true}, {"label": "C", "text": "Begin methotrexate and low-dose aspirin", "correct": false}, {"label": "D", "text": "Start tocilizumab alone", "correct": false}], "correct_answer": "B. Start prednisone 40-60 mg/day immediately", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy presents with a bilateral lower extremity rash that appeared 2 weeks after an upper respiratory tract infection. He also complains of abdominal pain and joint pain. On examination, there is a symmetrically distributed palpable purpuric rash present over both lower extremities, predominantly on the extensor surfaces. Which of the following is the most likely diagnosis based on the clinical presentation and image findings?", "options": [{"label": "A", "text": "Immune thrombocytopenic purpura (ITP)", "correct": false}, {"label": "B", "text": "IgA vasculitis (Henoch-Schönlein purpura)", "correct": true}, {"label": "C", "text": "Meningococcemia", "correct": false}, {"label": "D", "text": "Kawasaki disease", "correct": false}], "correct_answer": "B. IgA vasculitis (Henoch-Schönlein purpura)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy presents with palpable purpura, abdominal pain, and joint pain. Laboratory studies show normal platelet count with elevated IgA levels. Which of the following statements about this condition is incorrect?", "options": [{"label": "A", "text": "Renal biopsy is essential for confirming the diagnosis", "correct": true}, {"label": "B", "text": "Glucocorticoids help reduce arthralgias and abdominal discomfort", "correct": false}, {"label": "C", "text": "Glucocorticoids have not proven benefit in treating skin and renal manifestations", "correct": false}, {"label": "D", "text": "Complement levels are typically normal in this condition", "correct": false}], "correct_answer": "A. Renal biopsy is essential for confirming the diagnosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:599px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of<strong> two or more</strong> of the following:</p>\n<ul>\n<li>Palpable <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">purpura</span> without thrombocytopenia</li>\n<li>Patient 20 years or younger at disease onset</li>\n<li>Bowel <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> (diffuse <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain or diagnosis of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> ischemia)</li>\n<li>The <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> showed granulocytes in the walls of small arterioles or venules, and IgA deposits were found in the vessel wall.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Normal <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> (Option D ruled out).</strong> This is an important distinguishing feature from some other vasculitis.</li>\n<li><strong>Normal platelets</strong></li>\n<li><strong>Elevated IgA in ~50%</strong></li>\n<li>Mild leukocytosis</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> can confirm (shows <span class=\"customMeta\" data-dictid=\"6c7cd91ff41692777191606869024d\">leukocytoclastic vasculitis</span> with IgA and C3 deposition)</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is rarely needed<strong> (Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often self-limiting</li>\n<li>Glucocorticoids (1 mg/kg/day prednisone): <strong>(Option B ruled out)</strong>\n<ul>\n<li>Helpful for: edema, joint pain, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Not proven for skin/renal disease <strong>(Option C ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 19-year-old Asian female presents with persistent malaise, fever, night sweats, and unequal blood pressure readings in both arms (right arm 130/80 mmHg, left arm 100/70 mmHg). ESR is elevated at 85 mm/hr, and MR angiography shows ostial narrowing of the left subclavian artery with pan-arteritis. Which statement describes the pathogenesis and initial management?", "options": [{"label": "A", "text": "Primarily intimal disease; start anti-TNF therapy", "correct": false}, {"label": "B", "text": "Panarteritis; tocilizumab superior to steroids", "correct": false}, {"label": "C", "text": "Adventitial inflammation; methotrexate first-line", "correct": false}, {"label": "D", "text": "Panarteritis with intimal proliferation; start prednisone", "correct": true}], "correct_answer": "D. Panarteritis with intimal proliferation; start prednisone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child presents with fever, rash, and strawberry tongue. The child has circumoral pallor and a sandpaper-like rash. Laboratory investigations reveal elevated inflammatory markers. Which of the following statements is most likely to be true regarding this presentation?", "options": [{"label": "A", "text": "IVIG with high-dose aspirin is the first-line treatment", "correct": false}, {"label": "B", "text": "The rash begins over the face and shows circumoral erythema", "correct": false}, {"label": "C", "text": "Throat culture is essential for diagnosis and Penicillin is the treatment of choice", "correct": true}, {"label": "D", "text": "Coronary artery involvement is seen in the majority of untreated cases", "correct": false}], "correct_answer": "C. Throat culture is essential for diagnosis and Penicillin is the treatment of choice", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Kawasaki’s Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Scarlet Fever</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Etiology unknown; Likely Immune-Mediated.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Group A <span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\">Streptococcus</span> infection (Streptococcal <span class=\"customMeta\" data-dictid=\"c49139dccd169277719662aa0740c4\">pyrogenic</span> exotoxins A, B, C).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It primarily affects children,</li>\n<li>80% of cases in children ≤5 years old,</li>\n<li>Peak <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> at ≤2 years.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common in children aged 2–10 years, usually following Group A streptococcal pharyngitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on fever lasting ≥5 days + ≥4 of 5 principal criteria:</p>\n<ul>\n<li>Fever ≥5 days</li>\n<li>Bilateral conjunctival <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> (red eyes)</li>\n<li>Oral mucosal changes (strawberry tongue, red lips)</li>\n<li>Rash (polymorphous)</li>\n<li>Extremity changes (swelling, redness, peeling)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever,</li>\n<li>Pharyngitis,</li>\n<li>Headache,</li>\n<li>Characteristic <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> with a <strong>sandpaper-like texture</strong>, beginning on the face, <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> to the trunk and extremities, sparing palms and soles, followed by desquamation.</li>\n<li>Circumoral pallor, and</li>\n<li>Strawberry tongue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> aneurysms,</p>\n<p>myocarditis, pericarditis, myocardial ischemia, infarction, cardiomegaly.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rash accentuates in skin folds <strong>(Pastia’s lines)</strong>, <span class=\"customMeta\" data-dictid=\"af1a0ced9d1692777186a726f04230\">desquamation</span> in the second week.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> Aneurysms</li>\n<li>Myocardial Infarction</li>\n<li>Thrombosis</li>\n<li>Vasculitis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rheumatic Fever</li>\n<li>Post-Streptococcal Glomerulonephritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis is <strong>clinical</strong> based on criteria and confirmed by <strong>echocardiogram</strong> for <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> changes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Throat culture</strong> or <strong>RADT</strong> (Rapid <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">Antigen</span> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">Detection</span> Test) for <strong>Group A Streptococcus</strong> confirmation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High-dose IV <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> and <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">Aspirin</span> to reduce <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> complications.</li>\n<li>In severe cases, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention may be required (e.g., <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> grafting).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibiotics (penicillin or amoxicillin),</li>\n<li>Supportive care for fever and throat pain.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the markers (Column B) with the correct vasculitis (Column A). a. Granulomatosis with Polyangiitis (GPA) 1. C-ANCA b. Polyarteritis Nodosa (PAN) 2. P-ANCA 3. Proteinase-3 4. Myeloperoxidase", "options": [{"label": "A", "text": "a-1, 4 &amp;amp; b- 2, 3", "correct": false}, {"label": "B", "text": "a-1, 3 &amp;amp; b- 2,4", "correct": true}, {"label": "C", "text": "a- 2, 4 &amp;amp; b-1,3", "correct": false}, {"label": "D", "text": "a- 2, 3 &amp;amp; b-1,4", "correct": false}], "correct_answer": "B. a-1, 3 &amp; b- 2,4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:681px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Granulomatosis with <span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\">Polyangiitis</span> (GPA)/ Wegener's granulomatosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Polyarteritis Nodosa</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Target Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> tract</li>\n<li>Lower <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> tract</li>\n<li>Kidneys</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Kidney</li>\n<li>Pulmonary arteries</li>\n<li>Multiple organs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Epistaxis</li>\n<li>Sinusitis</li>\n<li>Nasal ulcers</li>\n<li>Hemoptysis</li>\n<li>Lung cavities</li>\n<li>Hematuria</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hematuria</li>\n<li>Digital ulcers/gangrene</li>\n<li>Hypertension</li>\n<li>MI</li>\n<li>Stroke</li>\n<li>Livedo reticularis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>c-ANCA </strong>(antibody against <span class=\"customMeta\" data-dictid=\"face45cd5e1692777196c039e83718\">Proteinase</span> 3)</li>\n<li><strong>Proteinase-3</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>p-ANCA </strong>(antibody against MPO)</li>\n<li><strong>Myeloperoxidase</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cyclophosphamide</li>\n<li>Rituximab</li>\n<li>Steroids</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Similar immunosuppression</li>\n<li>BP control essential</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ANCA Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Common Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>p-ANCA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Microscopic polyangiitis</li>\n<li>Churg-Strauss syndrome</li>\n<li>Ulcerative colitis</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> cholangitis</li>\n<li>Crescentic glomerulonephritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>c-ANCA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wegener's granulomatosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atypical ANCA.</strong></p>\n<p><strong>(p-ANCA and c-ANCA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>IBD</li>\n<li>Rheumatoid arthritis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents with fever, purpura, and arthralgias. Biopsy shows small vessel vasculitis with immune deposits. Lab tests reveal C-ANCA antibodies. Which of the following is most consistent with this clinical picture?", "options": [{"label": "A", "text": "Microscopic polyangiitis with segmental necrotizing glomerulonephritis", "correct": false}, {"label": "B", "text": "Granulomatosis with polyangiitis with pauci-immune glomerulonephritis", "correct": true}, {"label": "C", "text": "Churg-Strauss syndrome with peripheral eosinophilia", "correct": false}, {"label": "D", "text": "Mixed cryoglobulinemia with Hepatitis-C", "correct": false}], "correct_answer": "B. Granulomatosis with polyangiitis with pauci-immune glomerulonephritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:685px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Antibodies/Labs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulomatosis with <span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\">Polyangiitis</span> (GPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pauci-immune vasculitis</li>\n<li>Upper/lower respiratory</li>\n<li>Glomerulonephritis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PR3-ANCA</li>\n<li>c-ANCA pattern</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Granulomatous inflammation</li>\n<li>Small vessel vasculitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic Polyangiitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary-renal syndrome</li>\n<li>No granulomas</li>\n<li>Segmental <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> GN</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MPO-ANCA</li>\n<li>p-ANCA pattern</li>\n<li><strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Necrotizing vasculitis</li>\n<li>No granulomas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Churg-Strauss (EGPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asthma</li>\n<li>Peripheral eosinophilia</li>\n<li>Allergic rhinitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MPO-ANCA</li>\n<li>p-ANCA pattern</li>\n<li><strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Eosinophilic granulomas</li>\n<li>Vasculitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mixed Cryoglobulinemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often HCV-associated</li>\n<li>Purpura</li>\n<li>Arthralgias</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cryoglobulins</li>\n<li>HCV antibodies <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immune complex deposits</li>\n<li>Small vessel vasculitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vasculitis Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Examples of Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulomatous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Granulomatosis with Polyangiitis</li>\n<li>Churg-Strauss Syndrome</li>\n<li>Sarcoidosis</li>\n<li>Behcet's Disease (granulomatous form)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Granulomatous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Microscopic Polyangiitis</li>\n<li>Polyarteritis Nodosa</li>\n<li>Henoch-Schonlein Purpura</li>\n<li>Takayasu Arteritis</li>\n<li>Giant Cell Arteritis</li>\n<li>Kawasaki Disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Necrotizing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Granulomatosis with Polyangiitis</li>\n<li>Microscopic Polyangiitis</li>\n<li>Polyarteritis Nodosa (PAN)</li>\n<li>Churg-Strauss Syndrome</li>\n<li>Henoch-Schönlein Purpura</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Necrotizing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Takayasu Arteritis</li>\n<li>Giant Cell Arteritis</li>\n<li>Kawasaki Disease</li>\n<li>Sarcoidosis (rare <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> involvement)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old man from Turkey presents with recurrent painful oral ulcers, genital ulcers, and bilateral red eyes. Examination reveals bilateral anterior uveitis and erythema nodosum on his legs. After the needle prick, he develops an erythematous papule in 48 hours. Laboratory studies show elevated IL-1, TNF-α, and increased neutrophil activity. Which of the following best describes the pathogenesis and clinical features of this condition?", "options": [{"label": "A", "text": "ANCA-mediated vasculitis with small vessel involvement", "correct": false}, {"label": "B", "text": "Auto-inflammatory vasculitis with T-cell mediated immunity and neutrophilic inflammation", "correct": true}, {"label": "C", "text": "Antibody-mediated disease with preferential renal involvement", "correct": false}, {"label": "D", "text": "IgA-mediated vasculitis with predominant GI manifestations", "correct": false}], "correct_answer": "B. Auto-inflammatory vasculitis with T-cell mediated immunity and neutrophilic inflammation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/PG1kxiZw00OdOaWWpmHo1744301802.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>T-cell mediated immunity</li>\n<li>Th1 cell activation</li>\n<li>Elevated cytokines (IL-1, TNF-α)</li>\n<li>Neutrophilic vasculitis</li>\n<li>No specific autoantibodies</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Auto-inflammatory rather than autoimmune</li>\n<li>Affects vessels of all sizes</li>\n<li>Treatment targets inflammation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucocutaneous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral ulcers (97-99%)</li>\n<li>Genital ulcers (&gt;80%)</li>\n<li>Erythema nodosum</li>\n<li>Pathergy reaction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often initial presentation</li>\n<li>Oral ulcers heal without scarring</li>\n<li>Genital ulcers leave scars</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uveitis (&gt;50%)</li>\n<li>Vascular (25%)</li>\n<li>Neurologic (5-10%)</li>\n<li>Arthritis (non-erosive)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More severe in males</li>\n<li>Ocular disease can cause blindness</li>\n<li>Vascular involvement can be fatal</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presents with recurrent oral ulcers, genital ulcers, and bilateral uveitis. He develops pustules 48 hours after the needle prick. Further examination reveals erythema nodosum and non-erosive arthritis of the knees. Based on clinical criteria, Behcet's Disease is diagnosed. Which of the following represents the most appropriate initial management strategy?", "options": [{"label": "A", "text": "High-dose steroids alone for all manifestations", "correct": false}, {"label": "B", "text": "Targeted therapy based on organ involvement: colchicine for mucocutaneous, topical steroids for anterior uveitis", "correct": true}, {"label": "C", "text": "Immediate cyclophosphamide for all patients", "correct": false}, {"label": "D", "text": "Anticoagulation alone for all manifestations", "correct": false}], "correct_answer": "B. Targeted therapy based on organ involvement: colchicine for mucocutaneous, topical steroids for anterior uveitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria (ITR-ICBD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two Points Each:</p>\n<ul>\n<li>Genital aphthosis</li>\n<li>Ocular lesions</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>One Point Each:</p>\n<ul>\n<li>Oral aphthosis</li>\n<li>Skin lesions</li>\n<li>Vascular manifestations</li>\n<li>Positive pathergy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥3 points needed for diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-specific <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> markers</li>\n<li>No specific autoantibodies</li>\n<li>ESR, <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> elevation</li>\n<li>Leukocytosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps rule out other conditions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Required Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ophthalmologic examination</li>\n<li>Pathergy test</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> if needed</li>\n<li>Imaging, based on symptoms</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirms involvement and monitors complications</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucocutaneous Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Colchicine 1-2mg/day</li>\n<li>Topical steroids</li>\n<li>Topical sucralfate</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory: <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> steroids, azathioprine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anterior: <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">Topical</span> steroids</li>\n<li>Posterior: Steroids + azathioprine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory: <span class=\"customMeta\" data-dictid=\"6dfb2b0c981692777200eae81482e9\">TNF</span> inhibitors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vascular: High-dose steroids + cyclophosphamide</li>\n<li>Neurologic: High-dose steroids + immunosuppression</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires aggressive therapy and monitoring</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old Asian boy presents with 6 days of fever, bilateral conjunctival injection without exudate, strawberry tongue, and cervical lymphadenopathy &amp;gt;1.5 cm. On day 7, he develops erythema of palms and soles. Laboratory studies show elevated TNF-α and pro-BNP. Which of the following best describes the pathogenesis of this condition?", "options": [{"label": "A", "text": "Direct viral invasion of coronary vessels with late thrombosis", "correct": false}, {"label": "B", "text": "Immune-mediated medium vessel vasculitis with coronary artery predilection", "correct": true}, {"label": "C", "text": "Bacterial toxin-mediated endothelial damage with early thrombosis", "correct": false}, {"label": "D", "text": "Primary autoimmune arteritis with small vessel involvement", "correct": false}], "correct_answer": "B. Immune-mediated medium vessel vasculitis with coronary artery predilection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:725px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria (CREAM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever for &gt;= 5 days + 4 out of 5 criteria <strong>(CREAM)</strong></p>\n<p><strong>C</strong>: <span class=\"customMeta\" data-dictid=\"6ce77d5f5e1692777185cf7f8a67cd\">Conjunctivitis</span> (bilateral, non-purulent)</p>\n<p><strong>R</strong>: <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">Rash</span> (polymorphous)</p>\n<p><strong>E</strong>: <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">Extremity</span> changes (swelling, redness, peeling)</p>\n<p><strong>A</strong>: <span class=\"customMeta\" data-dictid=\"870b3521e21692777180ed5afdaf8b\">Adenopathy</span> (cervical &gt;1.5cm)</p>\n<p><strong>M</strong>: Mucosal changes (strawberry tongue)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Needs 4/5 criteria + fever ≥5 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Risk Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Male gender</p>\n<p>- Age &lt;1 year</p>\n<p>- Asian ethnicity</p>\n<p>- Fever &gt;8 days</p>\n<p>- High pro-BNP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> aneurysms</p>\n<p>- Myocarditis</p>\n<p>- <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">Pericardial</span> effusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-25% develop aneurysms if untreated</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old boy presents with 6 days of fever, bilateral conjunctivitis, strawberry tongue, and polymorphous rash. Initial labs show elevated CRP, ESR, and thrombocytosis. Which of the following represents the most appropriate initial diagnostic test and treatment strategy?", "options": [{"label": "A", "text": "Blood culture and broad-spectrum antibiotics", "correct": false}, {"label": "B", "text": "Echocardiogram and IVIG 2g/kg plus high-dose aspirin", "correct": true}, {"label": "C", "text": "Throat culture and penicillin", "correct": false}, {"label": "D", "text": "Viral panel and supportive care", "correct": false}], "correct_answer": "B. Echocardiogram and IVIG 2g/kg plus high-dose aspirin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Echocardiogram</p>\n<p>2. Labs:</p>\n<p>- <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> (typically <strong>&gt;3 mg/dL</strong>)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"49069760291692777187e0e72db819\">ESR</span> (typically <strong>&gt;40 mm/hr</strong>)</p>\n<p>- CBC: <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">Leukocytosis</span> <strong>&gt;15,000</strong></p>\n<p>- Platelets &gt;450,000</p>\n<p>- <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">Albumin</span> <strong>&lt;3.0 g/dL</strong></p>\n<p>-<strong> E</strong><strong>levated ALT</strong></p>\n<p><strong>- <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">Sterile</span> pyuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Echo: <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> status</p>\n<p>- ≥3 supplemental labs support diagnosis in incomplete KD</p>\n<p><strong>- Helps <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> from other <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> illnesses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1<strong>. IVIG:</strong></p>\n<p>- 2g/kg single dose</p>\n<p>- Within 10 days of fever</p>\n<p>2. <strong>Aspirin:</strong></p>\n<p>- High-dose (80-100mg/kg/d)</p>\n<p>- Until <span class=\"customMeta\" data-dictid=\"5b4680fc9b169277718092403965d7\">afebrile</span> 48h</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Reduces <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> risk</p>\n<p>- IVIG resistance in 15-20%</p>\n<p>- Time-sensitive intervention</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Second IVIG dose if needed</p>\n<p>- <strong>Steroids in high-risk cases</strong></p>\n<p>- <strong>Infliximab</strong> for <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases</p>\n<p>- <strong>Anticoagulation</strong> if aneurysms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Based on response</p>\n<p>- Risk stratification</p>\n<p>- Prevent complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follow-up</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Echo at 2 weeks</p>\n<p>- Echo at 6-8 weeks</p>\n<p>- <strong>Low-dose <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> (3-5mg/kg/d)</strong></p>\n<p>- Long-term <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> monitoring</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>- Monitor for aneurysms</p>\n<p>- Assess treatment response</p>\n<p>- Prevent thrombosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man with a history of asthma presents with worsening dyspnea, peripheral neuropathy, and palpable purpura on his lower limbs. He also has a history of sinusitis. Blood tests reveal marked eosinophilia and a positive p-ANCA. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Wegener's Granulomatosis", "correct": false}, {"label": "B", "text": "Churg-Strauss Syndrome", "correct": true}, {"label": "C", "text": "Microscopic Polyangiitis", "correct": false}, {"label": "D", "text": "Polyarteritis Nodosa", "correct": false}], "correct_answer": "B. Churg-Strauss Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vasculitis syndromes is not classified as an ANCA-associated vasculitis according to the Chapel Hill Classification?", "options": [{"label": "A", "text": "Granulomatosis with Polyangiitis (GPA)", "correct": false}, {"label": "B", "text": "Microscopic Polyangiitis (MPA)", "correct": false}, {"label": "C", "text": "Eosinophilic Granulomatosis with Polyangiitis (EGPA)", "correct": false}, {"label": "D", "text": "Polyarteritis Nodosa (PAN)", "correct": true}], "correct_answer": "D. Polyarteritis Nodosa (PAN)", "question_images": [], "explanation_images": [], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:50%\">\n<thead>\n<tr>\n<th colspan=\"2\" scope=\"col\" style=\"text-align:center\"><strong>Revised Chapel Hill <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> syndromes</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Large vessel vasculitis</strong></td>\n<td>\n<ul>\n<li>Takayasu arteritis</li>\n<li>Giant cell arteritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Medium vessel <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> </strong></p>\n</td>\n<td>\n<p> </p>\n<ul>\n<li>Takayasu arteritis</li>\n<li>Giant cell arteritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Small vessel <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> (SVV)</strong></td>\n<td>\n<ul>\n<li><strong>Antineutrophil cytoplasmic <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> (ANCA)–associated <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> </strong>\n<ul>\n<li>Microscopic polyangiitis</li>\n<li>Granulomatosis with <span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\">polyangiitis</span> (Wegener’s)</li>\n<li>Eosinophilic <span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\">granulomatosis</span> with <span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\">polyangiitis</span> (Churg-Strauss)</li>\n</ul>\n</li>\n<li><strong>Immune complex SVV</strong>\n<ul>\n<li>Anti-glomerular basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (anti-GBM) disease</li>\n<li>Cryoglobulinemic vasculitis</li>\n<li>IgA <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> (Henoch-Schönlein)</li>\n<li>Hypocomplementemic <span class=\"customMeta\" data-dictid=\"e490c7ac0216927772011cdb030650\">urticarial vasculitis</span> (anti-C1q vasculitis)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Variable vessel vasculitis</strong></td>\n<td>\n<ul>\n<li>Behcet’s disease</li>\n<li>Cogan’s syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Single-organ vasculitis</strong></td>\n<td>\n<ul>\n<li>Cutaneous leukocytoclastic angiitis</li>\n<li>Cutaneous arteritis</li>\n<li>Primary central nervous system <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> Isolated aortitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Vasculitis associated with <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disease</strong></p>\n</td>\n<td>\n<ul>\n<li>Lupus vasculitis</li>\n<li>Rheumatoid vasculitis</li>\n<li>Sarcoid vasculitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Vasculitis associated with probable etiology</strong></td>\n<td>\n<ul>\n<li>Hepatitis C virus–associated cryoglobulinemic vasculitis</li>\n<li>Hepatitis B virus–associated vasculitis</li>\n<li>Syphilis-associated aortitis</li>\n<li>Drug-associated immune complex vasculitis</li>\n<li>Drug-associated ANCA-associated vasculitis</li>\n<li>Cancer-associated vasculitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">